Esra Yucel

Preliminary results of auditory brainstem implantation in prelingually deaf children with inner ear malformations including severe stenosis of the cochlear aperture and aplasia of the cochlear nerve.

Objective: The aim of our study is to present the results of 11 children where auditory brainstem implantation (ABI) was successfully performed to restore hearing. Study Design: Case presentation. This study was conducted at the departments of Otolaryngology and Neurosurgery at Hacettepe University Ankara, Turkey. Patients: Between July 2006 and April 2008, 11 prelingual (30-56 mo) deaf children with several cochlear malformations had ABI. Intervention: All patients were programmed and were enrolled in auditory verbal therapy sessions and family counseling programs at Hacettepe Auditory Verbal Center. The evaluation was performed at preimplant and again 1, 3, 6, 9, and 12 months post-switch on. Main Outcome Measures: The main test components composing this test battery were Ling 6 Sound Detection-Identification Test, Word Identification Test in Turkish, Meaningful Auditory Integration Scale, and Meaningful Use of Speech Scale. Results: Successful brainstem implantations were performed in all patients with retrosigmoid approach. Six children gained basic audiologic functions and were able to recognize and discriminate sounds, and many could identify environmental sounds such as a doorbell and telephone ring by the third month of ABI. Improvement in mean performance on Meaningful Auditory Integration Scale is apparent for all ABI children. Improvement in Meaningful Use of Speech Scale scores in 2 patients, demonstrating that the child using its own voice for speech performance, was observed between the baseline and 12th month. First, 5 children were able to identify Lings 6 sound by the end of 2 to 6 months, and 2 of them also started to identify words due to their pattern differences and multisyllabic word identification by 6 to 9 months. Two children with Attention Deficit Hyperactivity Disorder have made slower progress than the other children with ABIs. Conclusion: Our preliminary results show that there is adequate contribution of brainstem implants in the development of auditory-verbal skills. Additional handicaps slow the progress of the prelingually deaf children.

Auditory brainstem implantation in children and non-neurofibromatosis type 2 patients: a consensus statement.

On the 18th of September 2009, a group of health care professionals and scientists involved in implantation of the auditory system attended a meeting convened by the Hacettepe Cochlear Implant Group. The aim of the meeting was to have a detailed discussion on the pressing and pertinent issues around

The effect of implantation age on visual attention skills

OBJECTIVE The aim of this study is to evaluate the visual attention skills of deaf children with cochlear implants and to determine whether age at implantation had any impact on visual attention skills. SUBJECT AND METHODS Thirty children with cochlear implants aged 6 and 11 years were evaluated and were compared with age matched 36 normal hearing children. The children with cochlear implants were analyzed in to two groups according to their age at implantation; under and at/over 4 years old. The Gordon Diagnostic System (GDS) was used in order to evaluate visual attention skills of cochlear implanted (Group 1 and Group 2) and children with normal hearing. The number of correct responses, extraneous button presses (commission errors) and the number of omission errors or the failure to respond to target stimuli which were recorded by GDS was used to evaluate the visual attention skills of the subjects. Also six different types of commission errors (19X, XX9, XX1, X1X, X9X, XXX) were analyzed and compared both for normal and cochlear implant user children. RESULTS Concerning the total number of correct response, omission and commission errors no statistical difference was found between two implanted groups. Besides, both groups with cochlear implantation differed from normal hearing peers on the total number of correct responses, omission errors (p<0.017). According to these findings cochlear implanted children had less correct responses and had more omission errors compared with control group. These findings clearly show that children with cochlear implants performed poorly on visual attention task which requires constant attention together with the ability to exert impulse control despite they hear enhanced sensory information by cochlear implants. Concerning the types of commission errors Group 1 and 2 performed similarly in all types of errors (p>0.017). Besides, Group 1 and 2 made more errors in types 19X, XX9 and XXX, XX9 compared with the control group (p<0.017). Group 2 who had their implants after age of 4 years old had more commission errors than the control group (p<0.017) and positive correlation was found between the total commission errors and XX9 error type with age at implantation. These findings show that children who had their implants at older ages made more commission errors and XX9 type of commission error. The children who were implanted after 4 years old were less mature; unsuccessful in controlling their impulsive behaviors and more careless where they can not get enough benefit from social and environmental motives compared with their normal hearing peers. CONCLUSION This present research points out the positive effect of early implantation on visual attention and the possible adversities such as impulsivity, over-impatience and attention deficits which have been previously suggested as preventive or slowing down factors for the pace of auditory-verbal therapy for cochlear implantees. Assuming that the results of this study support the theory of insufficiency which suggested that the deprivation in auditory system would also adversely affect cognitive structures involved in intermodal processing the importance of early implantation is underlined. If early cochlear implantation will be carried out especially at the very critical period of language development (before age of four), this will help the child, in his/her future life, not only with his/her hearing skills and communication but for his/her attention skills and behavior.

The needs of hearing impaired children's parents who attend to auditory verbal therapy-counseling program

OBJECTIVE Exploring the information and support needs of parents with hearing impairment in habilitation process. The effects of variables such as duration of hearing aid use and habilitation (duration of intervention) and the number of hearing impaired individuals in family are also considered during the evaluation. METHODS Sixty-five parents of children between 24 and 348 months of age (median: 80) participated in this study by returning the completed in The Family Needs Survey. Age at diagnosis of deafness varied from 1 to 84 months of age (median: 16). The duration of hearing aid use was 8-252 months (median: 24) and the duration of intervention was 2-176 months (median: 36). In view of the fact that the family dynamics might have effects on the type and amount of the needs of parents, the number of siblings (none, two or more siblings) and the presence of hearing impaired individuals apart from their child was also explored. RESULTS The parental needs with regard to different topics such as general information, hearing loss, communication-services and educational resources, family and social support, childcare and community services, financial were evaluated separately. The needs of parents participating in a multi-dimensional Auditory-Verbal intervention program differed by their preferential demands. The duration of intervention was found significantly correlated with the amount of information needs related with other conditions their children may have, explaining their childrens hearing problem to others, locating good baby-sitters and day-care programs for their children and transportation (p< or =0.05). It was also found that the long-termed continuing intervention generates additional psychotherapeutic, social and financial needs for the parents. No significant correlation was found between hearing impaired individuals existence with the type and amount of family needs (p>0.05). CONCLUSION These findings support the positive effect of persistent and long-term Auditory-Verbal therapy and Counseling approach which incorporates parents as inalienable members in all rehabilitation process. Creating an adequate and appropriate educational environment by considering individualized needs and family dynamics in a long term and persistent Auditory-Verbal therapy and Counseling approach are all equally important. In addition to a team approach to management, with parents taking a major role in the habilitation process, and all these will lead to a much better outcome.

Vestibular stimulation after cochlear implantation in common cavity deformity

Congenital malformations of the inner ear are very rare and constitute approximately 20% of children with congenital sensorineural hearing loss.1 According to Jackler and Luxford,2 common cavity deformity is the second most common malformation after Mondini deformity. Dizziness and vertigo after cochlear implantation have been reported in the literature.3 We present a case with abnormal vestibular stimulation during the hook-up of cochlear implant in a patient with common cavity malformation.

Long-term Results of ABI in Children With Severe Inner Ear Malformations.

Objective: To report the long-term outcomes of children who received auditory brainstem implant (ABI) because of severe inner ear malformations. Study Design: Retrospective chart review. Setting: Tertiary referral otolaryngology clinic. Subjects and Methods: Between July 2006 and October 2014, 60 children received ABI at Hacettepe University. Preoperative work up included otolaryngologic examination, audiological assessment, radiological evaluation together with assessment of language development and psychological status. The surgeries were performed via retrosigmoid approach with a pediatric neurosurgeon. Intraoperatively, electrical auditory brainstem response was utilized. Initial stimulation was done 4 to 5 weeks postoperatively. Outcomes were evaluated with Categories of Auditory Performance (CAP), speech intelligibility rate (SIR), functional auditory performance of cochlear implant (FAPCI) and Manchester Spoken Language Development Scale scores; receptive and expressive language ages were determined. Results: Sixty children who received ABI were between ages of 12 and 64 months. Thirty-five patients with follow up period of at least 1 year, were reported in means of long-term audiological and language results. The most prevelant inner ear malformation was cochlear hypoplasia (n = 19). No major complication was encountered. Majority of the patients were in CAP 5 category, which implies that they can understand common phrases without lip reading. SIR was found out to be better with improving hearing thresholds. Children with ABI were performing worse than average cochlear implantation (CI) users when FAPCI scores were compared. Patients with the best hearing thresholds have expressive vocabulary of 50 to 200 words when evaluated with Manchester Spoken Language Development Scale. There was no relationship between the number of active electrodes and hearing thresholds. The type of inner ear anomaly with the best and the worst hearing thresholds were common cavity and cochlear aperture aplasia, respectively. Patients with additional handicaps had worse outcomes. Among 35 children, 29 had closed set discrimination and 12 developed open set discrimination above 50%. It was determined that, progress of the patients is faster in the initial 2 years when compared with further use of ABI. Conclusion: ABI is an acceptable and effective treatment modality for pediatric population with severe inner ear malformations. Bilateral stimulation together with CI and contralateral ABI should be utilized in suitable cases.

Consensus statement: Long-term results of ABI in children with complex inner ear malformations and decision making between CI and ABI

Consensus statement : Long-term results of ABI in children with complex inner ear malformations and decision making between CI and ABI

Cochlear implants: is there any relationship between stimulation rates and adaptation?

Objective To determine the relationship between stimulation rate and adaptation in cochlear implant users. Study Design A prospective clinical study. Setting This study was conducted at Hacettepe University Medical Faculty, which is a tertiary care and cochlear implant center in Ankara, Turkey. Patients Seven patients (three women, four men) who were using Nucleus CI 24 M cochlear implants (Cochlear Corp., Lane Cove, NSW, Australia). Two of them had become deaf after developing language skills, and five had congenitally deafness. Results Six patients demonstrated no tone decay. Only one patient, who had congenital hearing loss, demonstrated tone decay at stimulation rates of 250, 500, 720, 900 pulses per second. There is no statistically significant relationship between the stimulation rate and the selected electrode. Conclusion The majority of the cochlear implant patients sustained the perception of a continuous electrical signal for 1 minute at 5 to 10 current levels above threshold.

Auditory Reasoning Skills of Cochlear Implant Users

OBJECTIVES This study compared the auditory reasoning skills of school-going children with early and late cochlear implantation and assessed the relationship between auditory reasoning skills, language development, vocabulary knowledge, and communication skills. MATERIALS AND METHODS In this case series study, 90 pre-lingually deaf children aged 7-10 years were assessed. Children were divided into two groups: early-implanted group with children who received cochlear implants before 3 years of age (mean, 23.45; 12-35 months) and late-implanted group with children implanted after 3 years of age (mean, 50.54; 36-84 months). Tests were performed in the auditory-visual condition. Correlational analyses were used to assess the relationships between daily communication skills, language development performances, vocabulary knowledge, and auditory reasoning skills of both the groups. RESULTS Auditory reasoning skills were better in the early-implanted group than in the late-implanted group (Mann-Whitney U test=518, p<0.05). Language performances of the early-implanted group were significantly better than those of the late-implanted group (receptive language performances: Mann-Whitney U=522, p<0.05; expressive language performances: Mann-Whitney U=552, p<0.05). Stepwise regression analysis showed that expressive language performances, vocabulary knowledge, and chronological age could predict 82% of the variance. CONCLUSION Reasoning skills of children with cochlear implants should be supported during the language-learning process.