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Rates of long-term cochlear implant use in children.

ABSTRACT: To determine the rate of long-term cochlear implant (CI) use in children.Consecutive case series.Tertiary referral center.Approximately 474 patients younger than 18 years who received a first CI from 1999 to 2011.Cochlear implantation.Regular CI use, defined as using the CI for 8 hours or greater per day.We successfully contacted and obtained follow-up data on 402 patients (85%) via email, telephone, and postal survey. The rate of regular CI use was 93.2% (95% CI, 90.0-95.4) at 5 years postimplantation and 87.7% (95% CI, 82.9-91.3) at 10 years postimplantation. The mean number of hours of use per day was 12.0 hours (SD, 4.1 h). Cox proportional hazard regression analysis demonstrated a linear association between the age at implantation and the risk of discontinuing regular CI use. Rates of CI discontinuation increased by 18.2% per year of age at implantation (95% CI, 7.2%-30.4%). Reported reasons for CI use less than 8 hours per day include poor hearing benefit (53.2%), social pressure (21.3%), and recurrent displacement of the transmitter coil (17.0%).High rates of regular CI use are sustained after childhood implantation, and younger age at implantation is associated with a higher rate of continued device usage.

SUBMITTER: Contrera KJ

PROVIDER: S-EPMC3927162 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Rates of long-term cochlear implant use in children.

Contrera Kevin James KJ Choi Janet Seolin JS Blake Caitlin Rebecca CR Betz Joshua Francis JF Niparko John Kim JK Lin Frank R FR

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 20140301 3

<h4>Objective</h4>To determine the rate of long-term cochlear implant (CI) use in children.<h4>Study design</h4>Consecutive case series.<h4>Setting</h4>Tertiary referral center.<h4>Patients</h4>Approximately 474 patients younger than 18 years who received a first CI from 1999 to 2011.<h4>Interventions</h4>Cochlear implantation.<h4>Main outcome measure(s)</h4>Regular CI use, defined as using the CI for 8 hours or greater per day.<h4>Results</h4>We successfully contacted and obtained follow-up dat ...[more]

PMID: 24518403

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Project description:ObjectivesIn this study, we aimed to (1) review the long-term outcomes of cochlear implantation in children with cochlear nerve aplasia and (2) compare the development of their auditory and speech abilities to children with normal-sized cochlear nerves.DesignThis is a retrospective case-control study. Patients who underwent unilateral cochlear implant (CI) surgery in a tertiary referral center from September 2012 to December 2018 were reviewed. The study group included 55 children with cochlear nerve aplasia diagnosed using preoperative images. The control group included 35 children with normal-sized cochlear nerves. The control group did not differ from the study group in terms of age at implantation, pre-implantation auditory and speech abilities, or the electrode array type. Cochlear implantation outcomes were assessed using a test battery, including the Categories of Auditory Performance (CAP) score, the Speech Intelligibility Rating (SIR) score, behavioral audiometry, and closed- or open-set speech recognition tests. The development of auditory and speech abilities was compared between the two groups using Generalized Linear Mixed-effect Models.ResultsThe mean duration of CI usage was 4.5 years (SD = 1.5, range = 2.0 to 9.5) in the study group. The CAP scores, SIR scores, and aided hearing thresholds improved significantly post-implantation in the study group, but were significantly poorer than those in the control group. Generalized Linear Mixed-effect Models showed that the development of CAP and SIR scores was significantly slower in the study group than in the control group. Overall, 27 (49%) children with cochlear nerve aplasia had some degree of open-set speech perception skills, but the monosyllabic and bisyllabic word recognition rates were significantly lower than those in the control group.ConclusionFor children with cochlear nerve aplasia, auditory perception and speech intelligibility continued to improve in the long-term follow-up, but this progress was significantly slower than in children with normal-sized cochlear nerves. Most children with cochlear nerve aplasia could obtain the ability of common phrase perception and understanding simple spoken language with consistent CI usage and auditory rehabilitation.

Project description:Experimental studies play an important role in establishing the safety and efficacy of cochlear implants and they continue to provide insight into a new generation of electrode arrays and stimulation strategies. One drawback has been the limited depth of insertion of an electrode array in experimental animals. We compared the insertion depth and trauma associated with the insertion of Cochlear Ltd's Hybrid-L (HL) array with a standard 8 ring array in cat cochleae. Both arrays were inserted into cadaver cochleae and an X-ray recorded their anatomical location. The implanted cochlea was serially sectioned and photographed at 300 ?m intervals for evidence of electrode insertion trauma. Subsequently two cats were chronically implanted with HL arrays and electrically-evoked potentials recorded over a three month period. Mean insertion depth for the HL arrays was 334.8° (SD = 21°; n = 4) versus 175.5° (SD = 6°; n = 2) for the standard array. This relates to ?10.5 mm and 6 mm respectively. A similar insertion depth was measured in a chronically implanted animal with an HL array. Histology from each cadaver cochleae showed that the electrode array was always located in the scala tympani; there was no evidence of electrode insertion trauma to the basilar membrane, the osseous spiral lamina or the spiral ligament. Finally, evoked potential data from the chronically implanted animals exhibited significantly lower thresholds compared with animals implanted with a standard 8 ring array, with electrical thresholds remaining stable over a three-month observation period. Cochlear Ltd's HL electrode array can be safely inserted ?50% of the length of the cat scala tympani, placing the tip of the array close to the 4 kHz place. This insertion depth is considerably greater than is routinely achieved using a standard 8-ring electrode array (?12 kHz place). The HL array evokes low thresholds that remain stable over three months of implantation. This electrode array has potential application in a broad area of cochlear implant related research.

Project description:BackgroundSpecific clinical conditions could compromise cochlear implantation outcomes and drastically reduce the chance of an acceptable development of perceptual and linguistic capabilities. These conditions should certainly include the presence of inner ear malformations or brain abnormalities. The aims of this work were to study the diagnostic value of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in children with sensorineural hearing loss who were candidates for cochlear implants and to analyse the anatomic abnormalities of the ear and brain in patients who underwent cochlear implantation. We also analysed the effects of ear malformations and brain anomalies on the CI outcomes, speculating on their potential role in the management of language developmental disorders.MethodsThe present study is a retrospective observational review of cochlear implant outcomes among hearing-impaired children who presented ear and/or brain anomalies at neuroimaging investigations with MRI and HRCT. Furthermore, genetic results from molecular genetic investigations (GJB2/GJB6 and, additionally, in selected cases, SLC26A4 or mitochondrial-DNA mutations) on this study group were herein described. Longitudinal and cross-sectional analysis was conducted using statistical tests.ResultsBetween January 1, 1996 and April 1, 2012, at the ENT-Audiology Department of the University Hospital of Ferrara, 620 cochlear implantations were performed. There were 426 implanted children at the time of the present study (who were <18 years). Among these, 143 patients (64 females and 79 males) presented ear and/or brain anomalies/lesions/malformations at neuroimaging investigations with MRI and HRCT. The age of the main study group (143 implanted children) ranged from 9 months and 16 years (average = 4.4; median = 3.0).ConclusionsGood outcomes with cochlear implants are possible in patients who present with inner ear or brain abnormalities, even if central nervous system anomalies represent a negative prognostic factor that is made worse by the concomitant presence of cochlear malformations. Common cavity and stenosis of the internal auditory canal (less than 2 mm) are negative prognostic factors even if brain lesions are absent.

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Rates of long-term cochlear implant use in children.

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Rates of long-term cochlear implant use in children.

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