Domenico Cuda

Piezoelectric round window osteoplasty for Vibrant Soundbridge implant.

Objective: To evaluate the Piezosurgery (PZS) ultrasonic bone dissector as an alternative to conventional drilling to implant the Vibrant Soundbridge transducer in the round window (RW) niche. Study Design: Prospective noncontrolled study. Audiologic and surgical records analysis. Methods: Eight patients with mixed hearing loss and previous unsuccessful otologic surgeries were recruited. A transcanal or transmastoid approach was used. Round window osteoplasty was performed with the PZS device to implant the VBS floating mass transducer for cochlear stimulation. Results: The osteoplasty was performed safely with PZS, and all patients were successfully implanted. No sensorineural hearing deterioration occurred in all but 1 patient. The postoperative air conduction threshold was slightly higher than preoperatively because of minor middle ear transfer function changes. After fitting, patients continue to wear their speech processors full-time. The aided speech discrimination scores at conversational level ranged from 65 to 100%. Aided hearing threshold was 32.2 dB HL (preoperative threshold under earphones, 62.8 dB HL). One patient affected by congenital aural atresia had a posterior canalithiosis on the operated side that was successfully treated by the repositioning maneuver. Conclusion: The PZS device proved to be effective for RW osteoplasty; floating mass transducer was successfully implanted in all patients. Audiologic results are comparable to those obtained from traditionally operated patients. Relative to conventional drilling, the PZS allows a safer osteoplasty because it does not produce any rotation or torque that reduces the risk of RW membrane injury. Although hearing was preserved in our sample, the potential inner ear risks need to be further evaluated in both experimental and clinical fields.

Microdrill, CO2-laser, and piezoelectric stapedotomy: a comparative study.

Objective: To compare 3 different devices used to perforate the stapes footplate in otosclerotic patients. Study Design: The study design was a prospective unblinded study. It was conducted at the ENT Department of a general hospital. Materials and Methods: Ninety subjects undergoing primary stapedotomy for otosclerosis by a senior surgeon participated. A stapedotomy operation was performed under local anesthesia with reversed sequence of surgical steps. Three different devices were used to perforate the posterior half of the footplate: a microdrill (MD), a CO2 laser (CO2), and a Piezosurgery bone device (PZS). The hole diameter was 0.7 mm. Three consecutive samples of unselected patients were recruited. All patients of each sample were operated with the same device. Main outcome measures were preoperative and postoperative air- (AC) and bone-conduction (BC) audiometry, intraoperative findings, and postoperative complications. Postoperative pure-tone audiometry was done 1 month after surgery. Results: The CO2 laser was used in 30 stapedotomies, the PZS in 30, and the MD was used in 30. Bone-conduction pure-tone averages did not worsen in the MD and CO2 groups. CO2 laser shows a trend toward less residual air-bone gap and more functional gain at low frequencies. Piezosurgery bone device patients lost approximately 10 dB in BC at 4,000 Hz. Significant differences in AC thresholds gain and in the residual air-bone gap were found between groups. Piezosurgery bone device patients had less gain and more residual gap at high frequencies as a result of a slight deterioration of BC threshold. A higher rate of postoperative vertigo was also found in PZS patients. Conclusion: The use of the CO2 laser seems associated with the best functional results, although on a statistical basis, they do not differ significantly from that obtained with the standard MD platinotomy. The PZS stapedotomy is effective from a surgical point of view for most patients. However, it is associated with a slight but significant deterioration of BC at high frequency and at higher vertigo rate. More basic validation of the stimulation parameters is necessary for safe use of this new technology.

Pre-school children have better spoken language when early implanted

OBJECTIVES The objectives of this study were: (1) to investigate the effect of age at cochlear implantation (CI) on vocabulary development; (2) to evaluate the age effect at CI surgery on the syntactic development; and (3) to examine the role of gender, age at first diagnosis and maternal education level on spoken language development. MATERIAL AND METHODS Retrospective study. Thirty children with congenital severe- to -profound sensorineural hearing loss (SNHL) were sampled. They were diagnosed and fitted with hearing aids through six months of age. They were implanted between 8 and 17 months of age. The MacArthur-Bates Communicative Development Inventory (MCDI) was administrated at the age of 36 months. The total productive vocabulary (word number raw score), the mean length of utterance (M3L) and the sentences complexity were analysed. RESULTS The average word number raw score was 566.3 for the children implanted before 12 months of age versus 355 for those implanted later. The M3L was 8.3 for those implanted under 1 year versus 4.2 of those implanted later. The average sentences complexity was 82.3% for those receiving CI before 12 months, while it was 24.4% for those underwent at CI after 12 months. Regression analysis revealed a highly significant and negative linear effect of age at CI surgery on all outcomes. Females had better outcomes. Age at diagnosis was not correlated with the linguistic results. The mothers education level had a positive significant effect on sentences complexity. CONCLUSION The CI in pre-school children with SNHL implanted under 1 year has a positive effect on spoken language. Females seem to have better linguistic results. Finally high maternal educational level appears to have some positive effect on language development.

Clinical evaluation of cochlear implant sound coding taking into account conjectural masking functions, MP3000™

Abstract Efficacy of the SPEAK and ACE coding strategies was compared with that of a new strategy, MP3000™, by 37 European implant centers including 221 subjects. The SPEAK and ACE strategies are based on selection of 8–10 spectral components with the highest levels, while MP3000 is based on the selection of only 4–6 components, with the highest levels relative to an estimate of the spread of masking. The pulse rate per component was fixed. No significant difference was found for the speech scores and for coding preference between the SPEAK/ACE and MP3000 strategies. Battery life was 24% longer for the MP3000 strategy. With MP3000 the best results were found for a selection of six components. In addition, the best results were found for a masking function with a low-frequency slope of 50 dB/Bark and a high-frequency slope of 37 dB/Bark (50/37) as compared to the other combinations examined of 40/30 and 20/15 dB/Bark. The best results found for the steepest slopes do not seem to agree with current estimates of the spread of masking in electrical stimulation. Future research might reveal if performance with respect to SPEAK/ACE can be enhanced by increasing the number of channels in MP3000 beyond 4–6 and it should shed more light on the optimum steepness of the slopes of the masking functions applied in MP3000.

A simplified fixation of the new thin cochlear implant receiver-stimulators in children: Long term results with the “back-pocket” technique

OBJECTIVE To describe a simple technique for pediatric cochlear implant receiver-stimulators (R/S) fixation and long term results with it. METHODS Clinical sample include thirty-two children with severe-to-profound or profound hearing loss candidate for cochlear implantation. Low-profile devices were used (Med El Concerto and Nucleus CI512). The R/S was housed into a tight subperiosteal pocket carefully dissected behind the mastoidectomy. The pocket was closed with a single periosteal to bone suture around the posterior edge of mastoidectomy. No skull drilling was required for housing the device. RESULTS No intraoperative complications have been observed. 20% of operating time was saved. No migration of R/S over time was apparent at follow up. CONCLUSIONS The back-pocket technique seems effective in retaining the CI package and in optimizing surgical time and safety in pediatric cochlear implantation. It seems particularly suitable with new generation low profile CI devices.

A New De Novo Missense Mutation in Connexin 26 in a Sporadic Case of Nonsyndromic Deafness

Objectives: Mutations in the GJB2 gene, encoding Connexin 26, can cause nonsyndromic recessive deafness or dominant hearing loss (HL) with or without keratoderma. The objective was to perform a molecular evaluation to establish the inherited pattern of deafness in the sporadic cases afferent to our center.

Narrative abilities in early implanted children

To investigate the effect of age at cochlear implant activation on oral narrative ability in children implanted before 2.5 years of age and to examine the role of other variables (gender, parental education level, stimulation modality) in narrative skills.

The Carina© middle ear implant: surgical and functional outcomes.

The Carina© system (Cochlear Ltd, Sydney, Australia) is a totally implantable prosthesis designed to meet the needs of acoustic amplification in adults with moderate-to-severe sensorineural or mixed hearing loss. It mechanically stimulates the ossicles or labyrinthine windows. The object of this study was to update surgical and functional results obtained in a consistent sample of Carina© recipients. The data sheets of 26 patients who underwent Carina© surgery at two ENT units [i.e., ENT Audiology and Phoniatrics Unit of the University Hospital of Pisa (Pisa, Italy) and ENT Unit of “Guglielmo da Saliceto” Hospital of Piacenza (Piacenza, Italy)] were evaluated for the surgical and audiological outcomes. Twenty patients received a unilateral device, whereas six patients were bilaterally implanted (simultaneously in one patient and sequentially in the remaining five patients). The total number of ears implanted in this study was 32. Most implanted patients expressed a high degree of satisfaction with the prosthesis, which highlights the improvement in hearing in different environmental conditions, the cosmetic advantages, and greater freedom in performing common activities in daily living. Audiological examination demonstrated valid functional gain and significant improvement in speech perception in quiet. Based on this experience, the Carina© is a valid alternative to hearing aids. Moreover, a bilateral implantation, even a simultaneous implantation, is a viable option for selected motivated patients because the intervention is generally well tolerated and the surgery time is relatively fast.

Production of infant scale evaluation (PRISE) in Italian normal hearing children: a validation study.

OBJECTIVES Parental questionnaires are important tools in the evaluation of auditory and language skills of very young children affected by sensorineural hearing loss. One of these instruments is the Production on Infant Scale Evaluation (PRISE). The purposes of this study were to adapt and validate the PRISE on Italian children with normal hearing; and to obtain normative data. METHODS A back translation technique was used to adapt the Italian version of PRISE. The PRISE was submitted to parents of 234 normal children aged between 3 and 18 months of life. All of them passed local universal newborn hearing screenings and they presented no audiological risk factors. RESULTS The PRISE internal reliability (Cronbachs alpha) was 0.87. Split-half reliability indexes were λ(4) = 0.89 and λ(6) = 0.89. Corrected item-total correlation coefficients were significant for all items. The correlation of PRISE with a modified Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS), collected for convergent validity measurement purposes, was good (r = 0.743). A positive correlation of PRISE scores with age was found, reflecting on the age-dependence of pre-verbal skills. CONCLUSION These findings demonstrate high reliability and convergent validity of the Italian PRISE version. This questionnaire constitutes a robust tool for assessing early language development in infants and toddlers with normal hearing. It seems particularly sensitive to the normal language development in the first years of life, which can be very useful for early rehabilitation of hearing loss.

Social conversational skills development in early implanted children

Social conversational skills are a salient aspect of early pragmatic development in young children. These skills include two different abilities, assertiveness and responsiveness. This study investigated the development of these abilities in early implanted children and their relationships with lexical development and some language‐sensitive variables.