Search

Objectives: Considering the size of the electromagnetic bone conduction floating mass transducer of Bonebridge implant, its implantation requires adequate anatomical conditions. In case of patients after radical ear surgeries placement of internal part in the typical position, which is in the sinodural angle, may be difficult due to bone defects. The aim of this paper is presentation of a novel technique of Bonebridge implantation with one-time reconstruction of the posterior wall of the external auditory canal (EAC) with autogenous material in a patient after a radical surgery. We present a case of a patient with bilateral mixed hearing loss of moderate degree who, based on the results of laryngological and audiological evaluation, underwent surgery for a Bonebridge implantation. In view of the post-radical ear surgery status of the ear selected for implantation it has been decided to perform at the same time reconstruction of the posterior EAC wall with autogenous bone dust. Material and Methods: In this paper we present the surgical procedure of one-time implantation and reconstruction of the EAC wall as well as the assessment of the effects of the device application. At 12 months after surgery we have noted preserved and correct healing of the posterior EAC wall and hearing benefits involving improved hearing sensitivity and speech discrimination. Results and Conclusions: In the presented case the surgical technique combining simultaneous reconstruction of the posterior EAC and implantation of a bone conduction device has enabled reducing the size of the postoperative cavity, thus facilitating its future debridement and, by covering the floating mass transducer has separated it from the external environment allowing its proper placement. Stable auditory results and local conditions after the posterior EAC wall reconstruction in our case suggest that this method may be an alternative for other bone conduction devices in patients with extensive bony defects. [ABSTRACT FROM AUTHOR]

The main problem of rehabilitation of unilateral conductive hearing loss (UCHL) with a hearing device or surgical repair is that the treated impaired ear has to compete with the normal hearing ear. Because of the impressive capacities of a normal hearing ear, rehabilitation results in a significant hearing asymmetry (20 -30 dB in children), and unilateral absence of spectral information processing. We review binaural hearing data as obtained after treatment in a population of subjects with congenital UCHL. Several measures addressing binaural hearing after treatment have been studied, e.g. directional hearing (detection of interaural time and level differences), binaural summation, binaural squelch and the effective use of head shadow. Whenever possible, binaural outcomes are compared with values obtained in normal hearing subjects, using the same tests. Included in this review are 11 papers, describing results in 169 subjects with treated unilateral aural atresia. Six papers presented binaural data gathered after atresia repair and five papers after application of either a percutaneous bone-conduction device (BCD), an active transcutaneous BCD, a passive transcutaneous BCD or an active middle ear implant. Binaural scores were collected and compared to norm values. Mean binaural scores are expressed, as z-scores; if z < 2 then the mean score falls within the normal range. Subjects with unilateral amplification do not perform as good as normal hearing listeners. It remains uncertain to conclude whether subjects with congenital UCHL have an equal chance for optimal rehabilitation compared to subjects with acquired UCHL. Subjects from the latter group can benefit from a maturated auditory system once they are aided. The congenital group might benefit from auditory system development while in the aided situation. When consistent amplification, although resulting in an asymmetrical input, is present during a certain critical period, it might result in better handling of the listening situation. [ABSTRACT FROM AUTHOR]

Traditionally, Auditory Rehabilitation is carried out with support from a Speech and Language Therapist, usually in a clinical centre. Training may be required to acquire optimal performance from a Cochlear Implant, for example, speech recognition in challenging situations such as distance, background noise, different speakers, telephone use, etc. In addition, sequential cochlear implantation and new indications, such as SSD or asymmetrical hearing loss, require intense and specific auditory training. Clinical studies of auditory plasticity following placement of Cochlear implants suggests that additional auditory training may be needed for reorganization of the brain to occur (1). Traditionally, this training has required an economic and time effort on the part of the patient, family or caregivers. The literature also emphasizes many reasons that support the importance of daily practice taking advantage of routine activities and in natural contexts (2). There are software programs designed for this purpose, but there may be barriers to access such as cost and technical equipment requirements, etc.(3) This paper will present one approach to empowering Cochlear Implant recipients to use the opportunities for listening practice and rehabilitation afforded by the Nucleus 7 sound processor and streaming with IOS devices. Options for using a range of different commercially available apps, many of them free, will be shared along with ideas for using data streaming, not always with a specific educational purpose, but through activities that can be more pleasant, engaging and entertaining for the patient such as listening to audiobooks, podcasts and other listening resources to build auditory experience and confidence. This paper will present options for using the N7 MFI processor for self-directed rehabilitation using streaming, to provide the patient with training possibilities tailored to his or her interests and needs, adapted to maximize and motivate their time availability; the incentive being the ability to select and design their own varied listening program. The key elements of how to support and motivate recipients to design their own listening program plus the options and how this has been applied in clinical practice as well as clinical examples and outcomes will be addressed. 1. Polonenko, Melissa Jane,Gordon, Karen Ann, Cushing, Sharon Lynn, Papsin, Blake Croll. Cortical organization restored by cochlear implantation in young children with single sided deafness. Scientific Reports. 04.12.2017. DOI:10.1038/s41598-017-17129-z 2. Lone Percy-Smith, Tenna Lindbjerg Tønning, Jane Lignel Josvassen, Jeanette Hølledig Mikkelsen, Lena Nissen, Eveline Dieleman, Maria Hallstrøm & Per Cayé-Thomasen. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants International Vol. 19, Iss. 1, 2018 3. Olson AD. Options for Auditory Training for Adults with Hearing Loss. Seminars in Hearing. 2015;36(4):284-295. doi:10.1055/s-0035-1564461. [ABSTRACT FROM AUTHOR]

Cochlear implant site infection and/or skin extrusion remain challenging issues in cochlear implant field. Staged procedures with implant removal is the standard treatment in most of cochlear implant centers. However, in many areas, this may be very difficult due to budget restrain. In this paper, I'm going to present our personal experiences in managing those cases without removal of the implant. We had total of 6 cases of either postoperative infection with skin breakdown or skin breakdown over the implant with infection. We could treat 5 cases without removal of the implant. The key steps are covering the implant with skin flap together with use of local antibiotic powders over the implant (in the 5 cases we used vancomycin powder). The failure case in which we had to remove the implant had vancomycin hypersensitivity. We believe that there is a chance with this technique to treat implant site infection and biofilm formation without removal of the implant with high success rate. [ABSTRACT FROM AUTHOR]

Recent trends in bone conducting hearing implant technology have led to the development of a range of transcutaneous (i.e. no skin penetrating components) devices, both for bone conduction hearing devices and middle ear implants. Transcutaneous devices promise the possibility of fewer wound complications, but are surgically more complex. Two such devices are MED-EL's Bonebridge bone conduction hearing device and Vibrant Soundbridge middle ear implant. As part of both a multicentre NHS UK study to review the long term complication rates and reliability and the development of a UK national registry of the outcomes of the Bonebridge and Vibrant Soundbridge, intra-operative and post-operative surgical questionnaires have been developed for both devices. This paper reports the development of these questionnaires through an iterative process based on available literature and expert review [ABSTRACT FROM AUTHOR]

Introduction: Cochlear implants have revolutionised the management of patients with severe to profound sensorineural losses. Preoperative investigations involve radiological assessment of the cochlear by MRI scan, CT imaging or both. For parents and patients one of the main focuses is understanding and hopefully having surgery. In our unit patients have choice of devices. The reasons for varied are quite varied. Issues such as accessories and water compatibility appear to be significant factors to the patients and families. Clinically, it is clearly understood that the magnetic components, and to a certain degree the internal electronics, have a compatibility issue with MRI scanning. Some devices require removal of magnets. Others, are conditional to 1.5 Tesla. No matter what system is used significant voids and distortions are produced by the magnet when imaging the brain. There is a high chance that a child would require an MRI during his/her lifetime. Information from Germany indicates 114 MRI / 1000 inhabitants with head scans using CT / MRI being fairly equal (55% v 45%). Spine and extremities have higher proportion of MRI. The aim of this paper is to investigate what information is given pre implant to ensure informed consent is given. How issues are managed in the acute and non-acute situation will be reviewed. Methods: A survey was sent to all UK implant centres asking them about the giving of information, formal surgical consent, their experience of dealing with patients potentially needing and actually having MRI scans. Final questions focused on any subsequent issues that arose. Results were used to compare our practice and subsequent management. Results: 22 centres were approached and 18 replied. - Is departmental information given about MRI scanning? 69% No - Which/how is MRI related information is given? - Verbal 38%, - BCIG safety guidelines 35%, - Manufactures literature 23%, - No specific advice 4%. - Specifically mentioned at surgical consent? Yes 46% - In the past 12 months; median (range) - What external request for advice has been received? - 3 (1 - 25) - What number of actual known MRI scans have your patients had? - 2 (1 - 10) several centres did not know.- What reported issues have been reported? - demagnetised; displacement; pain. Conclusion: MRI scanning can be performed without side effects. However, there does seem to be a range of patient experiences and varied outcomes. As a result of our own experience we have developed a mould to cover the implant and offer local anaesthetic before firm head bandaging. From the survey reasons behind the need for an MRI scan should always be investigated. Would other imaging such a s CT +/- contrast be more appropriate? Also, clearly we need to pay more attention to consenting with future MRI scanning. [ABSTRACT FROM AUTHOR]

Introduction: The goal of all surgery is the best results with the least possible damage to anatomical structures involved in the procedure. This premise has led in recent years to find methods that allow us to reduce the risks associated with surgery. In the case of cochlear implant surgery, in recent years many surgical techniques have been described. This paper presents our experience in cochlear implant surgery assisted with endoscopy. Objective: To describe the usefulness of the endoscopy in the classical approach to cochlear implant surgery Method: Retrospective study from September 2015 to January 2018 in the Sótero del Rio Hospital. During this period 49 surgeries were performed with this technique. All were evaluated previously with audiological and imaging studies. Surgery was performed with an anterior tympanomeatal flap, identifying the anatomy of the middle ear. Later mastoidectomy and posterior tympanotomy is made. One advantage of this technique is that the posterior tympanotomy is smaller. Once this process is completed, opening round window and inserting the electrode in the scala tympani is performed. Result: Endoscopic Assisted Cochlear Implant had no complications, 100% of the inserts were by round window into the scala tympani. In one patient with inner ear malformation (incomplete partition), it allowed detailed visualization of the middle ear. The same occurs in a patient with a bilateral cochlear fracture. In 4 patients with advanced otosclerosis, there was no problem in the approach to the round window or the insertion of the electrodes. There were no problems with the tympanomeatal or infections. Conclusion: The use of endoscopy seems a good tool with many advantages for cochlear implant surgery independent of alterations that may exist in both the middle ear and internal ear. [ABSTRACT FROM AUTHOR]

Objectives: Main aim of the cochlear implantation in congenital or acquired total and partial deafness is provision of development of hearing, speech and communicaton skills. Excellent results of rehabilitation in a group of implanted patients made the development of artistic skills of patients a measure of progress in therapy. Results of active and passive music therapy indicate that children rehabilitated with music have accelerated auditory development have as well as developed their cognition. The best results were obtained in patients rehabilitated with active music therapy (systematic music training. Aim of this paper is to present a study of implanted patients whose hearing development was supported with acvtive and passive music therapy. Material and methods: Material includes a group of CI patients presenting musical skills. All patients were operated according to the 6 step Skarzynski's precedure. Patients using active and passive music therapy accelerated the process of hearing rehabilitation. In addition, they have developed other skills, including linguistic, communication, cognitive and general development skills. Results and conclusions: In all operated patients, the standard- shaped, and personalized post-operative rehabilitation program was supplemented with musical activities. Inclusion of musical activities contributed to the intensification of the rehabilitation program and quick acquisition of auditory, linguistic and additionally musical skills. At the same time, in the group of teenage and adult patients, the positive influence of music contributed to the reduction or elimination of tinnitus. Results: Supplementing the traditional post-operative rehabilitation program after cochlear implantation in various types of deafness and profound sensorineural hearing loss with properly selected musical elements has a significant impact on the acquisition of auditory, linguistic, musical and general development skills. It also reduces tinnitus. [ABSTRACT FROM AUTHOR]

Objectives :Deafness affects the lives of children which were born deaf. Cochlear implantation offers a solution for the development of language skills, and often, the implanted children manage to catch up with their hearing peers. Early diagnosis and implantation, as well as the appropriate type of intervention are of upmost importance for the efficiency of cochlear implantation. In this paper, we deal with factors of pediatric patients' management strongly impacting the development of communication skills early after cochlear implantation. The literature reports several investigations on the management of the hearing recovery procedures after cochlear implantation, or the achievement indicators in communication of preschool implanted children, however examined in isolation from each other. In this work, we move towards the development of a questionnaire that will encompass both of these factors and will attempt to investigate their potential relations and relevance. Methods: We propose a novel questionnaire resulting from the reprocessing of established and commonly used questionnaires (CAP, SIR, GBI, MEDEL LittlEARS Auditory Questionnaire and a questionnaire constructed after a joint research project between the Attikon Hospital 2nd ENT University Clinic, Athens, Greece and the AHEPA Hospital 1st ENT University Clinic, Thessaloniki, Greece), with item selection based on comparative and correlational control in which communality between questions was compensated by exclusion after expert paneling. Results and Conclusions: Aspects of the construction and initial evaluation are presented together with a planning towards analyzing of relations between factors of pediatric CI population management and performance achievement. The application of the questionnaire to a larger sample will hopefully provide important information and constitute a useful guide for parents and specialists involved in the restoration and rehabilitation process chain of implanted children. [ABSTRACT FROM AUTHOR]

The cochlear implant is a technical and surgical creation, being the first direct connection between the brain and an electronic device, opening new perspectives in the field of neurobiology. The purpose of the study was to investigate the variations in the impedance values of intraohlear electrodes in implanted patients, taking measurements in three different stages: intraoperatively, upon activation of the cochlear implant (1 month after surgery) and to the first fitting after activation. This study is a retrospective view on patients who underwent implantation of a cochlear implant. The general objective of this paper, what we are focusing on, will show the change in impedance measurement before and after nerve stimulation, meaning during the operation, at the time of device activation and at the first fitting. This monitors the function of- and the healing process around the electrode which reflects the success rate. This may show that continuous electrical stimulation and repeated measurement of electrical is important for sufficient setting and functioning of the complete device and each electrode, and might be beneficial as not only a diagnostic or monitoring, but also as a therapeutic tool in cochlear implantation and fitting process. [ABSTRACT FROM AUTHOR]

This paper will present a case study of a post-lingually deaf adult who reported a significant difference in pitch perception between the two ears after receiving sequential bilateral cochlear implants. In spite of one ear sounding lower in pitch than the other, speech perception tests using open set sentences showed maximum scores in each individual ear. Inter-aural comparison of pitch perception of every electrode in each ear confirmed patient's report that one side sounded lower in pitch than the other. Imaging studies of the petrous temporal bones using high resolution CT-scans revealed cochlear implant electrode array insertion to be deeper in the ear with lower pitch perception in comparison to the side with higher pitch perception. Interestingly, 6 months after consistent usage of bilateral cochlear implants, the difference in pitch between the two ears was no longer noticed suggesting that neural plasticity had taken place. [ABSTRACT FROM AUTHOR]

Objectives. It has been suggested that the density of spiral ganglion neurons will affect on speech intelligibility. The results of previous studies shows that the supra-threshold characteristics of the Evoked Compound Action Potentials (ECAP) characterize the condition of spiral ganglion neurons. Aim of this paper is to evaluate the dependence of maximum comfort levels on ECAP parameters (threshold and amplitude). Materials and methods. The study included fitting data of 20 patients with sensorineural hearing loss with unilateral cochlear implantation. All patients were implanted with the Med-El (Sonata or Concerto) CI system with a standard electrode array. The results of electrodes impedance did not exceed 10 kΩ. Auditory development was assessed depending on the age of the patient and the condition of the hearing skills. Recognition results exceeded 90%. Results. A correlation between comfort levels and ECAP thresholds was found. The values of the comfort levels were reduced when ECAP amplitude was increased. Conclusions. ECAP thresholds can not be considered as an absolute reference point for determining the CI comfort levels. The amplitude of the ECAP response is one of the indicators of the preservation of the neurons of the auditory nerve. The correlation of the ECAP thresholds and comfort levels higher when ECAP amplitude values increase. [ABSTRACT FROM AUTHOR]

Background: Increases in the demand and range of cochlear implant services due to expanded criteria over the past 30 years have not correlated with increases in funding. Quality standards for CI service delivery must be maintained. This paper outlines the mapping of value stream of the CI model of service and the financial implications for ensuring standard of care is maintained whilst maximising economic efficiencies. Method: A total of 56 intervals of service delivery over a 10 year period was mapped across the journey of adult CI recipients. A review of the profit and loss of service delivery over this 10 year period based on a range of parameters cost of service, recipient and clinician numbers and appointment types. Results: Results indicated that cochlear implant services were not profitable until 5 years post cochlear implantation. All service delivery prior to that point was running at a significant loss. Costs did not even out until approximately 9 years following cochlear implantation. Five areas emerged that showed cost inefficiencies. Conclusion: Cost inefficiencies of a cochlear implant service delivery model were identified using the value stream mapping approach. This enabled steps to be taken toward implementing a more sustainable model of CI service delivery whilst maintaining good quality of care. [ABSTRACT FROM AUTHOR]

In the past decade, numerous papers have published on variability in speech recognition in adults with a cochlear implant (CI). Many variables thought to influence the outcome of cochlear implantation have been investigated both in retrospective and prospective studies. In this study, we investigated different biographic, audiologic and electrode position related variables for their relation with speech recognition performance in both quiet and in noise. Participants were 134 adults with post-lingual onset of deafness, with Cochlear CI systems (either with a Contour Advanced or with a Slim Straight electrode) implanted at one single CI center. Biographic factors were: age, level of education and psychological screening questionnaires. Audiologic factors were: duration of hearing loss, and pre-implantation speech recognition scores. The electrode position was determined on a high-resolution CTscan post-implantation, using "Matlab" software. Electrode position variables were: electrode scalar position, electrode insertion angle and wrapping factor (electrode proximity to the modiolus). NVA-wordlists, (55 dB and 70 dB) were used to measure speech recognition scores in quiet at three time-points post-implantation: three months, 12 months and at the time of post-implantation CT-scan. Speech recognition scores in noise were assessed using the digits-innoise (DIN) test at 12 or more months post-implantation. To investigate the influence of biographic, audiologic and electrode position related variables of adult CI patients on speech perception performance in quiet and in noise, we used multivariate linear regression analysis. [ABSTRACT FROM AUTHOR]

Background: An increased number of children and adults with SSD receiving cochlear implants over the past 10 years has guided clinical protocols for evaluation and ongoing management. The benefits of CI are clear for hearing in background noise, localising sound, and decreased overall listening effort. This paper will provide an outline of SCIC's protocols including pre-operative support and counselling, guidelines for device programming, & rehabilitation. Outcomes and rate of progress will also be discussed. Methods: A total of 65 people with SSD were included in this retrospective review of management pathways. This included 5 groups of children that received specialist advice, assessment and management by a multidisciplinary team. These groups included those with absent auditory nerves, benefit from conventional devices, no devices who received ongoing monitoring, children who received a CI, and those suitable for CI, but did not proceed to surgery. Results: In adults, approximately 30% of those assessed chose to use a conventional device or have no intervention. Children who received CI's for SSD comprised only 29% of the children in the entire sample of those assessed. Auditory nerve was absent in 43% of the children. Recipients showed functional benefit on one or more of the subtests of the Speech Spatial Qualities questionnaire. Methodologies for device programming and rehabilitation varied across the cohort. A review of these processes was required for ensuring protocols were addressing client need. Conclusions: Evaluation and intervention protocols for SSD must take into account the onset and duration of the hearing loss; integrity of the cochlear nerve on the affected side; benefit received from other hearing devices; current functional hearing performance, and the investment in time and resources that will be required to facilitate the integration of the acoustic hearing from the better ear and electrical hearing. [ABSTRACT FROM AUTHOR]

Background: Auditory training (AT) is a sound-based intervention aimed at improving individuals' speech and hearing skills through varied listening exercises. It has been used with individuals using hearing aids and/or cochlear implants (CIs) to maximize benefit of hearing devices. Objective: The purpose of this systematic review PROSPERO (2017:CRD42017057346) is to evaluate the published research in AT for pediatric CI recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language, cognition, and/or quality of life; and whether improvements, if any, remain over time post AT intervention. Outcomes of this review may help clinicians to make informed decisions about the usefulness and type of AT for pediatric CI users. Method: A systematic search of seven databases identified 96 papers published up until January 2017, 9 of which met the set criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICO framework. Results: All studies reported improvements in the trained AT tasks including speech discrimination/identification and working memory tasks. Retention of improvements overtime was found whenever it was assessed. Transfer of learning was measured in four out of six studies, which assessed generalization. Quality of life was not assessed in any of the reviewed studies. Level of evidence for the included studies was determined to be low. Conclusion: Benefits of AT were clearly illustrated through the improvement of all trained tasks across all studies regardless of the duration or type of training. Transfer of improvement to other domains and retention of benefits post AT were evident when assessed. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed. [ABSTRACT FROM AUTHOR]

Introduction: Eosinophilic otitis media (EOM) is an uncommon type of chronic suppurative otitis media characterized by recurrent or persistent thick glue like discharge, resistant to medical treatment or tympanoplasty and progressive gradual deterioration of hearing. EOM is a challenging clinical entity which imposes difficulty management problem to otologists. Method: A case of a patient suffered bilateral discharging ear and bilateral profound hearing loss due to EOM underwent two sequential cochlear implantations were reported in this paper. And a literature review of cochlear implantation for patients suffering from hearing loss resulted from EOM is also presented. Results and Conclusion: Typically, patients suffering from EOM have strong atopic history including asthma, nasal polyposis, allergic rhinitis and drug allergy. Tympanoplasty and mastoidectomy were ineffective treatments for the inflammatory disease process. Repeated topical steroid to the middle ear or systemic steroid therapy can alleviate the local inflammation and decrease the ear discharge. However, topical or systemic steroid therapy will not alter the natural course of illness with progressive gradual deterioration of hearing and some patients will eventually suffer from bilateral profound deafness. As reported in the literature, cochlear implantation is a feasible treatment of deafness in patients suffering from EOM. In our opinion, it is necessary to eradicate the mucosal disease in the middle ear and isolated the middle ear and the surgical implant to prevent secondary bacterial infection. [ABSTRACT FROM AUTHOR]

Aim: To assess whether a single, peri-operative, high dose of methylprednisolone can improve hearing preservation following cochlear implantation (CI). Methods: Patients with hearing at 85 dB or better at 500 Hz in the ear to be implanted were randomly allocated to either treatment (methylprednisolone, 1g i.v. on induction of anaesthesia) or control (normal saline infusion). All patients received a routine "anaesthetic" dose of dexamethasone (8 mg i.v. on induction of anaesthesia). Implantation was undertaken with Cochlear's Slim Straight electrode via the round window. Audiometry was performed prior to implantation, and again at 3 and 12 months. The primary outcome was the level of residual hearing 12 months following cochlear implantation. Secondary outcomes included audiometry, lectrode impedance, and speech perception scores at 3 and 12 months after surgery. Results: Forty-six patients were enrolled into the control group and 48 patients received the steroid. There was no statistical difference in hearing at 12 months, nor at 3 months following surgery. Electrode impedances did not differ between the groups. Conclusions: There is an extensive experimental literature to suggest that steroids can reduce the loss of residual hearing during CI surgery, including when the steroid is given systemically. This paper demonstrates that high-dose local steroid injection at surgery is not effective in preventing a loss of residual hearing. Similarly, electrode impedances are not reduced by the high-dose steroid regime. Recent studies have suggested that steroid treatment may be more effective if used for a period of weeks after implantation. Future studies should explore this approach, or prolonged local steroid delivery via the cochlear implant. [ABSTRACT FROM AUTHOR]

Over the last decade there have been a number of seismic shifts in the hearing implant landscape. This has been led by marked advances in hearing implant technology, surgery and rehabilitation. The criteria for cochlear implantation has broadened dramatically for all ages. At the same time, there has been heightened clinical expertise in hearing implants demonstrated by clinicians across the industry. People are now more knowledgeable and demanding of independent decision-making so they can actively control their own hearing implant care. Australia has excellent access to cochlear implant innovation, technology and clinical care, with well qualified medical and allied health professionals. When indicated, hearing implants are available for unilateral and bilateral hearing losses, in children and adults and across all socioeconomic strata. Despite this rich and ripe environment, we have in Australia the embarrassing statistic that only one in ten adults who could benefit from a cochlear implant eventually accesses the benefit of such technology. Furthermore, those people who eventually do receive a cochlear implant often do so after years of unnecessary and unacceptable delay. This inadequacy is a reflection of a wanting healthcare delivery model for implantable hearing solutions in Australia, particularly in its regional areas. Presently there are the technological tools to address this, including e-consultation, remote programming and the utilisation of cloud--based technology. This paper will review an innovative new hearing health service established in Australia and take a detailed look at the barriers experienced by people considering hearing implants and how each are being address to improve access to implantable hearing devices. this includes challenging all medical and hearing clinicians to rethink, revisit and re-shape the means of referring people for the hearing implant care they need and deserve. [ABSTRACT FROM AUTHOR]

Introduction: There are many rehabilitation tools and programs available for adults receiving cochlear implants, with a strong emphasis on self management. Recipient suitability of technology based tools varies, hence the CI clinician must identify the most appropriate methodology for their client. Further, these tools, do not provide the opportunities to develop the social wellbeing that many recipients seek following CI. This paper will identify methods of supporting adult CI recipients through the use of available resources as well as identifying the role of direct traditional 1:1 therapy and the use of volunteers in the rehabilitation process. Method: Two to four weeks post device activation clients were screened to determine and review preoperative goals to determine rehabilitation approaches to be used. Outcomes were measured following a series of individual sessions; therapy supported through self management with support from a volunteer or a combination of both. Results : One or more of the client goals were achieved in all conditions within the period of intervention following device activation. Subjective data and self rating scores showed no significant difference regardless of the type of intervention provided. A longer term rehabilitation program was required in most of the cases which was readily accommodated through ongoing self management and volunteer support. Conclusion : A blend of post operative auditory training approaches in the acute phase following device activation was recommended for clients requiring support in their rehabilitation process. Generalisation of skills was facilitated through the use of volunteers and through self management following a period of individual sessions whereby the recipient gained confidence in their skills and abilities. This study provided a template for managing newly implanted CI recipients across the organisation to ensure that immediate and longitudinal training needs were. [ABSTRACT FROM AUTHOR]

Background: There are cases of hearing loss, where air conduction prostheses either cannot be used at all or there are significant limitations as to their use. For this group of patients, an alternative can be bone conduction systems. Currently in clinical practice there are several systems of this type -- some of them do not require surgical intervention, but others are partially implantable. The aim of this paper is the compare modern bone conduction systems, i.e. BAHA Attract and ADHEAR. Although both devices are not percutaneous, the former one requires screw and magnate implantation, the latter one is non-implantable. The systems differ in the method of mounting the processor and transmission of bone vibrations. Those differences influence the range of indications, application possibilities and comfort of use. Material and Methods : The study involved a group of 5 adult patients from the Institute of Physiology and Pathology of Hearing with unilateral or bilateral conductive hearing loss, who use BAHA Attract system in one ear. Audiometric tests in free field -- audiometry, speech audiometry in quiet and noise both unaided and aided with BAHA Attract and ADHEAR system -- were performed in all patients. Results: The obtained results indicate a statistically significant improvements both in audiometry and word tests in free field after the BAHA Attract and ADHEAR systems had been used. In both solutions comparable results were obtained in terms of increasing both the sensitivity of hearing and speech discrimination. Conclusions: Those preliminary results indicate a comparable effectiveness of the presented solutions, however, due to a small group of patients, it is recommended to continue studies. The analysis of the history of the development of bone conduction systems shows a clear tendency to use transcutaneous devices, thus minimalizing dermatological complications. Manufacturers of those devices, trying to meet patients' needs, create more and more modern systems, which not only are characterised by a higher degree of technological sophistication but also the location and nature of the transmission of vibrations allows safer and more comfortable use of the prosthesis. [ABSTRACT FROM AUTHOR]

Introduction : Longitudinal use of telepractice as a model for service delivery is reliant on integration of new technologies and practices whilst adhering to basic principles underpinning quality standards of care. This paper will focus on innovations that have made the longevity of the telepractice model possible for all aspects of CI management, with particular focus on an APP that has been designed and verified for use in measuring speech discrimination in enabling self efficacy of clients with ongoing evaluation and monitoring of performance. Method: A model to evaluate effectiveness and efficiencies of telepractice in clinical service delivery was used to evaluate evaluation, mapping and rehabilitation of CI recipients using telepractice. Clients, clinicians and facilitators in the telepractice process completed survey's questionnaires and outcomes measured to provide this information. Results :Effectiveness of speech discrimination measures were not impacted by the service model. This is consistent with longitudinal findings from the implementation of telepractice in other aspects of cochlear implant management including counselling, device mapping, and rehabilitation. Efficiencies in timeliness of service and reductions in travel time were reported. Satisfaction ratings revealed that most of the clients felt more integrated into their device management and reported a deeper understanding of their technology and the processes involved. Conclusion : Longitudinal implementation of telepractice model must readily adapt to new technologies and the evolving landscape within the field of CI. Evidence is required to ensure that any changes to the model are efficient and effective. Telepractice models will continue to evolve for all aspects of management for CI and can provide a service delivery model that can benefit a range of clients. [ABSTRACT FROM AUTHOR]

In far the most cases spiral canal ossification primarily affects the descending part of the basal turn. In this paper the method of atraumatic drilling of the ossified spiral canal is proposed. In the experimental procedure on 25 cadaveric temporal bones we revealed that the distance between round window membrane and basal turn curvature equals 8.0 mm; the width of labyrinthine capsule which borders spiral canal and internal auditory canal amounts to 0.36 mm and its width between spiral canal and internal carotid artery accounts for 0.77 mm. The original method, which is based on atraumatic drilling out of the ossification, was put forward. The drilling starts from the ossified round window membrane and proceeds till the basal turn curvature. Notable color difference between otic capsule and ossified tissue is observed: labyrinth capsule tends to look greyish and ossified tissue -- whitish. This enables gradual drilling out of the ossification along the descending part of the cochlea basal turn and preservation of modiolus. Taking into consideration close adjacency of the internal auditory canal and internal carotid artery lateral basal turn wall should always be kept in mind the landmark. The above-described surgical technique was applied in 62 patients with the ossification of the basal turn descending part. In 22 cases the length of the ossified spiral canal varied from 1 to 3 mm, in 40 patients it was in the interval of 4-6 mm and proceeded till the basal turn curvature. In all the 62 patients the proposed method enabled adequate approach to the cochlea spiral canal and full CONCERTO (MED-EL, Innsbruck, Austria) standard electrode insertion. In these cases only straight rigid electrode can be used to make its way through the drilled out spiral canal lumen. Postoperative audiological performance of the implanted patients correlated with the ones without ossification. [ABSTRACT FROM AUTHOR]

Objectives: To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI). Materials and Methods: Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. Age appropriate speech perception and production assessments were performed to measure performance. Results: Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject has only preliminary outcomes, but subjectively performs best with both devices. Conclusions: We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that the ABI and CI have a synergistic effect or simply the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency. [ABSTRACT FROM AUTHOR]

Potential treatment options for patients with single sided deafness (SSD) are; i) a conventional contralateral routing of sound (CROS) hearing aid, ii) a CROS bone-conduction devices (C-BCD), iii) a cochlear implant (CI). In some countries, cochlear implantation is becoming the standard treatment. Whereas the CI enables bilateral input, which might lead to some form of binaural hearing (Dillon et al., 2017), most countries only offer and reimburse CROS devices which do not restore binaural hearing, as they only lift the head shadow and stimulate the contralateral hearing ear. We present an overview of localization behaviour of SSD patients listening with one normal-hearing ear and a contralateral C-BCD, a contralateral CI, and when they are listening in the unaided condition. Several studies reported moderate to good unilateral sound-localization abilities in unaided SSD listeners. We demonstrate that this ability is related to processing of monaural cues which are only available when SSD listeners demonstrate thresholds better than 40 dB HL for 4 and 8 KHz. Listening with a CI potentially can improve the localization abilities, listening with a C-BCD might deteriorate these localization abilities. Especially listeners with acquired SSD experience serious problems in daily life. The loss of binaural hearing is causing problems related to feeling of wellbeing and safety as well as problems in localization of sounds. Although a CI provides bilateral input by way of direct stimulation to the impaired ear, true processing of binaural cues might not be restored. In case of C-BCDs, there are a growing number of reports suggesting non-use is rising with increasing time after BCD implantation. Both the CI and C-BCD might be used only because SSD listeners are experiencing serious problems and are searching for treatment. Initially both interventions are helpful. In the long term it might be that the auditory system adapts to unilateral input and that the CI and C-BCD are no longer used because processing of binaural cues is insufficient. [ABSTRACT FROM AUTHOR]

Objectives: Bonebridge implantation is usually performed on a planned site of temporal bone with guidance of preoperative CT scan. However, planning of the exact site for BMT is difficult due to variations of anatomical structures. We present an implantation technique using common surgical landmarks of mastoid bones such as the tegmen mastoideum and the sigmoid sinus. Methods: A small hole in the mastoid bone was made first in keeping with the planned position for the BMT using preoperative CT scan, then the tegmen mastoideum and the sigmoid sinus through the hole were identified. After two structure were identified and then the cortical bones over the structures were removed. If the tegmen mastoideum and the sigmoid sinus displaced inferior and anterior. The bone bed was widen inferior to the tegmen mastoideum and anterior to the sigmoid sinus. Results: This technique allows exact positioning of the BMT by identifying the surgical landmarks first and minimizes the risk of complication. Conclusions: A surgical technique using landmarks such as the tegmen mastoideum and the sigmoid sinus for Bonebridge implantation is useful and safe. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics, management and outcome of pain over the CI receiver/stimulator (R/S) presenting months to years after implantation, with an update on previous reports. Materials and methods: A follow-up on previously reported and new cases of unexplainable pain over the R/S, presenting through the years 2009-2017, with a follow-up of at least 6 months. The therapy regimen, outcomes and effect on hearing performance were reviewed. Results: Thirty-six patients complained of 39 ears with pain over their R/S presenting months to years after their implantation, being 3% of 1225 primary implantations performed at the Sheba Medical Center as of 2017. The pain was unrelated to implant use, and without any local findings, apart from sensitivity in specific points around the R/S. While 28 ears responded, at least temporarily, to conservative therapy, 11 ears required explantation and either primary or delayed revision surgery. At explantation no signs of infection, foreign body reaction or obvious device damage were found. Following re-implantation, the pain resolved in 8 ears. Only one explanted implant was found faulty in the analysis performed by the manufacturers. The hearing performance at last follow-up did not significantly change compared to the performance at last evaluation before the presentation of pain. All-in-all, in 31 ears (80%) the pain has resolved, and the patients use their implant/s. Conclusion: Delayed pain over the R/S, unrelated to use, is a serious consequence of cochlear implantation, and in some cases, those necessitating re-implantation or becoming non-users, should be considered a major complication. [ABSTRACT FROM AUTHOR]

Objectives: the auditory brainstem implant (ABI) is an option for hearing rehabilitation in profoundly deaf patients ineligible for cochlear implantation (CI). Over the past recent years, surgeons have started implanting ABIs in pediatric subjects who cannot benefit from cochlear implantation due to malformations or absence of either inner ear or auditory nerve. In this study will be discussed the experience with ABI in children of a tertiary referral center that for many years have implemented a broad program in auditory implants. Material and methods: the study run on a group of circa 20 children who received a ABI given to diverse etiologies of deafness : cochlear nerve aplasia, auditory neuropathy, cochlear malformations, neurofibromatosis type 2. A group of individuals showed also congenital comorbidities. The children were examined on the Categories of Auditory Performance (CAP) scale. When possible audiograms, Freiburg monosillable test were also taken in account. Moreover were reported the preoperative investigations for children candidates to ABI as well as the corresponding surgical approaches. Results and conclusion: Long-run audiological outcomes indicate that children benefit from ABI in terms of hearing and language development. However the achievements of ABI in children did not reach the goals obtained by children using CIs. We learnt that at very limited benefit from CI, e.g. in cases of uncertain nerve/cochlear aplasia, the time-gap to ABI should be shortened, in order to obtain the best possible results. Performing ABI surgery in a child gathers undoubted risks, altought in experienced centers the complications are very rare. [ABSTRACT FROM AUTHOR]

Cochlear implants (CIs) provide severe to profoundly deaf recipients with substantial speech intelligibility in quiet. In difficult listening situations such as background noise however, communication often remains challenging. For unilateral CI recipients with a bilateral hearing loss, speech intelligibility for speech sources on the non-implanted side is further impaired by the head-shadow effect. One possibility to overcome this impairment is the use of Contralateral Routing of Signal (CROS) systems, which capture sounds from the non-implanted side and wirelessly transmit them to the implant processor, therefore increasing audibility. With the Phonak Naída Link CROS, a wireless CROS system is now available that is compatible with the latest generations of Advanced Bionics sound processors, Naída CI Q70 and Q90. Several studies have investigated the speech intelligibility benefit such a system is able to provide to unilateral CI users. In addition to acute speech intelligibility tests, all studies also included chronic trial phases. The subjects' feedback was gathered regarding sound quality, subjective speech intelligibility benefit as well as the practical usability of the device in everyday life. The Naída Link CROS enables consistent listening performance regardless of the target speaker location. For speakers located on the non-implanted side, benefits of up to 8 dB SRT and 30% speech intelligibility were shown, compared to listening with the CI alone. Subjects reported high satisfaction with the device itself as well as perceived speech intelligibility benefits. The wireless CROS system provides a viable option to improve upon unilateral implantation for rehabilitating bilateral deafness. Such a system is most applicable in cases where medical or financial reasons only permit unilateral implantation. [ABSTRACT FROM AUTHOR]

Cochlear implant (CI) users show great individual variability in their speech comprehension outcomes. This variability is a challenge when we study the role of ageing in speech perception outcomes in CI users. We investigate how individual listeners vary in processing effort, and whether objective measures of effort can be used to identify sources of processing difficulties for individual CI users. Pupil dilation, as an index of increased attentional control during sentence comprehension, is combined with the measure of gaze fixations as a direct index of listeners' integration of sentential information for efficient mapping of the signal onto meaning. 34 experienced CI users, and 34 normal-hearing (NH) age-matched controls were tested. Participants' ocular responses (gaze fixations and pupil dilation) were recorded when they were listening to sentences that contained a target words (e.g. hamster), which was depicted on a screen together with a picture of a competitor word with overlapping onsets (e.g. ham) and two unrelated pictures. The sentence preceding the targets allowed listeners to anticipate the durational relations between syllables within the sentence, and hence to anticipate the distinction between the target and the competitor if listeners were able to integrate this rhythm information on time. Proportions of fixations towards the target versus fixations towards the competitor where then analysed together with listeners' pupil dilation over time. Gaze fixations results for NH listeners show a fast uptake of acoustic information for a quick disambiguation of the target and competitor, and the pupil dilation data shows a targeted use of attention during disambiguation. For the CI listeners we find that individual differences in the timing of pupil dilation reveal different demands of the task - speech processing - on individual listeners. The data will be discussed and related to its potential for enabling more individualised hearing rehabilitation. [ABSTRACT FROM AUTHOR]

The therapeutic options in otosclerosis are limited to medications (acute disease/active symptoms) as well as the rehabilitation of the hearing loss (HL).Rehabilitation can be with hearing aids (HA),stapedectomy,middle ear devices,osseointegrated implants and even with cochlear implants,depending on the HL degree. Conventional HA stimulates the hearing acoustically, with sound amplification,so there are feedback limitations,distortions,limited auditory gain,eczema of the external auditory canal,and other disadvantages. HA advantages remains on aesthetic aspects (intracanal/retroauricular, small dimensions),it does not require any surgical approach,which less morbidity. In MHL,the ideal is to combine technologies to achieve a complete improvement of hearing.Therefore, the option of middle ear/osseointegrated implants is a great solution, already well established in the world medical literature as one of the gold standard treatments for the correction of mixed/moderate hearing loss.Such devices achieve great auditory benefits in cases of MHL of mild/moderate degree,because of the power of a mechanical auditory stimulation technology.This allows them to provide a great auditory gain without sound distortion and with great sound quality.Their disadvantages lies in not being as aesthetic compared to HA,and the need for the patient to undergo surgery, which implies obvious risks. The therapeutic options in your health and health, as well as the rehabilitation of your hearing. The patient can be rehabilitated only with hearing aids, stapedectomy surgery, middle ear or osseointegrated implants and even with cochlear implants, one dependent on the degree of deafness and involvement of his hearing. It is worth mentioning that conventional hearing aids stimulate hearing in an acoustic way, with an amplification of the children, on the other with limitations of feedback, distortions, difficulty in obtaining adequate auditory gain, eczema of the external auditory canal, within other limitations. Its advantages are more aesthetic (it can be intracanal, retroauricular) and does not require any surgical surgery, which greatly reduces the risks for the patientThe therapeutic options in otosclerosis are limited to medications (when the disease is in its acute stage, with active symptoms) as well as the rehabilitation of its hearing. Materials and Methods used: To evaluate the Surgical and clinical outcomes of the Treatment for MHL in Otosclerosis with Stapedectomy & VSB.All patients receive a SP(short process) coupler of VSB/Medel and a stepedectomy (teflon prostheses/0.4 mm). Results: Five patients underwent to surgery (stapedectomy with VSB SP) for treating MHL in Otosclerosis.All patients get closed the air-bone gap wiht the stapedectomy and get normal pure tone thresholds after activation of the VSB. Excellent vocal and speech outcomes. There were no surgical or audiological complications untill now.The follow up time is 16 months. Conclusion: Stapedectomy & VSB is a good option for surgical rehabilitantion for treating MHL in Otosclerosis. [ABSTRACT FROM AUTHOR]

Having access to the signals at the two ears is important for understanding speech in noisy conditions. One of the contributing mechanisms is better-ear glimpsing (BEG), which takes advantage of the fluctuating signal-to-noise ratios (SNRs) across ears. Even though the spatial benefit provided by bilateral (over unilateral) implantation has been studied widely, the benefit provided by BEG is still poorly understood. Therefore, speech comprehension performance was measured in ten bilateral CI users in a spatially-symmetric masker paradigm. Helen-like questions recorded with a female native English speaker were presented from a loudspeaker in front of the subject (0o) while two female speech distractors were presented either from loudspeakers at ±90o or co-located with the target questions. The subjects' task was to answer the questions. The combined distractor level was kept constant at 60 dBSPL and the level of the target questions was varied adaptively to obtain speech comprehension thresholds (SCTs), i.e., the SNR at which 50% of the questions were answered correctly. SCTs were measured unilaterally and bilaterally. The spatial benefit was calculated as the difference in SCTs between the spatially-separated and co-located condition for bilateral stimulation. The average benefit was 2 dB with individual results varying from -2 to 7 dB. The bilateral benefit was calculated as the difference in SCTs between bilateral and unilateral stimulation in the spatially- separated condition. The average bilateral benefit was 1.4 dB when compared to the better ear and 5.9 dB when compared to the worse ear. Individual results varied from -2.5 to 5 dB and 1.9 to 12.7 dB, respectively. Hence, bilateral CI users can benefit significantly from a second device in spatially-symmetric, fluctuating noise where neither of the ears receives a constant favorable SNR. Future research should further investigate the large inter-subject variability and further improve the observed benefits. [ABSTRACT FROM AUTHOR]

Introduction: A retrospective audit determined that recorded rates of complications exceeded those reported in the literature. Through consultation with the department of Infectious Diseases, a Cochlear Implant Care Protocol was formulated, standardising care pre-, intra- and postoperatively, including guidelines for managing complications. The aim of this study was to determine the effect of this protocol. Methods: After introduction of the Cochlear Implant Care Protocol in the first year, a prospective study was conducted. Data on all cochlear implants performed through our regional cochlear implant service was collected from 2013 to 2017 inclusive. Complications were defined as major or minor and prospectively audited for each consecutive year. Results: Reductions were achieved in a minor complication rate of 53% in 2013 to 5.4% in 2017. The major complication rate was reduced from 10.6% in 2013 to 2.7% over the same time period. Conclusions: The Cochlear Implant Care Protocol is described and its evidence base. The introduction of the Cochlear Implant Protocol, based on multidisciplinary input, has successively improved outcomes in cochlear implantation by reducing complications. [ABSTRACT FROM AUTHOR]

Brain-Derived Neurotrophic Factor (BDNF) plays an important role in synaptic functions and experience-related plasticity. Peripheral BDNF blood concentration changes could be a marker of plasticity which might help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array. In the current study, we evaluated the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (HA). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds. Results showed that plasma BDNF level in children with CI increased significantly after CI surgery, while this difference in HA group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes. It is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced- related plasticity after CI stimulation. [ABSTRACT FROM AUTHOR]

Objectives: Auditory temporal resolution one of the main capabilities of the central auditory system and it is the main feature of speech processing abilities. Gap in noise test (GIN) is the one of the tests for assessing temporal resolution. In this study we aimed to assess and compare temporal resolution ability of subjects who wear cochlear implants (CI) and normal-hearing listeners with GIN test. Material and methods: It was a cross-sectional and descriptive study, with a non-probabilistic sample for convenience. In the study subjects was divided into two groups. First one is consisted of 14 adult users of cochlear implants who have approximately normal hearing in free field and second one is consisted of 14 adults with normal hearing, matched for age and gender with the study group. The Gaps in Noise test were conducted in free-field and was applied at 50 dB SL. Data was analyzed by independent paired t- test using SPSS software version 23. Results: The average of free field threshold was 29.3±6.8 dB HL at CI users. The average of pure tone threshold was 18± 2.7 dB HL at normal hearing subjects. The mean of GIN threshold was significantly higher and total percentage score was significantly lower in the CI user group compared to the normal hearing group. There was significant difference in approximate threshold and percent of corrected response between CI users and normal-hearing subjects (p<0.05). Conclusions: The results demonstrated that subjects with CI can never have as good temporal resolution as normals, although they have normal hearing. They have significant alterations in temporal processing abilities in comparison to subjects of the same age with normal hearing. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: A good coupling quality of the Vibrant Soundbridge's (VSB) Floating Mass Transducer (FMT) (MED-EL, Austria) is essential to obtain postoperative VSB-aided threshold and SRT improvements. An intraoperative assessment of the coupling quality would allow for correction of the FMT positioning and thus revision surgery could be avoided. Therefore, hearing thresholds must be measured objectively and frequency specifically while the patient is being stimulated via the implant. This was done in the first part of a prospective study including patients who were already implanted with a VSB in order to collect normative data and calibrate the set-up. Methods: The hearing thresholds during stimulation via the implant's FMT were measured using ASSR (FMT-ASSR thresholds). The ASSR module of the Eclipse system (Interacoustics, A/S,Denmark) was used and narrowband CE-Chirps at 500, 1000, 2000, and 4000 Hz were presented simultaneously. The stimuli were transmitted to the implant using a Samba audio processor (MED-EL, Austria) and a miniTek (Siemens, Germany) connected to the Ecplise. Additionally, the subjective hearing thresholds for this set-up, i.e., for the Chirp-stimuli presented via the miniTek, were recorded. Bone conduction hearing thresholds were also measured before psychoacoustically (BC thresholds) and objectively via ASSR (BC-ASSR thresholds). The patients' Vibrogram thresholds were recorded using the Connexx software (Siemens, Germany). The thresholds were statistically analyzed by dependent t-tests. Results: The preliminary results show that the FMT-ASSR thresholds are consistent with the subjective thresholds in this set-up. The relation between the FMT-ASSR thresholds and the Vibrogram thresholds shows an offset of approximately 30 dB over all frequencies. However, significant differences were observed between BC and BC-ASSR thresholds. Conclusion: By the relation between the Vibrogram and FMT-ASSR thresholds the results provide the calibration factors for future measurements. For further evaluation intraoperative measurements are planned. [ABSTRACT FROM AUTHOR]

where this is available. However, up to 40% of very early born babies have significant and permanent disabilities. These frequently include difficulties in the areas of hearing, vision, kidney function and respiration. Society can now offer much to premature babies. Multiple disabilities can cause fatigue and frustration in dealing with everyday situations, especially: communication, learning, orientation and mobility, social relationships (isolation, lack of confidence and self-esteem), independence in daily living skills, access to information, access to education, access to employment, access to aids and equipment (because of cost), access to interpreters. Significant changes have taken place, and continue to take place, in the tools and technology to support them. One example is the Cochlear Implant (CI): this can benefit children who are profoundly deaf, including those with complex additional needs. Cochlear implants can bring benefits across a range of areas, including listening, the development of communication, psychosocial skills, and pre-academic and academic function. However, there are differences in the type of benefits cochlear implantation will bring to children who are deaf with complex additional needs and to those whose primary need is caused by deafness alone. By using standard tests, it is sometimes difficult to measure different benefits from CI for complex needs children. Also the rehabilitation strategies to develop different listening skills, communication and social skills are different than strategies usually used with hearing impaired children without additional disabilities. MED-EL has useful materials supporting children with severe complex needs. One of such materials is the assessment tool Quality of Life Improvement of Hearing Impaired Children with Complex Needs and Their Families Related to Cochlear Implant Use 'QLICI . « QLICI' is to highlight different but significant benefits for children with severe complex needs which they can get from CI and impact of this device for quality of life for this population of children and their families This material will be introduced during the lecture as well as QLICI international multicente study results. [ABSTRACT FROM AUTHOR]

Background: There are multiple companies that manufacture cochlear implants available for patient use. Currently, the Cochlear Implant Clinic at St. Paul's Hospital uses primarily one manufacturer, and patients do not have the opportunity to choose a particular manufacturer during the decision process. Using the latest models there is no evidence to show that there is superiority with any one particular manufacturer when comparing hearing results post-implantation. Adding choice could potentiate patient anxiety, however, there are other centres that do offer choices to patients with evidence to show that there is high patient satisfaction with this model as well. Objectives: • To determine if patients at our centre wish to have a choice and participate in the selection of their cochlear implant manufacturer • To gather and evaluate patient experiences with the current pre-operative cochlear implant decision process at our centre Methods: Thirty semi-structured qualitative one-on-one interviews will be conducted to evaluate patient choice and preferences when it comes to deciding on a particular cochlear implant manufacturer. Both pre-operative CI candidates and post-operative patients are allowed to participate. Transcripts of the interviews will undergo qualitative analysis tools, including coding and thematic analysis. Results: Qualitative analysis of the data currently suggests that many patients do not place large emphasis on the manufacturer or brand of cochlear implant, as long as the decision is supported by the cochlear implant team. Conclusions: At this time, there may not necessarily be significant advances in patient satisfaction by allowing patients to select the manufacturer of their cochlear implant. When it came to the decision process, patients felt more empowered selecting a device that matched their personal preferences and lifestyle, which correlates more to the specific model of the implant, as opposed to the particular brand or manufacturer. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Hypernasality is considered a prevalent speech abnormality that could significantly contribute to the unintelligibility of the hearing-impaired speakers. The aim of this study was to evaluate the effect of cochlear implantation and the duration of hearing loss on nasalance of speech of a post-lingually impaired group of Saudi adult patients. Material and Methods: This study included 25 post-lingually hearing-impaired patients who underwent cochlear implantation and 25 age-matched control subjects. Patients were divided into three groups according to the duration of hearing loss. The nasometric data of the hearing- impaired group were compared with the control group. Also, the preoperative values were compared with the postoperative values 6, 12, and 24 months after surgery. Results: Significant differences were demonstrated between the pre-implantation nasalance scores of the three sub- groups and between the patients and control groups. There were statistically significant differences demonstrated between the pre- and the post-implantation nasalance values for the three groups of patients. Conclusion: Cochlear implantation appears to have significant effects on improving the nasalance of the speech of post-lingually hearing-impaired adult patients. However, the degree of improvement might vary according to the duration of hearing loss the patients had pre-implantation. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate (1) if patients with bilateral vestibulopathy (BV) suffer from spatial and non-spatial cognitive deficits and (2) to assess if these deficits are caused by their vestibular and/or hearing loss. Methods: 40 patients (59y±14) with an established diagnosis of BV according to the Barany criteria, were included. All patients received audiometric and vestibular testing. Cognition was assessed by the means of the Repeatable Battery for the Assessment of Neuropsychological Status, for hearing impaired persons (RBANS-H). The RBANS measures 5 domains of cognition: immediate memory, delayed memory, visuospatial abilities, attention and language. 82 healthy, normal hearing, controls (63y±11) without vestibular complaints completed the RBANS-H. Spatial cognition was assessed by the Virtual Morris Water Maze (VMWT) in the 40 BV patients and in 20 healthy normal hearing controls (48y±12) without vestibular complaints. Results: RBANS-H. Overall, patients with BV and hearing loss had a worse total score then patients with BV without hearing loss and healthy controls (95±17, vs respectively 101±13 and 100±13, p>0.05). Mainly, immediate memory (p=0.04) and attention (p=0.03) seem to be affected in BV patients with hearing loss compared with healthy controls. No statistically significant differences were observed between BV patients with normal hearing and healthy controls. VMWT. Regardless of their hearing status, BV patients seem to take longer paths and more time to find a hidden platform than healthy controls (p>0.05). Conclusion: Our results confirm the previous findings of impaired cognition in BV patients, although the deficits in non-spatial cognition seem to be rather caused by the associated hearing loss in BV patients than their vestibular loss. [ABSTRACT FROM AUTHOR]

Objectives: As candidacy criteria for cochlear implantation (CI) have been progressively relaxed to include very young children and those with residual hearing, there is the special interest in evaluation of early auditory development in these groups of children. The research question is whether there are differences in early auditory development between children with and without residual hearing. Material and Method: 63 with residual hearing and 59 with profound deafness were tested with the LittlEARS questionnaire. The test was performed at CI activation assessing pre implant auditory development and up to 12 months of CI use. The LittlEARS normative values were used to calculate the delay in auditory development of children from both groups. The delay in auditory development was analyzed separately for children implanted before the age of 12 months and for children implanted at the age of 12 to 24 months. Results: In children implanted before 12 months of age the delay in auditory development decreased over 12 months of CI use from 8 months to 1 month in the group with profound deafness and form 7 months to 1 month in children with residual hearing. In children implanted at the age of 12 to 24 months the delay in auditory development decreased over 12 months of CI use in both groups. However in children with profound deafness this delay after 12 months of CI experience was significantly higher comparing to the delay in auditory development in children with residual hearing. Conclusion: Children with profound deafness should be implanted before their first birthday to promote faster auditory development. [ABSTRACT FROM AUTHOR]

Background: Cochlear implantation (CI) has been found to be an effective technique for hearing restoration and tinnitus suppression in patients with severe to profound sensorineural hearing loss and ipsilateral incapacitating tinnitus. While the effects of CI on tinnitus is an aria of active investigation, the effect of electrical brainstem stimulation by use of an auditory brainstem implant (ABI) on tinnitus perception has scarcely been reported and mainly in NF2 patients. Aim of the study: To investigate the effects of auditory brainstem implantation in a patient with unilateral profound sensorineural hearing loss and incapacitating tinnitus. Methods: The present study reports on a case study of a 59 - year - old male patient with an asymmetrical sensorineural hearing loss with ipsilateral incapacitating tinnitus after labyrinthitis. First, the patient underwent cochlear implantation (MED-EL Pulsar100 FL) in the deaf ear. In the contralateral ear, he was wearing a hearing aid. Due to obliteration of the cochlea, the electrode array could only be partially (4 electrodes) inserted. Consequently, hearing performance was unsatisfactory and tinnitus suppression decreased over time until there was only minimal tinnitus suppression. Therefore, the patient received an ABI (MED-EL Concerto) at the same ear 6 years post-cochlear implantation. He was evaluated pre- ABI implantation and up to 5 years after ABI implantation. Audiological test battery comprised free field pure-tone audiometry (PTA500, 1000 and 2000Hz), speech perception in quiet (phonetically balanced monosyllabic word lists) and in noise (LIST sentences). Tinnitus was assessed with the Visual Analogue Scale for loudness (VAS). Results: Daily ABI use was reported by the patient. A PTA(500, 1000 and 2000Hz) of 45 dB HL with ABI was obtained. With activation of the ABI, the tinnitus decreased. Pre- implantation, the tinnitus loudness was rated 9.3/10 on the VAS and was reduced to 3/10 12 months after ABI implantation, 5/10 36 months post-ABI and 4.5/10 after 48 months. When the ABI was switched off, tinnitus immediately appeared with a loudness of 8-9/10 on the VAS. The patient obtained a 61% score on the Dutch opens set monosyllabic word list (NVA) at the 48 month interval with ABI alone, 45% with hearing aid only and a 94% score with the combination of the ABI and the contralateral hearing aid. 4 years after the ABI implantation, speech in noise scores showed a speech to noise ratio from +10 dB SNR with ABI only, +7 dB SNR with hearing aid alone and +4 dB SNR with the combination of the ABI and a contralateral hearing aid Conclusion: This case study reports on a patient with unilateral profound sensorineural hearing loss and ipsilateral incapacitating tinnitus after labyrinthitis. The patient benefitted from tinnitus suppression and improved speech recognition in quiet and in noise through auditory brainstem implantation at the deaf side. [ABSTRACT FROM AUTHOR]

Malawi is the 7th poorest country in the world however ten implants in post lingually deaf children have now been implanted in the country. The surgery has been carried out without complication and the switch ons, with subsequent audiological programming, have been carried out with the input of local audiological professionals. The details of the 10 patients will be presented but all have made good progress and have now returned to full time education. The development of the service has been possible due to a collaboration between UK & Malawi professionals and charitable support (including a CI manufacturer). Further plans are in place to develop the service including rehabilitation within families and the educational environment. The rehabilitation of such a small number of patients is, however, simply a 'drop in the ocean' with regard to the need in Sub-Saharan Africa. Our aim however is to show that it is possible to do implants in a poor country and that, with appropriate follow up and support (including long term), they do vastly improve the lives of those who have been fitted As well as outlining how the Malawian program has come about, including the major challenges arising, the presentation will also highlight the issues facing those looking to treat patients with severe to profound loss in the developing world. It will utilize our experience in detailing lessons learned but also outline how future developments could potentially radically change the outlook for those patients in the poorest countries in the world. [ABSTRACT FROM AUTHOR]

Objective:. Adolescent cochlear implant (CI) users experience signficiantly more peer problems and higher bullying rates than peers with typical hearing (TH), which may stem from deficits in peer social dynamics. Successful social interactions require perception of not only message content, but also integration of sensory input to infer a speaker's emotion from visual (facial expressions) and auditory (prosody) cues. This study examines the effect of auditory status (CI vs. TH) on visual emotion recognition in adolescents. METHODS. Participants included 34 adolescents with CIs and 24 with TH. CI users had a mean age of 13.3 years, mean age at first CI of 2.7 years, and mean duration of CI use of 10.7 years. TH peers had a mean age of 13.7 years. All participants completed an emotion recognition task with static images of 4 individuals expressing 6 emotions (anger, disgust, fear, happy, sad, surprise). Participants labeled the emotion in the image from a closed-set list. We recorded mouse clicks to examine behavioral accuracy and reaction time, and eye movement patterns via eyetracking. Results: No significant group differences emerged for behavioral accuracy or reaction time for emotion recognition. However, eye tracking revealed differences relative to areas of the face on which each group fixated, with the CI group fixating longer on the mouth area across emotions compared to TH peers. Conclusions: Longer fixations on the mouth may represent a compensatory strategy to mitigate effects of a compromised CI signal, but it detracts attention from the eyes, which underscore conversation management and social interaction. Knowledge of the effect of CI on emotion recognition could lead to more effective, efficient therapeutic intervention related to social deficits in adolescents with CI. [ABSTRACT FROM AUTHOR]

Music training has been proposed as a complementary means of (re)habilitation for children with hearing loss, and although the number of studies investigating this is modest, there have been positive and significant results indicating improvement to music perception, music appreciation, and elements of speech perception--most notably prosody. This study aims to explore which aspects of music perception are improved from music training, and if additional transfer effects generalise to other auditory domains such as speech perception. 13 children aged between 5.9 and 9.0 years (M=7.3, SD=1.0) with moderate to profound prelingual hearing loss (6 bilateral CIs, 4 bimodal, 3 bilateral HAs) participated in this study. The design was a pseudo-randomised, longitudinal study with a delayed/waitlisted control group. Music training was 12 weeks, consisting of weekly music therapy sessions and online music apps 3 times a week. Testing occurred at pre, mid, post, and follow-up sessions. The test battery measured: music perception (pitch and timbre), speech perception (SIN, emotional and question/ statement prosody), and spectral resolution. After training and relative to the control group, the music group significantly improved their perception of timbre by 14.2%, F(1,14)=4.658, p=.049 and spectral resolution by 1.6 ripples/octave, F(1,14)=7.403, p=.017. Pitch, F(1,14)=.238, p=.238 and SIN perception, F(1,14)=3.686, p=.075 were not significantly improved, although the music group improved their SRTs by 1.4 dB. Both groups improved significantly in emotional prosody by 7%, F(1,14)=13.177, p=.003 and question/statement prosody by 12%, F(1,14)=11.113, p=.005. The findings suggest that even a modest amount of music training can improve timbre perception and spectral resolution, though the evidence for speech perception enhancement is weak. As both groups improved in prosody perception, the results suggest that these gains are derived through natural maturation or development. [ABSTRACT FROM AUTHOR]

Objective(s): The ADHEAR is a novel non-implantable bone conduction hearing system, in which audio processor is connected directly to the skin via a special Adhesive Adapter that is placed behind the ear. It is intended for treatment of patients with conductive hearing loss. The ojbective of this acute clinical study was to assess the audiological efficacy with this hearing. Material and Methods: Material of this study consists of five native Polish adults with uni- or bilateral conductive hearing loss. Unaided and two aided conditions with the ADHEAR and the BC device on softband will be compared using the following tests: (1) Sound field audiometry with warble tones. (2) Speech in quiet by determining the word recognition score and speech reception threshold (SRT50) in sound field with Polish monosyllables. (3) Speech in noise by determining the SRT50 in sound field using the Polish Matrix Test with speech and noise coming from the front. Results and Conclusions: Preliminary results of pilot tests showed comparable performance between the ADHEAR and a bone conduction hearing device on a softband. The new bone conduction hearing device ADHEAR as a nonimplantable solution could be a good alternative to the other bone conduction hearing devices and shows comparable audiological benefit in patients with pure conductive hearing loss. It seems that the ADHEAR can be a good solution for patients with small mastoids, especially for babies and children, who are waiting for surgical procedure or are not suitable for it. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of cochlear implantation (CI) in cases of ossified cochlea Patients and Methods: 25 patients with cochlear ossification underwent simultaneous bilateral CI. Bony occlusion spread to the ascending segment of the basal turn in 11 cases (unilateral). We performed an electrode insertion trough round window after gentle drilling ossification of the inferior segment of the basal turn in 39 cases. The superior cochleostoma was perform and the electrode was insert though the second turn in other 11 cases. Using the cochleariform process as a landmark, the second cochleostomy was perform 1 mm inward to the anterior margin of the oval window niche on the line proceeding from the pyramidal process parallel to the stapes crura. A remain electrodes placed in exposed basal turn after removal of the part promontory wall separating the basal and the second turn. The follow-up period varied from 6 months to 1 year Results: Most electrodes has an impedance in the normal range. A postoperative CT scan showed in all cases. The subjects' audiological performances correlated with those of cochlear implant users without cochlear ossification. No complications were reveal postoperatively. Conclusion: Bilateral CI with using the described surgical tactic allows patients with ossified cochlea after meningitis to achieve high levels of audio-verbal assessment. The risk of total ossification of the cochlea and the ability to maximize the using of no ossified cochlea areas for auditory stimulation in the early period after meningitis justifies the indications for simultaneous bilateral cochlear implantation. Applying the described approach to the second cochlear turn in patients with cochlear ossification enables maximal spiral ganglion cell and modiolus preservation and full electrode insertion, and, therefore, improves postoperative auditory performance. [ABSTRACT FROM AUTHOR]