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This article provides the reader with basic knowledge regarding the measurement tools needed to assess hearing in children. The test batteries described here are adaptable and interchangeable to meet the needs of the entire pediatric population no matter what the age or developmental stage. It is meant to provide the team of professionals involved in the treatment of pediatric hearing disorders with a framework from which the process of diagnosis, treatment, and rehabilitation can begin at an early age.

To assess whether recombinant growth factor (hGH) therapy has an effect on cochlear implant (CI) performance.

To analyze the effects of residual hearing on postoperative speech performance in traditional cochlear implant (CI) patients implanted with a conventional electrode.

This pilot study examined speech recognition, localization, temporal and spectral discrimination, and subjective reports of cochlear implant (CI) recipients with unilateral deafness.

To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI).

OBJECTIVES To determine the efficacy of cochlear implantation (CI) in prelingually deafened adolescent children and to evaluate predictive variables for successful outcomes. DESIGN Retrospective medical record review. PARTICIPANTS Children aged 10 to 17 years with prelingual hearing loss (mean length of deafness, 11.5 years) who received a unilateral CI (mean age at CI, 12.9 years). INTERVENTION Unilateral CI. MAIN OUTCOME MEASURES Standard speech perception testing (Consonant-Nucleus-Consonant [CNC] monosyllabic word test and Hearing in Noise [HINT] sentence test) was performed preoperatively, 1 year postoperatively (year 1), and at the last follow-up/end of the study (EOS). RESULTS There was a highly significant improvement in speech perception scores for both HINT sentence and CNC word testing from the preoperative testing to year 1 (mean change score, 51.10% and 32.23%, respectively; P < .001) and from the preoperative testing to EOS (mean change score, 60.02% and 38.73%, respectively; P < .001), with a significantly greater increase during the first year (P < .001). In addition, there was a highly significant correlation between improvements in performance scores on the CNC word and HINT sentence speech perception tests and both age at CI and length of deafness at the year 1 testing (P ≤.009) but not from the year 1 testing to EOS testing. Adolescents with progressive deafness and those using oral communication before CI performed significantly better than age-matched peers. CONCLUSIONS Adolescents with prelingual deafness undergoing unilateral CI show significant improvement in objective hearing outcome measures. Patients with shorter lengths of deafness and earlier age at CI tend to outperform their peers. In addition, patients with progressive deafness and those using oral communication have significantly better objective outcomes than their peers.

To investigate whether children implanted in the first year of life show higher levels of speech perception than later-implanted children, when compared at the same ages and to investigate the time course of sensitive periods for developing speech perception skills. More specifically, to determine whether faster gains in speech perception are made by children implanted before 1 year old relative to those implanted at 2 or 3 years.

To determine whether intraoperative neural response telemetry (tNRT) is predictive of postoperative speech perception.

Bilateral sequential cochlear implantation outcomes are dependent on many different factors. Newer technology in the second implanted ear may also contribute to outcome. This study examines the effect of cochlear implant technology on speech recognition outcomes in a population of adult patients who have undergone bilateral sequential implantation using different technologies in each ear.

To examine speech perception outcomes as related to a reduction in the number of functional electrodes postimplantation and to determine the effect of electrode reduction on subsequent device failure.

To review our experience with partial standard and double-array cochlear implantation in the ossified cochlea.

To describe a safe and effective technique for the implantation of common cavity cochleae.

To examine speech perception outcomes and determine the impact of length of deafness and time between implants on performance in the sequentially bilateral implanted population.

To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing.

Objectives:Ear anomalies and deafness are associated with CHARGE syndrome, which also presents with a cluster of features including coloboma of the eye, heart defects, atresia of the choanae, developmental retardation, and genitourinary abnormalities. The aim of this study is to explore the viability of cochlear implantation in children with CHARGE syndrome and to assess the outcome.

The purpose of this study was to compare the accuracy of sound-direction identification in the horizontal plane by bilateral cochlear implant users when localization was measured with pink noise and with speech stimuli.

Emerging evidence in auditory neuroscience suggests that central auditory pathways process speech asymmetrically. In concert with left cortical specialization for speech, a "right-ear advantage" in speech perception has been identified. The purpose of this study is to determine if this central asymmetry in speech processing has implications for selecting the ear for cochlear implantation.

Sensorineural hearing loss resulting from otosclerosis, meningitis, chronic otitis media, autoimmune ear disease, and trauma can be associated with partial or total obstruction of the cochlear scalae. Multichannel cochlear implantation may be difficult in a cochlea with an obstructed scala tympani. The purpose of this study is to determine the safety and efficacy of scala tympani electrode insertion.

Perimodiolar electrode arrays were developed in an attempt to improve stimulation of specific neural populations and to decrease electrical thresholds, thereby decreasing power consumption. Postoperative radiographs show that coiling of the arrays is variable. Our previous study explored the relationship between the angle of coiling, threshold levels, and functional outcomes using the Nucleus Contour electrode array. This study compares coiling angle, electrical threshold levels, and speech perception measures with the Nucleus Contour Advance electrode array implanted using the new advance off stylet technique versus the Nucleus Contour electrode array implanted using the standard technique.

Perimodiolar electrode arrays were developed to improve stimulation of specific neural populations and to decrease power consumption. Postoperative radiographs suggest that some arrays are more tightly coiled than others. The purpose of this study was to evaluate whether the degree of modiolar coil correlates with electrical threshold and/or performance measures postimplantation with the Nucleus CI24RCS (Contour) device.

The development of oral language in children with a cochlear implant is dependent on numerous factors. Although baseline achievements have been established, ceiling attainment levels have yet to be explored. One indicator of a higher capability level is the ability of children with implants to learn to communicate orally using a second language. The purpose of this research was to explore 1) the feasibility of children with cochlear implants developing oral fluency in a second language and 2) the factors that affect the development.

To determine the efficacy of cochlear implants with current processing strategies in children and adults with long-term congenital deafness, and to determine whether the growth of auditory perceptual skills in these patients is similar to the data reported for patients who have undergone implantation with earlier devices and coding strategies.

Objectives/HypothesisThe most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of “upgrades” (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist.

The purpose of this paper is to provide performance data on long-term congenitally and prelingually deafened children and adults who are implanted with the CLARION® Multi-Strategy™ Cochlear Implant and who use the Continuous Interleaved Sampler (CIS) speech processing strategy. Open-set speech perception was assessed preoperatively and postoperatively with word and sentence recognition tests. Results indicate that a majority of subjects showed improvement from preoperative performance to the last available postoperative evaluation. These results represent a change from previously reported data on a similar population who used earlier speech processing strategies.

Eighteen patients using the Nucleus multichannel cochlear prosthesis underwent annual evaluations for electrical thresholds, dynamic range, and speech recognition abilities for a period of 1 to 5 years. Results revealed no correlation between length of usage of a cochlear implant and electrical thresholds. The dynamic range was initially wider in the patients with open-set speech recognition, but narrowed in subsequent years. There was a correlation between length of deafness and postoperative performance.

The use of preoperative round window stimulation has been advocated for its possible predictive value in cochlear implant patients. We have attempted to correlate cause of deafness, preoperative radiologic study, and postoperative stimulability and performance with preoperative stimulation. Round window stimulation procedures consisted of measurements of electrical thresholds and comfort levels, gap detection, and temporal difference limen. Radiologic studies were performed using high-resolution computerized seml-axial and coronal tomography with 1.5-millimeter overlapping cuts. Patient performance was measured using a standard audiologic test battery. Sixteen postlingually, profoundly deaf adults who received the Nucleus multichannel cochlear implant were studied. All 16 patients who responded to preoperative stimulation had acceptable CT scans for the ear operated on and stimulated postoperatively with the prosthesis. The lowest level at which a patient could reliably detect a gap between two signals ranged from 10 to 150 milliseconds, which was not predictive. For the temporal difference limen task, the patients who could reliably identify the longer of two pulses when the difference was less than 100 milliseconds didachieve varying amounts of open-set speech discrimination postoperatively. In summary, results indicate that the preoperative psychoacoustic electrical stimulation test battery provides useful information in predicting postoperative performance.

The deterioration of speech-understanding abilities in the aged that results from factors such as reduced speed and accuracy in processing has been well documented. The purpose of this study was to evaluate whether the geriatric population could benefit from a cochlear implant, despite the possibility of reduced processing abilities. Twenty patients, ages 65 to 85 years, with bilateral profound sensorineural hearing loss received the Nucleus multichannel cochlear prosthesis at NYU Medical Center. All patients underwent extensive preoperative medical and audiologic assessments to determine candidacy. The surgical procedure was well-tolerated by all patients. Mean postoperative test results revealed significant improvements in both auditory performance and quality of life as a result of implant usage. These data support the concept that although a reduction in the processing of sensory stimulation might exist, the elderly can process a new auditory code delivered by means of a cochlear implant.

In our series of patients operated on for acoustic neuromas at New York University Medical Center between 1974 and 1983, 13% (17 of 133) had sudden hearing loss. Of these, approximately 23% (four of 17) had recovered auditory function before acoustic neuroma extirpation. Three patients spontaneously recovered, while one improved with steroid therapy. Contrast computerized tomography demonstrated a widened internal auditory canal and evidence of cerebellopontine angle tumor, respectively, in 88% and 59% of patients with sudden hearing loss and acoustic neuroma. Clinical characteristics suggesting acoustic neuroma as the cause of sudden hearing loss with or without auditory recovery could not be identified in our series. Our data support the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion.

The course of the facial nerve may place it within the current field generated by an activated cochlear implant to produce incidental facial movement. We investigated the presence of facial nerve stimulation associated with cochlear implants in the VA Cooperative Study of Advanced Cochlear Implants. Twelve of 82 patients enrolled in this study demonstrated facial nerve stimulation within 2 years of implant activation. Facial nerve stimulation in six patients with multiple channel implants (Nucleus or Ineraid devices) either resolved spontaneously (n = 2), or was eliminated by deactivating basal (n = 2) or apical (n = 2) electrodes. Two of six patients with single-channel electrodes (3-M/Vienna devices) demonstrated facial nerve stimulation that resolved spontaneously (n = 2), resolved with lowering current output (n = 2), or was refractory to processor adjustment (n = 2). Intraoperative assessment in one of the refractory cases indicated that facial nerve stimulation resulted from current spread through the modiolus to activate the facial nerve. A variety of factors, including implant design, stimulus parameters, and local tissue impedances, may interact to produce incidental facial stimulation. Low-impedance pathways between the scala tympani and the modiolus may deserve increased recognition as an interactive factor in cochlear implant performance.

The speech perception abilities of 15 patients were measured preoperatively using hearing aids and postoperatively using the Nucleus 22-channel cochlear implant over a period of 1, 2, or 3 years. Analysis of mean data revealed that, although the greatest amount of improvement in speech perception scores occurred between the preoperative and 3-month poststimulation evaluation, there was also significant improvement in perception of segmental features and open-set speech recognition over the 3-year time period. When individual patient data were examined, however, it was clear that these improvements were due, in large part, to the performance of a subset of patients who had measurable open-set speech recognition abilities at the time of their 3-month, poststimulation evaluation. Subjects who used the processing scheme that included coding of F1 showed significantly more improvement over time than subjects who used the original FOF2 processing scheme exclusively. It was concluded that open-set speech recognition ability at 3 months is an important prognostic indicator of continued improvement in speech perception abilities over time.

Objective: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re‐evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. Study Design: Prospective radiographic analysis of electrode position of cochlear implants in young children. Methods: Twenty‐seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multichannel cochlear prostheses were subjects for this study. Follow‐up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. Results: An analysis of the data revealed no migration of the electrode array over time. Conclusions: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children.

The use of preoperative round window stimulation has been advocated for its possible predictive value in cochlear implant patients. We have attempted to correlate cause of deafness, preoperative radiologic study, and postoperative stimulability and performance with preoperative stimulation. Round window stimulation procedures consisted of measurements of electrical thresholds and comfort levels, gap detection, and temporal difference limen. Radiologic studies were performed using high-resolution computerized seml-axial and coronal tomography with 1.5-millimeter overlapping cuts. Patient performance was measured using a standard audiologic test battery. Sixteen postlingually, profoundly deaf adults who received the Nucleus multichannel cochlear implant were studied. All 16 patients who responded to preoperative stimulation had acceptable CT scans for the ear operated on and stimulated postoperatively with the prosthesis. The lowest level at which a patient could reliably detect a gap between two signals ranged from 10 to 150 milliseconds, which was not predictive. For the temporal difference limen task, the patients who could reliably identify the longer of two pulses when the difference was less than 100 milliseconds didachieve varying amounts of open-set speech discrimination postoperatively. In summary, results indicate that the preoperative psychoacoustic electrical stimulation test battery provides useful information in predicting postoperative performance.

The course of the facial nerve may place it within the current field generated by an activated cochlear implant to produce incidental facial movement. We investigated the presence of facial nerve stimulation associated with cochlear implants in the VA Cooperative Study of Advanced Cochlear Implants. Twelve of 82 patients enrolled in this study demonstrated facial nerve stimulation within 2 years of implant activation. Facial nerve stimulation in six patients with multiple channel implants (Nucleus or Ineraid devices) either resolved spontaneously (n = 2), or was eliminated by deactivating basal (n = 2) or apical (n = 2) electrodes. Two of six patients with single-channel electrodes (3-M/Vienna devices) demonstrated facial nerve stimulation that resolved spontaneously (n = 2), resolved with lowering current output (n = 2), or was refractory to processor adjustment (n = 2). Intraoperative assessment in one of the refractory cases indicated that facial nerve stimulation resulted from current spread through the modiolus to activate the facial nerve. A variety of factors, including implant design, stimulus parameters, and local tissue impedances, may interact to produce incidental facial stimulation. Low-impedance pathways between the scala tympani and the modiolus may deserve increased recognition as an interactive factor in cochlear implant performance.

The deterioration of speech-understanding abilities in the aged that results from factors such as reduced speed and accuracy in processing has been well documented. The purpose of this study was to evaluate whether the geriatric population could benefit from a cochlear implant, despite the possibility of reduced processing abilities. Twenty patients, ages 65 to 85 years, with bilateral profound sensorineural hearing loss received the Nucleus multichannel cochlear prosthesis at NYU Medical Center. All patients underwent extensive preoperative medical and audiologic assessments to determine candidacy. The surgical procedure was well-tolerated by all patients. Mean postoperative test results revealed significant improvements in both auditory performance and quality of life as a result of implant usage. These data support the concept that although a reduction in the processing of sensory stimulation might exist, the elderly can process a new auditory code delivered by means of a cochlear implant.

In our series of patients operated on for acoustic neuromas at New York University Medical Center between 1974 and 1983, 13% (17 of 133) had sudden hearing loss. Of these, approximately 23% (four of 17) had recovered auditory function before acoustic neuroma extirpation. Three patients spontaneously recovered, while one improved with steroid therapy. Contrast computerized tomography demonstrated a widened internal auditory canal and evidence of cerebellopontine angle tumor, respectively, in 88% and 59% of patients with sudden hearing loss and acoustic neuroma. Clinical characteristics suggesting acoustic neuroma as the cause of sudden hearing loss with or without auditory recovery could not be identified in our series. Our data support the rationale that patients with unilateral sudden hearing loss, even with recovery, must be evaluated for a possible cerebellopontine lesion.

Eighteen patients using the Nucleus multichannel cochlear prosthesis underwent annual evaluations for electrical thresholds, dynamic range, and speech recognition abilities for a period of 1 to 5 years. Results revealed no correlation between length of usage of a cochlear implant and electrical thresholds. The dynamic range was initially wider in the patients with open-set speech recognition, but narrowed in subsequent years. There was a correlation between length of deafness and postoperative performance.

The use of traditional electrocautery is prohibited in revision or replacement cochlear implant surgery because of the concern for end organ tissue damage. Additionally, electrical current spread to the malfunctioning device could interfere with an accurate cause-of-failure analysis. Clinical reports have confirmed the utility of the Shaw scalpel for dermatologic, ophthalmic, and head and neck surgery. The Shaw scalpel is a thermally activated cutting blade that provides a bloodless field through immediate capillary and small vessel hemostasis. Avoidance of wound and flap complications is of primary concern in cochlear implant surgery. The long-term wound healing compared favorably to that of other surgical cutting instruments in several experimental reports. We have routinely used the Shaw scalpel in revision cochlear implant surgery and in primary surgery whenever electrocautery was contraindicated. We have retrospectively evaluated 22 cases in which the Shaw scalpel was used for cochlear implant revision and primary surgery. The chart review included patient demographics, the indication for surgery, the contraindication for electrocautery, intraoperative surgical notes, the wound healing evaluation, the evaluation for alopecia, and postoperative speech understanding. No significant complications occurred intraoperatively, and the long-term wound healing results were no different from those obtained with conventional surgical techniques. The explanted devices were undamaged, and valuable diagnostic information could be obtained. All patients performed at or better than their preoperative levels on speech recognition testing. Our results indicate that the Shaw scalpel is a relatively safe, easy-to-use, and effective instrument.