Purpose The aim of this study is to evaluate speech perception outcomes after a frequency realloc... more Purpose The aim of this study is to evaluate speech perception outcomes after a frequency reallocation performed through the creation of an anatomically based map obtained with Otoplan®, a tablet-based software that allows the cochlear duct length to be calculated starting from CT images. Methods Ten postlingually deafened patients who underwent cochlear implantation with MED-EL company devices from 2015 to 2019 in the Tertiary referral center University Hospital of Verona have been included in a retrospective study. The postoperative CT scans were evaluated with Otoplan®; the position of the intracochlear electrodes was obtained, an anatomical mapping was carried out and then it was submitted to the patients. All patients underwent pure tonal and speech audiometry before and after the reallocation and the audiological results were processed considering the Speech Recognition Threshold (SRT), the Speech Awareness Threshold (SAT) and the Pure Tone Average (PTA). The differences in th...
Objective Complex middle and inner ear malformations are considered an important limitation for c... more Objective Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears. Study Design Case series with chart review of consecutive patients. Setting Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy. Subjects and Methods In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed. Results All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transa...
OBJECTIVEWe sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in... more OBJECTIVEWe sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in the application of auditory brainstem implants (ABIs) in adults with monolateral and bilateral vestibular schwannoma (VS) and in children with cochlear nerve aplasia.STUDY DESIGNWe conducted a retrospective case review.SETTINGThe study was conducted at the ENT Department of the University of Verona, Italy.PATIENTSSix adult patients (5 men and 1 woman) with neurofibromatosis type 2 (NF2) were operated on for VS removal with ABI. An additional patient had a unilateral VS in the only hearing ear. Tumor size ranged from 12 to 40 mm. In addition, 2 children received ABIs for bilateral cochlear nerve aplasia.INTERVENTIONAn RS‐TM approach was used in all VS patients, and an RS approach was used in the subjects with cochlear nerve aplasia. After tumor excision, landmarks (VII, VIII and IX cranial nerves, choroid plexus) for the foramen of Luschka were carefully identified. The choroid plexus wa...
The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insert... more The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insertion of a cochlear implant. Fibroadhesive otitis media (n = 1), bilateral cavity radical mastoidectomy (n = 1), autoimmune inner ear disease (n = 2), previous cranial trauma (n = 1), genetic prelingual deafness (n = 5), and otosclerosis (n = 1) were the causes of deafness. A cochleostomy was performed on the most superficial part of the basal turn, and the electrode array was inserted up to the cochlear apex. Speech perception tests (1-9 months after cochlear implant activation) yielded better results in these patients compared with a homogeneous group of postlingually deaf patients operated on through the traditional transmastoid route. Insertion of the implant through the middle fossa cochleostomy furnishes the possibility of stimulating areas of the cochlea (ie, the middle and apical turns) where a greater survival rate of spiral ganglion cells is known to occur, with improvement of in...
The current article describes the surgical technique and the very preliminary results of insertio... more The current article describes the surgical technique and the very preliminary results of insertion of a cochlear implant, via the middle fossa (MF), in patients with middle ear disease. The study design was a case report and a description of surgical technique. The study was conducted at an ENT Department, University of Verona, Verona, Italy. Two subjects with profound bilateral hearing loss, the first one presenting a bilateral radical mastoidectomy cavity and the second one with fibroadhesive otitis media, were operated on via the current technique. After adequate exposure of the MF floor, a triangular bony area between the greater superficial petrous nerve and the projection of the labyrinthine portion of the facial nerve was drilled out. The basal cochlear turn facing the middle cranial fossa floor was easily encountered, a small cochleostomy measuring 1 1/2 mm in diameter was performed on the most superficial part of the basal turn, and the electrode carrier was inserted into t...
The aim of this study was to illustrate the different imaging features of middle and inner ear im... more The aim of this study was to illustrate the different imaging features of middle and inner ear implants, brainstem implants and inferior colliculus implants. We retrospectively reviewed the computed tomography (CT) images of 468 patients with congenital or acquired transmissive or neurosensory hearing loss who underwent surgery. The implants examined were: 22 Vibrant Soundbridge implants, 5 at the long limb of the incus and 17 at the round window, 350 cochlear implants, 95 brainstem implants and 1 implant at the inferior colliculus. All patients underwent a postoperative CT scan (single or multislice scanner) and/or a Dentomaxillofacial cone-beam CT scan (CBCT) (axial and multiplanar reconstruction), and/or a plain-film radiography to visualise the correct position of the implant. The CBCT scan depicts Vibrant site of implant better than plain-film radiography, with a lower radiation dose compared to CT. For cochlear implants, a single plain radiograph in the Stenvers projection can directly visualise the electrodes in the cochlea. All patients with brainstem or inferior colliculus implants underwent postoperative CT to exclude complications and the assess correct implantation, but the follow-up of these implants can be performed by plain radiography alone. CT and CBCT scans are reliable and relatively fast methods for precisely determining the location of middle ear implants. CBCT is preferable to CT because of the lower radiation dose administered; a single plain-film radiograph is enough to visualise and follow-up cochlear, brainstem and inferior colliculus implants.
Fifty years ago auditory scientists were very skeptical about the potential of new prosthetic app... more Fifty years ago auditory scientists were very skeptical about the potential of new prosthetic approaches that electrically stimulated the auditory nerve, the cochlear nuclei (CN), and the inferior colliculus (IC). In those decades, the basilar membrane was considered to play a fundamental and irreplaceable role as a fine spectrum analyzer in hearing physiology, and therefore it was thought that electrical stimulation of the auditory system would have never produced functionally useful hearing. Over the last 30 years, cochlear implants (CIs) have improved steadily to the point where the average sentence recognition with modern multichannel devices is better than 90% correct. More recently, similar performance has been observed with electric stimulation of the brainstem with auditory brainstem implants (ABIs). However, it is clear that to fully understand hearing and to design the next generation of prosthetic devices we must better understand the ear-brain relationship. Indeed some aspects of hearing do not require the intricate complexities of cochlear physiological responses, while other auditory tasks rely critically on specialized details of cochlear processing. The progress in electrical stimulation of the central auditory system requires us to reconsider the patient selection criteria for different implant devices, in particular to evaluate the possibility of ABIs for etiologies with poor outcomes with CIs. In the present review, the latest outcomes in restoration of hearing with ABI are presented. New guidelines are proposed for device selection for different etiologies and future research is suggested to further refine the process of matching an individual patient to the most appropriate implant device.
ObjectiveThe traditional indication for auditory brainstem implants (ABIs) is neurofibromatosis t... more ObjectiveThe traditional indication for auditory brainstem implants (ABIs) is neurofibromatosis type 2 (NF2) in subjects older than 12 years. In our department, the indications for ABIs have been extended to non‐tumor children and adults with cochlear or cochlear nerve injuries or malfunctions who would not benefit from a cochlear implant. The results obtained in non‐tumor adults are reported in this study.MethodsIn our department, from April 1997 to February 2008, ABIs have been implanted in a total of 114 patients (83 adults and 31 children) for different tumor and non‐tumor diseases. 15 patients out of 114 have elsewhere previously had a CI with no sound detection. The retrosigmoid‐transmeatal approach was used in all tumor patients and the retrosigmoid approach was used in all non‐tumor patients.ResultsAll patients had a functioning implantation, and reported auditory sensations with activation of various numbers of electrodes. At 1 year after implantations, non‐tumor adults sco...
Objective This study illustrates the auditory perceptual development and the non-verbal cognitive... more Objective This study illustrates the auditory perceptual development and the non-verbal cognitive abilities in young deaf children fitted with auditory brainstem implant (ABI). Methods In our department, from 2000 to 2008, 31 children, aged 9 months to 16 years, received an ABI for different tumor and non-tumor diseases. Six children have elsewhere previously had a CI with no sound detection. 14 out of 31 children had associated disabilities. The retrosigmoid-transmeatal approach was used in tumor patients and the retrosigmoid approach was used in non-tumor patients. Perceptual auditory abilities were evaluated with the CAP and EARS battery tests. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale-Revised (LEITERS-R) test battery. Intraoperative EABRs and postoperative EABRs and EMLRs were performed. Results No postoperative complications were observed. All children consistently use their devices for more than 75% of waking hours and h...
The vestibular nerve of patients with Meniere's disease and vascular cross-compression sy... more The vestibular nerve of patients with Meniere's disease and vascular cross-compression syndrome of the root entry zone due to the antero-inferior cerebellar artery was studied. All patients underwent vestibular neurectomy using the retrosigmoid approach, which permits the removal of a long nerve segment. CA were found in the cytoplasm of astrocytes that had not shown signs of degeneration at the central portion of the vestibular root entry zone. No membrane intervened between CA and the surrounding cytoplasm, which was rich in filaments, in particular near the CA, and poorly equipped with other organelles. CA were round or oval inclusions measuring 10-12 microns in diameter. The matrix of the CA was composed of low-density amorphous material, with irregular masses displaying a medium density. A network of randomly oriented filaments and bilaminar, osmiophilic lipid fragments with the same structure and thickness of myelin layers were embedded in the matrix. The CA rich in bilaminar fragments were recognizable also at low magnification for their high electron density. In the astrocytic cytoplasm, near the CA, round or ovalshaped, electron-dense bodies with a multilamellar structure were often visible. These results confirm the hypothesis that CA may contain degenerating myelin embedded in a microenvironment rich in glucose polymers and that CA could be an indicator of neurodegeneration.
There is growing evidence that early application of a cochlear implant in children affected by pr... more There is growing evidence that early application of a cochlear implant in children affected by profound congenital hearing loss is of paramount importance for the development of an adequate auditory performance and language skills. For these reasons and as a result of advances in audiologic diagnosis and an enhanced awareness of the safety of cochlear implants, the age of implantation has substantially decreased over recent years. Children aged as little as 12 months are now being implanted in some centers. On the basis of our experience with very young children, we believe that the date of implantation may be further reduced to only 4 to 6 months of age. Over the period from November 1998 to April 2004, 103 children have been fitted with cochlear implants and 11 with auditory brainstem implants in our department, including 65 children aged below 3 years. The present study focuses on 10 children aged less than 12 months fitted with cochlear implants from November 1998 to December 2003. The children's ages ranged from 4 to 11 (mean 9.5) months. Five were males and five females. All received a Nucleus CI 24 M. Postoperative auditory performance, as evaluated at the latest follow-up, was based on the category of auditory performance (CAP). The results obtained in these 10 children were compared with those obtained with cochlear implants in children belonging to older age brackets. The criteria used to assess speech performance were onset of babbling onset and babbling spurt, and the results observed were compared with those of a control group of 10 normally hearing children. Surgery was uneventful, and no immediate or delayed complications were encountered. Auditory performance was seen to increase as function of early age of implantation and length of implant use. All 10 children had a CAP score of 3 within 6 months of cochlear implant activation. The onset of babbling occurred very early (i.e., within 1 to 3 months of activation of the implant in all 10 patients), regardless of age at implantation, whereas the babbling spurt was recorded at times ranging from 3 to 5 months after implant activation. The positive impact of early implantation on babbling was clearly shown by the fact that the earlier the activation of the cochlear implant, the closer the results were to the outcomes of normally hearing children. We encourage very early implantation to facilitate a series of developmental processes occurring in the critical period of initial language acquisition. The indices we used in the present study (i.e., CAP and babbling) suggest that early cochlear implantation tends to yield normalization of audio-phonologic parameters, which enables us to consider the performance of children implanted very early as being similar to that of their normally hearing peers.
Hearing loss is a possible complication of vestibular neurectomy and intratympanic gentamicin adm... more Hearing loss is a possible complication of vestibular neurectomy and intratympanic gentamicin administration in Ménière's disease. The aim of this study was to compare the incidence of this complication with the two treatments. Retrospective review. Tertiary referral center. The initial study population reviewed consisted of 24 patients receiving gentamicin injections and 209 patients undergoing vestibular nerve section. Comparison of data was performed among all 24 intratympanic gentamicin patients and the last 24 vestibular neurectomy patients operated on via the retrosigmoid approach. Intratympanic gentamicin administration (26-156 mg) and retrosigmoid vestibular neurectomy. Auditory and vertigo results were evaluated according to the American Academy of Otolaryngology 1995 criteria. The mean preoperative pure-tone average for patients undergoing vestibular nerve section was 48.5 dB, with a speech discrimination score of 85%. In these patients, the postoperative pure-tone average was 50.3 dB, and the speech discrimination score was 82%. Patients undergoing gentamicin injection had a mean pretreatment pure-tone average of 50.1 dB and a speech discrimination score of 87%. The posttreatment pure-tone average and discrimination score for the gentamicin group were 74.7 dB and 65%, respectively. The amount of postprocedure hearing loss was significantly greater in the gentamicin group (p = 0.03). Excellent control of vertigo (classes A and B) was obtained in 95.8% of the patients treated with vestibular nerve section and in 75% of the patients in the gentamicin group. Gentamicin administration and vestibular neurectomy are both effective for relieving vertigo in Ménière's disease. The incidence of hearing loss is significantly higher after gentamicin injection.
Purpose The aim of this study is to evaluate speech perception outcomes after a frequency realloc... more Purpose The aim of this study is to evaluate speech perception outcomes after a frequency reallocation performed through the creation of an anatomically based map obtained with Otoplan®, a tablet-based software that allows the cochlear duct length to be calculated starting from CT images. Methods Ten postlingually deafened patients who underwent cochlear implantation with MED-EL company devices from 2015 to 2019 in the Tertiary referral center University Hospital of Verona have been included in a retrospective study. The postoperative CT scans were evaluated with Otoplan®; the position of the intracochlear electrodes was obtained, an anatomical mapping was carried out and then it was submitted to the patients. All patients underwent pure tonal and speech audiometry before and after the reallocation and the audiological results were processed considering the Speech Recognition Threshold (SRT), the Speech Awareness Threshold (SAT) and the Pure Tone Average (PTA). The differences in th...
Objective Complex middle and inner ear malformations are considered an important limitation for c... more Objective Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears. Study Design Case series with chart review of consecutive patients. Setting Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy. Subjects and Methods In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed. Results All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transa...
OBJECTIVEWe sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in... more OBJECTIVEWe sought to describe the advantages of the retrosigmoid‐transmeatal (RS‐TM) approach in the application of auditory brainstem implants (ABIs) in adults with monolateral and bilateral vestibular schwannoma (VS) and in children with cochlear nerve aplasia.STUDY DESIGNWe conducted a retrospective case review.SETTINGThe study was conducted at the ENT Department of the University of Verona, Italy.PATIENTSSix adult patients (5 men and 1 woman) with neurofibromatosis type 2 (NF2) were operated on for VS removal with ABI. An additional patient had a unilateral VS in the only hearing ear. Tumor size ranged from 12 to 40 mm. In addition, 2 children received ABIs for bilateral cochlear nerve aplasia.INTERVENTIONAn RS‐TM approach was used in all VS patients, and an RS approach was used in the subjects with cochlear nerve aplasia. After tumor excision, landmarks (VII, VIII and IX cranial nerves, choroid plexus) for the foramen of Luschka were carefully identified. The choroid plexus wa...
The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insert... more The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insertion of a cochlear implant. Fibroadhesive otitis media (n = 1), bilateral cavity radical mastoidectomy (n = 1), autoimmune inner ear disease (n = 2), previous cranial trauma (n = 1), genetic prelingual deafness (n = 5), and otosclerosis (n = 1) were the causes of deafness. A cochleostomy was performed on the most superficial part of the basal turn, and the electrode array was inserted up to the cochlear apex. Speech perception tests (1-9 months after cochlear implant activation) yielded better results in these patients compared with a homogeneous group of postlingually deaf patients operated on through the traditional transmastoid route. Insertion of the implant through the middle fossa cochleostomy furnishes the possibility of stimulating areas of the cochlea (ie, the middle and apical turns) where a greater survival rate of spiral ganglion cells is known to occur, with improvement of in...
The current article describes the surgical technique and the very preliminary results of insertio... more The current article describes the surgical technique and the very preliminary results of insertion of a cochlear implant, via the middle fossa (MF), in patients with middle ear disease. The study design was a case report and a description of surgical technique. The study was conducted at an ENT Department, University of Verona, Verona, Italy. Two subjects with profound bilateral hearing loss, the first one presenting a bilateral radical mastoidectomy cavity and the second one with fibroadhesive otitis media, were operated on via the current technique. After adequate exposure of the MF floor, a triangular bony area between the greater superficial petrous nerve and the projection of the labyrinthine portion of the facial nerve was drilled out. The basal cochlear turn facing the middle cranial fossa floor was easily encountered, a small cochleostomy measuring 1 1/2 mm in diameter was performed on the most superficial part of the basal turn, and the electrode carrier was inserted into t...
The aim of this study was to illustrate the different imaging features of middle and inner ear im... more The aim of this study was to illustrate the different imaging features of middle and inner ear implants, brainstem implants and inferior colliculus implants. We retrospectively reviewed the computed tomography (CT) images of 468 patients with congenital or acquired transmissive or neurosensory hearing loss who underwent surgery. The implants examined were: 22 Vibrant Soundbridge implants, 5 at the long limb of the incus and 17 at the round window, 350 cochlear implants, 95 brainstem implants and 1 implant at the inferior colliculus. All patients underwent a postoperative CT scan (single or multislice scanner) and/or a Dentomaxillofacial cone-beam CT scan (CBCT) (axial and multiplanar reconstruction), and/or a plain-film radiography to visualise the correct position of the implant. The CBCT scan depicts Vibrant site of implant better than plain-film radiography, with a lower radiation dose compared to CT. For cochlear implants, a single plain radiograph in the Stenvers projection can directly visualise the electrodes in the cochlea. All patients with brainstem or inferior colliculus implants underwent postoperative CT to exclude complications and the assess correct implantation, but the follow-up of these implants can be performed by plain radiography alone. CT and CBCT scans are reliable and relatively fast methods for precisely determining the location of middle ear implants. CBCT is preferable to CT because of the lower radiation dose administered; a single plain-film radiograph is enough to visualise and follow-up cochlear, brainstem and inferior colliculus implants.
Fifty years ago auditory scientists were very skeptical about the potential of new prosthetic app... more Fifty years ago auditory scientists were very skeptical about the potential of new prosthetic approaches that electrically stimulated the auditory nerve, the cochlear nuclei (CN), and the inferior colliculus (IC). In those decades, the basilar membrane was considered to play a fundamental and irreplaceable role as a fine spectrum analyzer in hearing physiology, and therefore it was thought that electrical stimulation of the auditory system would have never produced functionally useful hearing. Over the last 30 years, cochlear implants (CIs) have improved steadily to the point where the average sentence recognition with modern multichannel devices is better than 90% correct. More recently, similar performance has been observed with electric stimulation of the brainstem with auditory brainstem implants (ABIs). However, it is clear that to fully understand hearing and to design the next generation of prosthetic devices we must better understand the ear-brain relationship. Indeed some aspects of hearing do not require the intricate complexities of cochlear physiological responses, while other auditory tasks rely critically on specialized details of cochlear processing. The progress in electrical stimulation of the central auditory system requires us to reconsider the patient selection criteria for different implant devices, in particular to evaluate the possibility of ABIs for etiologies with poor outcomes with CIs. In the present review, the latest outcomes in restoration of hearing with ABI are presented. New guidelines are proposed for device selection for different etiologies and future research is suggested to further refine the process of matching an individual patient to the most appropriate implant device.
ObjectiveThe traditional indication for auditory brainstem implants (ABIs) is neurofibromatosis t... more ObjectiveThe traditional indication for auditory brainstem implants (ABIs) is neurofibromatosis type 2 (NF2) in subjects older than 12 years. In our department, the indications for ABIs have been extended to non‐tumor children and adults with cochlear or cochlear nerve injuries or malfunctions who would not benefit from a cochlear implant. The results obtained in non‐tumor adults are reported in this study.MethodsIn our department, from April 1997 to February 2008, ABIs have been implanted in a total of 114 patients (83 adults and 31 children) for different tumor and non‐tumor diseases. 15 patients out of 114 have elsewhere previously had a CI with no sound detection. The retrosigmoid‐transmeatal approach was used in all tumor patients and the retrosigmoid approach was used in all non‐tumor patients.ResultsAll patients had a functioning implantation, and reported auditory sensations with activation of various numbers of electrodes. At 1 year after implantations, non‐tumor adults sco...
Objective This study illustrates the auditory perceptual development and the non-verbal cognitive... more Objective This study illustrates the auditory perceptual development and the non-verbal cognitive abilities in young deaf children fitted with auditory brainstem implant (ABI). Methods In our department, from 2000 to 2008, 31 children, aged 9 months to 16 years, received an ABI for different tumor and non-tumor diseases. Six children have elsewhere previously had a CI with no sound detection. 14 out of 31 children had associated disabilities. The retrosigmoid-transmeatal approach was used in tumor patients and the retrosigmoid approach was used in non-tumor patients. Perceptual auditory abilities were evaluated with the CAP and EARS battery tests. Cognitive evaluation was performed on 10 children using the Leiter International Performance Scale-Revised (LEITERS-R) test battery. Intraoperative EABRs and postoperative EABRs and EMLRs were performed. Results No postoperative complications were observed. All children consistently use their devices for more than 75% of waking hours and h...
The vestibular nerve of patients with Meniere's disease and vascular cross-compression sy... more The vestibular nerve of patients with Meniere's disease and vascular cross-compression syndrome of the root entry zone due to the antero-inferior cerebellar artery was studied. All patients underwent vestibular neurectomy using the retrosigmoid approach, which permits the removal of a long nerve segment. CA were found in the cytoplasm of astrocytes that had not shown signs of degeneration at the central portion of the vestibular root entry zone. No membrane intervened between CA and the surrounding cytoplasm, which was rich in filaments, in particular near the CA, and poorly equipped with other organelles. CA were round or oval inclusions measuring 10-12 microns in diameter. The matrix of the CA was composed of low-density amorphous material, with irregular masses displaying a medium density. A network of randomly oriented filaments and bilaminar, osmiophilic lipid fragments with the same structure and thickness of myelin layers were embedded in the matrix. The CA rich in bilaminar fragments were recognizable also at low magnification for their high electron density. In the astrocytic cytoplasm, near the CA, round or ovalshaped, electron-dense bodies with a multilamellar structure were often visible. These results confirm the hypothesis that CA may contain degenerating myelin embedded in a microenvironment rich in glucose polymers and that CA could be an indicator of neurodegeneration.
There is growing evidence that early application of a cochlear implant in children affected by pr... more There is growing evidence that early application of a cochlear implant in children affected by profound congenital hearing loss is of paramount importance for the development of an adequate auditory performance and language skills. For these reasons and as a result of advances in audiologic diagnosis and an enhanced awareness of the safety of cochlear implants, the age of implantation has substantially decreased over recent years. Children aged as little as 12 months are now being implanted in some centers. On the basis of our experience with very young children, we believe that the date of implantation may be further reduced to only 4 to 6 months of age. Over the period from November 1998 to April 2004, 103 children have been fitted with cochlear implants and 11 with auditory brainstem implants in our department, including 65 children aged below 3 years. The present study focuses on 10 children aged less than 12 months fitted with cochlear implants from November 1998 to December 2003. The children's ages ranged from 4 to 11 (mean 9.5) months. Five were males and five females. All received a Nucleus CI 24 M. Postoperative auditory performance, as evaluated at the latest follow-up, was based on the category of auditory performance (CAP). The results obtained in these 10 children were compared with those obtained with cochlear implants in children belonging to older age brackets. The criteria used to assess speech performance were onset of babbling onset and babbling spurt, and the results observed were compared with those of a control group of 10 normally hearing children. Surgery was uneventful, and no immediate or delayed complications were encountered. Auditory performance was seen to increase as function of early age of implantation and length of implant use. All 10 children had a CAP score of 3 within 6 months of cochlear implant activation. The onset of babbling occurred very early (i.e., within 1 to 3 months of activation of the implant in all 10 patients), regardless of age at implantation, whereas the babbling spurt was recorded at times ranging from 3 to 5 months after implant activation. The positive impact of early implantation on babbling was clearly shown by the fact that the earlier the activation of the cochlear implant, the closer the results were to the outcomes of normally hearing children. We encourage very early implantation to facilitate a series of developmental processes occurring in the critical period of initial language acquisition. The indices we used in the present study (i.e., CAP and babbling) suggest that early cochlear implantation tends to yield normalization of audio-phonologic parameters, which enables us to consider the performance of children implanted very early as being similar to that of their normally hearing peers.
Hearing loss is a possible complication of vestibular neurectomy and intratympanic gentamicin adm... more Hearing loss is a possible complication of vestibular neurectomy and intratympanic gentamicin administration in Ménière's disease. The aim of this study was to compare the incidence of this complication with the two treatments. Retrospective review. Tertiary referral center. The initial study population reviewed consisted of 24 patients receiving gentamicin injections and 209 patients undergoing vestibular nerve section. Comparison of data was performed among all 24 intratympanic gentamicin patients and the last 24 vestibular neurectomy patients operated on via the retrosigmoid approach. Intratympanic gentamicin administration (26-156 mg) and retrosigmoid vestibular neurectomy. Auditory and vertigo results were evaluated according to the American Academy of Otolaryngology 1995 criteria. The mean preoperative pure-tone average for patients undergoing vestibular nerve section was 48.5 dB, with a speech discrimination score of 85%. In these patients, the postoperative pure-tone average was 50.3 dB, and the speech discrimination score was 82%. Patients undergoing gentamicin injection had a mean pretreatment pure-tone average of 50.1 dB and a speech discrimination score of 87%. The posttreatment pure-tone average and discrimination score for the gentamicin group were 74.7 dB and 65%, respectively. The amount of postprocedure hearing loss was significantly greater in the gentamicin group (p = 0.03). Excellent control of vertigo (classes A and B) was obtained in 95.8% of the patients treated with vestibular nerve section and in 75% of the patients in the gentamicin group. Gentamicin administration and vestibular neurectomy are both effective for relieving vertigo in Ménière's disease. The incidence of hearing loss is significantly higher after gentamicin injection.
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