Talma Shpak

Binaural–bimodal hearing: Concomitant use of a unilateral cochlear implant and a contralateral hearing aid

Conclusion. The benefit obtained with a contralateral hearing aid (HA) in unilateral cochlear implantees improves over time, at least during the first year after implantation. Objective. To evaluate binaural–bimodal auditory ability and its early changes over time after unilateral cochlear implantation in patients with residual hearing in the non-implanted ear, in which they use an HA. Material and methods. Sentence identification in background noise was tested in 12 patients (3 post-lingual adults and 9 pre-lingual adults and older children) under 3 listening conditions: cochlear implant (CI) alone, HA alone and CI + HA. The presentation level was 55 dB HL with a signal-to-noise ratio of +10 dB. Subjects were tested after 1–6 months of concomitant use of both devices and again after a further 7–12 months. Results. At the first testing session, the mean score in background noise was 34.9% with CI alone (range 0–90%) and 41.1% with both devices (range 0–100%). Seven patients could recognize sentences in noise with CI alone, and four of them showed further improvement with added amplification. At the second session, at which all subjects could recognize sentences in noise with the CI alone, seven showed further improvement with added amplification. The mean score was 60.6% with CI alone (range 10–99%) and 75.5% with both devices (range 52–100%).

Cochlear implantation in healthy and otitis-prone children: a prospective study.

Objective To evaluate and compare the timing of surgery, intraoperative findings, and otitis media‐related outcome of cochlear implantation in children who are otitis‐prone with their counterparts who are not otitis‐prone.

Hearing progress and fluctuations in bimodal-binaural hearing users (unilateral cochlear implants and contralateral hearing aid).

Conclusions. Mean scores achieved using a cochlear implant (CI) plus a hearing aid (HA) were consistently higher (statistically non-significant) than those for CI alone. The addition of a contralateral HA partially compensated for the negative hearing fluctuations as well as for the slow initial progress with the CI. Objectives. To examine hearing progress over the first 3 years after unilateral cochlear implantation in users who had residual hearing in the non-implanted ear at the time of surgery and continued to use a HA in that ear thereafter. Patients and methods. Thirteen patients were followed up for 36months after continuous concomitant use of a CI and a contralateral HA. To evaluate hearing progress, sentence identification in background noise (presentation level, 55dB; S/N ratio, +10 dB) was tested for CI alone and for CI with contralateral HA (CI+HA). Subjects were tested after 6, 12, 18, 24, and 36months of concomitant use of both devices. Mixed regression model was used to evaluate the groups progression of scores and the added value of a contralateral HA over time. Results. When last tested (36 months after CI) the mean group score for CI alone was 72.6%±19.3%, and 12/13 patients scored at least 65% with either CI alone or CI+HA. Mean scores achieved using CI+HA were consistently higher than those for CI alone. Percentage improvement in CI+HA relative to CI alone was highest (19.2%) after 18 months of concomitant usage and then diminished gradually to 7.7% at 36months. Most patients showed some negative fluctuations in performance with CI alone at some point during the 36months of post-CI follow-up.

Case report: Cochlear implant in a child with schizencephaly and cortical dysplasia

Abstract Schizencephaly is a developmental disorder of the cerebral cortex, usually with seizures occurring before the age of 3. We describe pre-implantation considerations and post-implantation outcome in a child with schizencephaly and bilateral profound hearing loss. Cochlear implantation was performed in the right ear when she was 21 months old. At 4 years and 3 months she developed an epileptic pattern on electroencephalogram and had mild attacks of dysesthesia. Now aged 6, she uses the implant successfully and needs no anticonvulsant medication. Language skills, though delayed, are progressing steadily. We consider that the epileptic pattern was unrelated to the electrical stimulation, and conclude that implantation is not contraindicated in children with cortical anomalies. Copyright

Natural history of contralateral residual hearing in binaural-bimodal hearing

Conclusions. The range of evaluation tools used in deciding which ear to implant and which to designate for a hearing aid (HA) should be expanded to include additional aspects to those tested by audiometry and basic speech perception. Residual hearing in non-implanted ears remains stable for at least 3 years after unilateral cochlear implantation, but regular refitting and monitoring of the HA function combined with cochlear implant (CI) mapping are mandatory for maximizing benefit from binaural-bimodal hearing. Objectives. To examine whether the clinical decision-making tools currently used to assess hearing are reliable guides when choosing the preferred ear for CI, and to determine the rate of residual hearing deterioration in the non-implanted ear over 36 months post-CI as a guide to recommending subsequent continued use of a contralateral HA as opposed to CI. Patients and methods. This was a retrospective evaluation of patients’ charts. The pre-CI choice of the ear for implantation in a group of 37 binaural-bimodal users was re-evaluated. In a second group of 22 patients, residual hearing deterioration was followed for 36 months post-implantation. Results. In the group of 37 patients, subjective identification of the worse-hearing ear was in agreement with audiometric results in 28 cases, but disagreed with the unaided audiometric results in the other 9. Mean threshold values for the group of 22 patients remained stable over 36 months post-CI, except for the aided threshold at 4.0kHz, which deteriorated by 10.9dB (p=0.003).

Cochlear implantation in a patient with paget's disease

Hearing loss in Pagets disease, a metabolic bone disease, has been reported in as many as 60% of cases, and is presumably related to changes in mineral density of the otic capsule. We describe a 59‐year‐old man with Pagets disease who had severe to profound hearing loss and was referred to us for cochlear implantation. Preoperative evaluation revealed poor communication skills despite significant residual hearing, raising concerns about postimplantation outcome. Nevertheless, implantation was successful. As our literature search yielded only one report of cochlear implantation in Pagets disease, we record our clinical experience and discuss the hearing rehabilitation dilemmas in this case.

Objective measurements of auditory recovery time in Nucleus CI24 implantees in relation to subjective preference of stimulation rate

Choosing an optimal stimulation rate in cochlear implantees is a challenging and time-consuming process, since it is accomplished by a subjective trial-and-error procedure. With the overall objective of developing a reliable automated methodology for stimulation rate fitting we sought a possible correlation between the patient’s subjectively preferred stimulation rate and the objective measurement of the auditory nerve recovery time.