Manuel Manrique

Advantages of cochlear implantation in prelingual deaf children before 2 years of age when compared with later implantation

Objectives: To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing‐impairment when subjected to a cochlear implant (CI) before or after 2 years of age. To analyze the complications that arose during, or as a result of, the implantation process in these groups.

Results from a European clinical investigation of the Nucleus multichannel auditory brainstem implant.

Objective This study was designed to investigate the perceptual benefits and potential risks of implanting the Nucleus® multichannel auditory brainstem implant. Design Between September 1992 and October 1997 a total of 27 subjects received a Nucleus 20- or 21-channel Auditory Brainstem Implant (ABI). All subjects involved in the trial had bilateral acoustic tumour as a result of neurofibromatosis type 2 (NF2) resulting in complete dysfunction of the VIIIth nerve. The study used each subject as their own control without a preoperative baseline because residual hearing, if existing, was destroyed at surgery by tumour removal. A battery of speech tests was conducted to evaluate each patient’s performance and communication abilities. Tests were conducted, where possible, in the auditory-only, visual-only, and auditory-visual conditions at 3 days postoperatively (baseline), at 3-mo intervals for the first year and every 12 mo thereafter. A subjective performance questionnaire was administered together with an extensive neurological examination at each test interval. Results 27 subjects involved in this trial were successfully implanted with a Nucleus ABI. One subject died 2 days postoperatively due to a lung embolism unrelated to the device. Twenty-six subjects underwent device activation and all but one patient received auditory sensation at initial stimulation (96.2%). On average 8.6 (±4.2) of the available 21 electrodes were used in the patients’ MAPs. Performance evaluation measures showed that the majority of users had access to auditory information such as environmental sound awareness together with stress and rhythm cues in speech that assist with lipreading. Although most subjects did not achieve any functional auditory-alone, open-set speech understanding, two subjects from this series (7.4%) did receive sufficient benefit to be able to use the ABI in conversation without lipreading. Conclusions Although the medical risks and surgical complexity associated with ABI device implantation are far greater than those for a cochlear implant, the clinical results from this trial show that the Nucleus multichannel ABI is capable of providing a significant patient benefit over risk ratio for subjects suffering loss of hearing due to bilateral retrocochlear lesions.

Advantages of binaural hearing provided through bimodal stimulation via a cochlear implant and a conventional hearing aid: A 6-month comparative study

Conclusions Our study data demonstrate the additional benefit derived from continued use of a contralateral hearing aid (HA) post-cochlear implantation for speech recognition ability in quiet and in noise. Postoperative bimodal stimulation is recommended for all subjects who show some speech recognition ability in the contralateral ear as it may offer binaural listening advantages in various listening situations encountered in everyday life. Objectives To assess the benefits derived from bimodal stimulation for experienced HA users implanted with a cochlear implant (CI) (score ≥ 20% in disyllabic test). The correlation between pre- and postoperative performance on speech perception measures was examined to determine additional criteria for recommending bimodal stimulation postoperatively. Material and methods A within-subject repeated-measures design was used, with each subject acting as their own control. Assessments were carried out preoperatively in aided monaural and best-aided conditions and at 6 months postoperatively in CI-alone, contralateral HA-alone and bimodal listening conditions. Speech recognition using Spanish words and sentences materials was assessed at conversational level and for soft speech in quiet. Speech comprehension in noise was assessed using word materials at a signal:noise ratio of +10, for coincident speech in noise and for spatially separated speech in noise. Twelve adult native Spanish subjects with a severe-to-profound hearing impairment who were experienced with optimally fitted conventional amplification and who displayed suboptimal speech understanding preoperatively were enrolled in the study. Preoperatively, conventional amplification was worn by five subjects binaurally and by seven monaurally. Results Postoperatively, superior speech recognition ability in quiet and in noise for disyllabic words was achieved using bimodal stimulation in comparison to performance for either monaural aided condition. Mean improvement in speech recognition in the bimodal condition was significant over performance in the CI-alone condition for disyllabic words in quiet at 70 (p=0.006) and 55 dB SPL (p=0.028), for disyllabic words in noise at +10 dB with speech and noise spatially separated with the noise source closest to the contralateral HA (S0NHA) (p=0.0005) and when the noise source was closest to the CI ear (S0NCI) (p=0.002). When testing word recognition in noise with speech and noise sources coincident in space, word scores were superior in the bimodal condition relative to the CI-alone condition but this improvement was not significant (p=0.07). The advantages of bimodal stimulation included significant effects of binaural summation in quiet and significant binaural squelch effects in both the S0NHA and S0NCI test conditions. All subjects showed superior performance in the binaural situation postoperatively relative to the best-aided condition preoperatively for one or more test situations.

Cerebral auditory plasticity and cochlear implants.

Previous animal research and clinical experiences in humans suggest the existence of an auditory critical period in language acquisition. We review the literature and present the changes within the cochlear nuclei in bilaterally deafferentated adult non-human primates. We also present and analyse the results of 98 prelingually deaf children and teenagers who underwent a cochlear implantation at the University of Navarra. Patients received a Nucleus 22 or 24 multichannel cochlear implant (CI). They were grouped in five categories according to their age at surgery. Performance is compared with a control group of 58 postlinguals. Only early-implanted prelingual children (before 6 years of age) achieved a complete open-set speech recognition, even with better performance than postlinguals. These results clearly demonstrate the existence of a period of high neural auditory plasticity within the first 6 years of life. The introduction of auditory stimulation with a CI can not restore the loss of neural plasticity out of this period. Prelingual children under 6 years of age should receive a CI as soon as there is a reliable diagnosis of bilateral sensorineural hearing loss.

Worldwide trends in bilateral cochlear implantation

The goal of this study is to ascertain worldwide experience with bilateral cochlear implantation (BCI) with regard to patient demographics, trends in provision of BCI to adult and child patient populations, differences and similarities in BCI candidacy criteria, diagnostic requirements, and treatment approaches among clinicians in high‐volume cochlear implant centers.

Non‐verbal development of children with deafness with and without cochlear implants

Deprivation of sensory input affects neurological development. Our objective was to explore clinically the role of hearing in development of sensorimotor integration and non-verbal cognition. The study involved 54 children (15 males, 839 females; 5 to 9 years old) with severe or profound bilateral prelocutive deafness but without neurological or cognitive impairment. Of these, 25 had received an early cochlear implant (CIm). Patients were compared with 40 children with normal hearing. All were given a battery of non-verbal neuropsychological tests and a balance test, and were timed for simple and complex movement of limbs. Deafness, whether treated by CIm or not, resulted in a delay in development of complex motor sequences and balance. Lack of auditory input was also associated with lower, but non-pathological, scores in visual gnoso-praxic tasks and sustained attention. Such differences were not observed in children with CIm. Hearing contributes to clinical development of spatial integration, motor control, and attention. An early CIm enables good verbal development and might also improve non-verbal capacities.

Prospective long-term auditory results of cochlear implantation in prelinguistically deafened children: the importance of early implantation.

The objectives of this study were to report the long-term auditory results of prelinguistically deafened children with bilateral profound hearing impairment treated with a cochlear implant (CI); to analyze the role of auditory stimulation in the development of communicating abilities in early implanted children; and to define the limits of the auditory critical period. It was designed as a prospective cohort single-subject repeated-measures study of children with bilateral profound hearing impairment treated with a CI at a tertiary referral center with a pediatric CI program since 1991. A total of 182 children with bilateral prelinguistic hearing impairment of profound degree treated with a Nucleus CI were enrolled in the study. Eighty-six children received a Nucleus 22 CI and 74 received a Nucleus 24. For data analyses the children were categorized by ages: 0-3 years of age (n = 94); 4-6 years (n = 36); 7-10 years (n = 30); 11-14 years (n = 22). The children were evaluated with a protocol that included tests of audition and speech perception, with closed-set (Vowel Confusion test, Series of Daily Words) and open-set tests (e.g. bisyllables, CID Sentences, CID Sentences adapted for children). Pure-tone averages significantly improved for all children in all groups with the CI compared with preoperative values. Nevertheless, only children implanted before the age of 6 years developed a high ability for recognition of bisyllables and sentences in an open-set. Results show that the earlier the implantation is undertaken, the better the performance outcome. Children implanted outside of the auditory critical period demonstrated significantly poorer performance, suggesting the occurrence of irreversible changes in the central auditory system. In conclusion, eligible children should receive a CI as soon as bilateral profound hearing impairment is diagnosed. This usually permits them to achieve high-performance levels on speech and language measures and potentially integration into an oral communication environment.

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

Evaluación del implante coclear como técnica de tratamiento de la hipoacusia profunda en pacientes pre y post locutivos

Resumen Introduccion Los objetivos son los siguientes: 1. Evaluacion de los resultados en el ambito del lenguaje. 2. Impacto de los implantes cocleares (IC) en la calidad de vida. 3. Evaluacion de las complicaciones medicas y fallos tecnicos del IC. 4. Evaluacion de los costes directos e indirectos generados en las diferentes fases de un programa de IC. 5. Determinar factores que repercuten en la evolucion clinica y en el gasto economico Material y Metodos Se estudia una poblacion de 877 pacientes con hipoacusia pre o postlocutiva, ninos y adultos, tratados en 5 centros espanoles con programas de IC. Se han utilizado pruebas audiometricas y cuestionarios globales de calidad de vida. Se han contabilizado las complicaciones medicas y tecnologicas de los IC. Se han calculado los costes economicos directos e indirectos de una implantacion coclear Resultados Los pacientes postlocutivos alcanzaron umbrales de 40 dB SPL, estables a lo largo de 12 anos de evolucion. En Vocales pasaron de un 30% en el preoperatorio al 80-90%, en Bisilabas de un 10% a un 50-60% y en Frases CID de un 18% a un 60-70%. En la poblacion de prelocutivos la edad de implantacion influyo decisivamente en los resultados. Los mejores fueron los obtenidos en ninos implantados mas tempranamente. Asi, aquellos implantados entre 0 y 3 anos de edad en Vocales pasaron de un 0% en el preoperatorio a un 95%, en Bisilabas de un 0% a un 90% y en Frases CID de un 0% a un 90-95%. El desarrollo del lenguaje de la poblacion prelocutiva tambien estuvo marcado por la edad de implantacion. En torno al 80% de los pacientes adultos postlocutivos manifestaron haber mejorado su estado de animo y su sociabilidad. Su estado general de salud no se vio deteriorado, ni precisaron mas ayudas de familiares y amigos. Se registro un 3,42% de complicaciones medico-quirurgicas mayores, un 7,06% de complicaciones medico-quirurgicas menores y un 3,07% de fallos tecnicos en los componentes internos del IC. El costo de todo el proceso de implantacion en un adulto postlocutivo oscilo entre 36.912 y 37.048 euros y en ninos prelocutivos entre 37.689 y 44.273 euros Conclusiones Los IC benefician la capacidad de comunicacion de los pacientes implantados. Los resultados en la poblacion prelocutiva justifican la puesta en marcha de programas de deteccion precoz de la hipoacusia infantil. Los pacientes postlocutivos adultos se muestran satisfechos con los resultados obtenidos, aunque perciben limitaciones en ambientes acusticos no favorables. Se expone un analisis de costes directos e indirectos util para la realizacion de estudios coste-beneficio sobre IC en nuestro medio. El bajo indice de complicaciones indica unos margenes de seguridad adecuados. Entre los factores que mas influyen en la evolucion estan: la duracion de la hipoacusia, la edad de implantacion, la morfologia coclear y la funcionalidad de la via auditiva, la motivacion del paciente y de su familia y la coexistencia de otras minusvalias asociadas a la hipoacusia

Cochlear implantation in radical cavities of mastoidectomy

In recent years, cochlear implants have been found to be effective in the treatment of bilateral profound hearing loss. Their use has been extended progressively to different populations, including prelingually and postlingually deaf children and adults as well as patients with associated handicaps. Cochlear implants have also been used in patients with anatomic variations of the cochlea and the middle ear, such as cochlear ossification, congenital malformations of the ear, and previous middle ear surgery.