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Purpose: In patients with inner ear schwannomas (IES), reports on hearing rehabilitation with cochlear implants (CI) have increased over the past decade, most of which are case reports or small case series. The aim of this study is to systematically review the reported hearing results with CI in patients with IES considering the different audiologic outcome measures used in different countries., Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a search of published literature was conducted. We included patients with IES (primary or with secondary extension from the internal auditory canal (IAC) to the inner ear, sporadic or NF2 related) undergoing cochlear implantation with or without tumour removal. The audiological results were divided into the categories "monosyllables", "disyllables", "multisyllabic words or numbers", and "sentences"., Results: Predefined audiological outcome measures were available from 110 patients and 111 ears in 27 reports. The mean recognition scores for monosyllabic words with CI were 55% (SD: 24), for bisyllabic words 61% (SD: 36), for multisyllabic words and numbers 87% (SD: 25), and 71% (SD: 30) for sentences. Results from for multisyllabic words and numbers in general showed a tendency towards a ceiling effect. Possible risk factors for performance below average were higher complexity tumours (inner ear plus IAC/CPA), NF2, CI without tumour removal ("CI through tumour"), and sequential cochlear implantation after tumour removal (staged surgery)., Conclusion: Hearing loss in patients with inner ear schwannomas can be successfully rehabilitated with CI with above average speech performance in most cases. Cochlear implantation thus represents a valuable option for hearing rehabilitation also in patients with IES while at the same time maintaining the possibility of MRI follow-up. Further studies should investigate possible risk factors for poor performance. Audiological tests and outcome parameters should be reported in detail and ideally be harmonized to allow better comparison between languages., Competing Interests: Declarations Conflict of interest The institutions of SKP and TR receive research grants from Cochlear Ltd., Sydney, Australia, and MED-EL, Innsbruck, Austria. This work was supported by intramural funds from Martin Luther University Halle-Wittenberg only., (© 2024. The Author(s).)

Objective: Computer-based auditory training (CBAT) has been shown to improve outcomes in adult cochlear implant (CI) users. This study evaluates in new CI users whether starting CBAT within 3 months of activation or later impacts CI outcomes., Study Design: Prospective natural experiment., Setting: Tertiary academic medical center., Patients: Sixty-five new adult CI users., Interventions: CBAT use over the first-year postactivation., Main Outcome Measures: Speech recognition scores and CIQOL-35 Profile score improvements between CI recipients who started CBAT resources early (<3 mo) and late (3-12 mo) postactivation., Results: A total of 43 CI recipients started using CBAT within 3 months postactivation (early) and 22 after 3 months (late). Patients who used CBAT within 3 months postactivation showed significantly greater improvement in consonant-nucleus-consonant words (CNCw) (48.3 ± 24.2% vs 27.8 ± 24.9%; d = 0.84), AzBio Sentences in quiet (55.1 ± 28.0% vs 35.7 ± 36.5%; d = 0.62), and CIQOL-35 listening domain scores (18.2 ± 16.3 vs 6.9 ± 12.9, d = 0.73 [0.023, 1.43]), at 3 months postactivation, compared to those who had not yet initiated CBAT. However, by 12 months postactivation, after which all CI recipients had started CBAT, there were no differences observed between patients who started CBAT early or late in speech recognition scores (CNCw: d = 0.26 [-0.35, 0.88]; AzBio: d = 0.37 [-0.23, 0.97]) or in any CIQOL global or domain score (d-range = 0.014-0.47)., Conclusions: Auditory training with self-directed computer software (CBAT) may yield speech recognition and quality-of-life benefits for new adult CI recipients. While early users showed greater improvement in outcomes at 3 months postactivation than users who started later, both groups achieved similar benefits by 12 months postactivation., Competing Interests: Conflicts of interest: None to declare., (Copyright © 2024, Otology & Neurotology, Inc.)

Objectives: Possible beneficial "crosstalk" during cochlear implant stimulation on otolith end organs has been hypothesized. The aim of this case-control study is to analyze the effect of electrical cochlear stimulation on the vestibule (otolith end-organ), when using a cochleo-vestibular implant, comparing vestibular stimulation (VI) and cochlear stimulation (CI)., Methods: Four patients with bilateral vestibulopathy were included. A double electrode array research implant was implanted in all cases. Dynamic Gait Index (DGI), VOR gain measured by using vestibular head impulse test (vHIT), acoustic cervical myogenic responses (cVEMP) recordings, and electrical cVEMP were used in all cases. Trans-impedance Matrix (TIM) analysis was used to evaluate the current flow from the cochlea to the vestibule., Results: While patients did not have any clinical vestibular improvement with the CI stimulation alone, gait metrics of the patients revealed improvement when the vestibular electrode was stimulated. The average improvement in the DGI was 38% when the vestibular implant was activated, returning to the normal range in all cases. Our findings suggest that any current flow from the cochlear space to the otolith organs was insufficient for effective cross-stimulation. The functional results correlated with the data obtained in TIM analysis, confirming that there is no current flow from the cochlea to the vestibule., Conclusion: The only way to produce effective electrical otolith end-organ stimulation, demonstrated with this research implant, is by direct electrical stimulation of the otolith end organs. No effective cross-stimulation was found from cochlear electrode stimulation., Level of Evidence: 4 Laryngoscope, 134:2349-2355, 2024., (© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: Programming a cochlear implant (fitting) is an essential part of a user's post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high degree of variability in fitting practices, users' parameters, and probably outcomes. In this study a data-driven approach is used to retrospectively investigate the relation between cochlear implant fitting parameters and speech perception outcomes in post-lingually deafened adults., Methods: 298 data points corresponding to fitting parameters and speech audiometry test results for the same number of adult, post-lingually deafened, experienced CI users were analyzed. Correlation analysis was performed, after which parameters from the top-scoring and bottom-scoring tertiles were compared via the Mann-Whitney-Wilcoxon u test., Results: Weak correlations between dynamic range and speech audiometry outcomes were identified, having p values lower than (albeit close to) 0.05. A significant (p < 0.05) difference in electrical dynamic range (the difference between the minimum and maximum amount of current which may be delivered by each electrode) was found, with top-scoring subjects having on average a wider dynamic range., Conclusion: The association between dynamic range and speech perception outcomes shown in this retrospective study highlights the need for deeper investigation into evidence-driven fitting. It might be a first step in the direction of evidence-based fitting, minimizing variability in outcomes for cochlear implant users and helping mitigate the issue of unexplained low performance., (© 2023. The Author(s).)

Objective: To evaluate the effectiveness of the "60/60 Guideline" in a diverse patient population., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: Data were collected for adult patients (18 years and older) who underwent a cochlear implant evaluation (CIE) between January 2016 and March 2021., Main Outcome Measures: Development of the "60/60 Guideline" has provided better clarity on when to refer English-speaking patients for a CIE. Our study evaluated the effectiveness of this referral tool in the Spanish-speaking population., Results: In our group of patients who underwent a traditional CIE (n = 402), 209 met unaided and aided traditional cochlear implant (CI) candidacy criteria. Of the 193 individuals who did not meet both components of traditional candidacy criteria, a majority met the aided component (86%) but only 4.6% met the unaided component. When applying the 60/60 Guideline to patients who met traditional criteria, there is a sensitivity rating of 84.7% and a specificity index of 50.3%. For English and Spanish speakers who met traditional criteria but did not meet the 60/60 Guideline, a majority (83.3% English, 87.5% Spanish) had a better ear word recognition score (WRS) greater than 60%, suggesting the unaided WRS is the more restrictive component of the "60/60 Guideline.", Conclusion: Application of the "60/60 Guideline" is an effective method to identify potential CI candidates in the English-speaking population; however, it was less effective in the Spanish-speaking population. Spanish-speaking adults should be referred for a CIE when better ear pure tone average is greater than 60 dB hearing loss, regardless of their unaided WRS. This study highlights the need for inclusion of nonlinguistic test measures in the CI referral criteria and test battery to reduce CI access barriers for patients who speak a language other than English., (Copyright © 2023, Otology & Neurotology, Inc.)

Hypothesis: We aimed to identify practice trends and association between physician training and administration of perioperative steroids for cochlear implantation (CI) as it relates to hearing preservation., Background: Perioperative steroid therapy regimens are postulated to protect residual hearing and improve hearing preservation outcomes in CI., Methods: A 27-question online survey was developed by the senior authors using the Qualtrics Survey Tool, then distributed via email from September to November 2022 to otolaryngologists specializing in otology or neurotology and who practice in the United States or Canada., Results: The survey was sent to 463 physicians, 162 (35.0%) of whom completed the survey. One hundred forty-four (31.1%) responses underwent analysis. All physicians administering preoperative steroids (n = 31) prefer preoperative oral prednisone. Of 143 physicians administering intraoperative steroids, 54.5% prefer intraoperative intravenous dexamethasone. More than half (77.6%) of 85 physicians administering postoperative steroids prefer postoperative oral prednisone. Postoperative steroid administration (p < 0.006) and taper utilization (p < 0.041) were greater among physicians who complete greater than 40 CIs annually (n = 47 [71.2%]; n = 30 [49.2%]) than physicians who complete up to 40 CIs annually (n = 37 [48.7%]; n = 20 [31.3%]), respectively. Physicians practicing for 5 to 20 years after residency are more prevalent in using postoperative steroid tapers than physicians practicing for fewer than 5 years after and more than 20 years after residency (n = 37 [51.4%] versus n = 14 [25.5%], p < 0.001)., Conclusion: Consensus is needed about the optimal steroid treatment for CI patients., Level of Evidence: 4., Competing Interests: Sources of support and disclosure of funding: There are no financial disclosures, commercial associations, or other conditions posing a conflict of interest to report for any of the above authors., (Copyright © 2023, Otology & Neurotology, Inc.)

Objectives: To examine patterns of change and plateau in speech recognition scores in postlingually hearing impaired adult cochlear implant recipients. The study also examines variations in change patterns for different speech materials and testing conditions., Study Design: Used systematic review with meta-analysis., Methods: Articles in English reporting speech recognition scores of adults with postlingual hearing loss at pre-implantation and at least two post-implantation time points were included. Statistically significant changes were determined by meta-analysis and the 95% confidence interval., Results: A total of 22 articles representing 1954 patients were included. Meta-analysis of mean difference demonstrated significant improvements in speech recognition score for words in quiet (37.4%; 95% confidence interval [34.7%, 40.7%]), sentences in quiet (49.4%; 95% confidence interval [44.9%, 53.9%]), and sentences in noise (30.8%; 95% confidence interval [25.2%, 36.4%]) from pre-op to 3 months. Scores continued to increase from 3 to 12 months but did not reach significance. Similarly, significant improvements from pre-op to 3 months were observed for consonant nucleus consonant (CNC) words in quiet (37.1%; 95% confidence interval [33.8%, 40.4%]), hearing in noise test (HINT) sentences in quiet (46.5%; 95% confidence interval [37.0%, 56.0%]), AzBio sentences in quiet (45.9%; 95% confidence interval [44.2%, 47.5%]), and AzBio sentences in noise (26.4%; 95% confidence interval [18.6%, 34.2%]). HINT sentences in noise demonstrated improvement from pre-op to 3 months (35.1%; 95% confidence interval [30.0%, 40.3%]) and from 3 to 12 months (15.5%; 95% confidence interval [7.2%, 23.8%])., Conclusions: Mean speech recognition scores demonstrate significant improvement within the first 3 months, with no further statistically significant improvement after 3 months. However, large individual variation should be expected and future research is needed to explain the sources of these individual differences. Laryngoscope, 133:1014-1024, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Previous studies have shown that cochlear implant outcomes with respect to surgical morbidity and speech perception may be poorer in elderly patients as compared with younger adults. However, recent anecdotal reports suggest that elderly cochlear implant recipients are achieving increasingly higher speech perception performance and fewer surgical complications than previously noted. Our objective is to review cochlear implant outcomes using newer generation implants and minimally traumatic cochleostomy techniques in patients 80 years and older compared with younger adult recipients., Study Design: Retrospective chart review., Setting: Tertiary referral center., Patients: All adult cochlear implant recipients (232 patients, 258 implants) who underwent implantation with a Nucleus Freedom, Advanced Bionics HR90k, or Med El Sonata device at a tertiary academic institution., Intervention(s): Postoperative speech perception scores and clinical data extraction using the electronic medical record., Main Outcome Measure(s): Anesthetic and surgical complications, device malfunction, operative time, admission status, length of hospital stay, and postoperative speech perception scores were collected after 50 cochlear implant procedures in patients who were implanted beyond the eighth decade and 208 among younger adults (18-79 yr)., Results: Patients 80 years or older were more likely to have anesthetic complications and require hospital admission (p < 0.05). There was no statistical difference between groups with respect to surgical complications or device malfunction. Speech perception analysis revealed similar outcomes for older and younger patients., Conclusion: Cochlear implantation is well tolerated across all adult age groups with a relatively low risk for adverse surgical events or device malfunction. Given the favorable safety profile and high levels of speech perception achieved by older patients, routine implantation of octogenarian and nonagenarians seems warranted. These results also stress the need for thorough preoperative evaluation of elderly patients, given the increased likelihood for perioperative anesthetic complications.

Objective: To assess spatial hearing, tinnitus, and quality-of-life outcomes in adults with single-sided deafness (SSD) who underwent cochlear implantation., Databases Reviewed: PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus databases were searched from January 2008 to September 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines., Methods: Studies reporting spatial hearing, tinnitus, and quality-of-life outcomes in adult cochlear implant (CI) recipients (≥18 yr old) with SSD were evaluated. Study characteristics, demographic data, spatial hearing (speech recognition in noise, sound source localization), tinnitus (severity, loudness), and quality-of-life outcomes were collected., Results: From an initial search of 1,147 articles, 36 studies that evaluated CI use in 796 unique adults with SSD (51.3 ± 12.4 yr of age at time of implantation) were included. The mean duration of deafness was 6.2 ± 9.6 years. There was evidence of improvement for speech recognition in noise using different target-to-masker spatial configurations, with the largest benefit observed for target-to-masker configurations assessing head shadow (mean, 1.87-6.2 dB signal-to-noise ratio). Sound source localization, quantified as root-mean-squared error, improved with CI use (mean difference [MD], -25.3 degrees; 95% confidence interval [95% CI], -35.9 to -14.6 degrees; p < 0.001). Also, CI users reported a significant reduction in tinnitus severity as measured with the Tinnitus Handicap Inventory (MD, -29.97; 95% CI, -43.9 to -16.1; p < 0.001) and an improvement in spatial hearing abilities as measured with the Spatial, Speech, and Qualities of Hearing questionnaire (MD, 2.3; 95% CI, 1.7 to 2.8; p < 0.001)., Conclusions: Cochlear implantation and CI use consistently offer improvements in speech recognition in noise, sound source localization, tinnitus, and perceived quality of life in adults with SSD., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

Objective: Predictors of second-side cochlear implant performance have not been well studied. We sought to assess whether speech recognition scores from first-side cochlear implant (CI1) could predict second-side cochlear implant (CI2) scores in sequential bilaterally implanted adults., Study Design: Retrospective review using a prospectively collected database., Setting: Academic tertiary care hospital., Patients: Fifty-seven adults with postimplantation speech recognition testing performed at least 12 months after CI2., Intervention: Sequential bilateral CI., Main Outcome Measures: CI2 performance at ≥12 months as measured using consonant-nucleus-consonant (CNC) words and AzBio sentences in quiet and +10 dB signal-to-noise ratio (S/N)., Results: CI1 performance scores at ≥12 months were independently associated with CI2 performance scores at ≥12 months for CNC words (β = 0.371 [0.136-0.606], p = 0.003), AzBio sentences in quiet (β = 0.614 [0.429-0.80], p < 0.0001), and AzBio +10 dB S/N (β = 0.712 [0.459-0.964], p < 0.0001). CI1 scores on AzBio in quiet at 0 to 6 months were also independently associated with CI2 AzBio in quiet scores at ≥12 months (β = 0.389 [0.004-0.774], p = 0.048). Hearing loss etiology and duration, age at implantation, interval between CI1 and CI2, duration of hearing aid use, and preimplantation speech recognition testing scores were not consistently associated with CI2 scores at ≥12 months., Conclusions: CI1 performance is an independent predictor of second-side performance as measured ≥12 months postimplantation. This may be a clinically useful metric when considering adult sequential bilateral implantation., Competing Interests: Financial disclosures/conflicts of interest: This work was unfunded. There are no conflicts of interest, financial or otherwise., (Copyright © 2022, Otology & Neurotology, Inc.)

Cochlear implant recipients have demonstrated remarkable increases in speech perception since US FDA approval was granted in 1984. Improved performance is due to a number of factors including improved cochlear implant technology, evolving speech coding strategies, and individuals with increasingly more residual hearing receiving implants. Despite this evolution, the same recommendations for pre- and postimplant speech recognition testing have been in place for over 10 years in the United States. To determine whether new recommendations are warranted, speech perception performance was assessed for 156 adult, postlingually deafened implant recipients as well as 50 hearing aid users on monosyllabic word recognition (CNC) and sentence recognition in quiet (HINT and AzBio sentences) and in noise (BKB-SIN). Results demonstrated that for HINT sentences in quiet, 28% of the subjects tested achieved maximum performance of 100% correct and that scores did not agree well with monosyllables (CNC) or sentence recognition in noise (BKB-SIN). For a more difficult sentence recognition material (AzBio), only 0.7% of the subjects achieved 100% performance and scores were in much better agreement with monosyllables and sentence recognition in noise. These results suggest that more difficult materials are needed to assess speech perception performance of postimplant patients - and perhaps also for determining implant candidacy., ((c) 2008 S. Karger AG, Basel)

Objective: The goal was to report a method used for intraoperative ear selection for cochlear implantation using electrical brainstem response. Initial patient response and the longer-term results of cochlear implantation after labyrinthectomy were compared., Study Design: This was a specific retrospective review of a single case of cochlear implantation after labyrinthectomy., Setting: The study involved a tertiary referral center in both an ambulatory and a hospital setting., Patient: The study involved a report of a single patient who was evaluated for a possible cochlear implant and successfully underwent cochlear implantation., Interventions: A case study of a profoundly deaf individual is presented, including the diagnostic measures used to determine the candidacy for cochlear implantation, the ear selected, and the rehabilitation., Main Outcome Measures: Both early (3 months) and later (14 months) postoperative results clearly demonstrate that a cochlear implant in a patient with a previous labyrinthectomy can be beneficial., Results: The early and later results after cochlear implantation are compared in a single case study., Conclusion: This case study demonstrates that there is improvement in sound awareness, speech recognition, and communication after cochlear implantation in a previously labyrinthectomized ear.

Objective: To review studies evaluating clinically implemented image-guided cochlear implant programing (IGCIP) and to determine its effect on cochlear implant (CI) performance., Data Sources: PubMed, EMBASE, and Google Scholar were searched for English language publications from inception to August 1, 2021., Study Selection: Included studies prospectively compared intraindividual CI performance between an image-guided experimental map and a patient's preferred traditional map. Non-English studies, cadaveric studies, and studies where imaging did not directly inform programming were excluded., Data Extraction: Seven studies were identified for review, and five reported comparable components of audiological testing and follow-up times appropriate for meta-analysis. Demographic, speech, spectral modulation, pitch accuracy, and quality-of-life survey data were collected. Aggregate data were used when individual data were unavailable., Data Synthesis: Audiological test outcomes were evaluated as standardized mean change (95% confidence interval) using random-effects meta-analysis with raw score standardization. Improvements in speech and quality-of-life measures using the IGCIP map demonstrated nominal effect sizes: consonant-nucleus-consonant words, 0.15 (-0.12 to 0.42); AzBio quiet, 0.09 (-0.05 to 0.22); AzBio +10 dB signal-noise ratio, 0.14 (-0.01 to 0.30); Bamford-Kowel-Bench sentence in noise, -0.11 (-0.35 to 0.12); Abbreviated Profile of Hearing Aid Benefit, -0.14 (-0.28 to 0.00); and Speech Spatial and Qualities of Hearing Scale, 0.13 (-0.02 to 0.28). Nevertheless, 79% of patients allowed to keep their IGCIP map opted for continued use after the investigational period., Conclusion: IGCIP has potential to precisely guide CI programming. Nominal effect sizes for objective outcome measures fail to reflect subjective benefits fully given discordance with the percentage of patients who prefer to maintain their IGCIP map., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: Cochlear implant (CI) candidacy and postoperative outcomes are assessed using sets of speech perception tests that vary from center to center, limiting comparisons across institutions and time periods. The objective of this study was to determine if scores on one speech perception test could be reliably predicted from scores on another test., Study Design: Arizona Biomedical (AzBio) Sentence Test, Consonant-Nucleus-Consonant word (CNCw), and Hearing in Noise Test (HINT) scores in quiet for the implanted ear were collected for individuals who received a CI between 1985 and 2019. Scores collected during the same testing session were analyzed using Bland-Altman plots to assess agreement between testing methods. Simple linear regression with logit transformation was used to generate predictive functions and 95% confidence intervals for expected mean and individual scores., Setting: Single academic medical center., Patients: A total of 1,437 individuals with a median age of 59.9 years (range, 18-95 yr) and 46% (654 of 1,437) male., Interventions: N.A., Main Outcome Measures: Agreement as a function of test score, mean, variance, and correlation coefficients., Results: A total of 2,052 AzBio/CNCw, 525 AzBio/HINT, and 7,187 CNCw/HINT same-session score pairings were identified. Pairwise test comparisons demonstrated limited agreement between different tests performed in the same session, and a score correlation between different speech tests revealed large variances., Conclusion: Transformation functions between test batteries were predictive of mean scores but performed poorly for prediction of individual scores. Point-wise comparisons of scores across CI test batteries should be used with caution in clinical and research settings., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Hypothesis: Stimulation-Current-Induced Non-Stimulating Electrode Voltage Recordings (SCINSEVs) can help detect extracochlear electrodes for a variety of Cochlear Implant (CI) devices., Background: Extracochlear electrodes (EEs) occur in 9 to 13% of cochlear implantations and commonly go unnoticed without imaging. Electrodes on the electrode array located extracochlearly are associated with non-auditory stimulation and a decrease in speech outcomes. We have previously shown that SCINSEVs, with hardware and software from one manufacturer, could detect EEs. Here, we test the generalizability to other manufacturers., Methods: Fresh-frozen human cadaveric heads were implanted with Cochlear Ltd. CI522 (CI-A) and MED-EL's FLEX24 (CI-B) electrodes. Contact impedances and SCIN- SEVs were measured, with Cochlear Ltd. research Custom Sound software (Transimpedance Matrix) and MED-EL's clinical MAESTRO (Impedance Field Telemetry), for full insertion and EEs in air, saline and soft tissue. An automated detection tool was optimized and tested for these implants. Intra-operative SCINSEVs with EEs were collected for clinical purposes for six patients., Results: The pattern of SCINSEVs changed in the transition zone from intracochlear to extracochlear electrodes, even with low contact impedances on EEs. Automated detection in the cadaveric specimens, with two or more EEs in saline or soft tissue, showed a mean 91% sensitivity and specificity for CI-A and 100% sensitivity and specificity for CI-B. Quantification of EEs showed significant correlations of r  = 0.69 between estimated and actual EEs for CI-A and r = 0.76 for CI-B., Conclusion: The applicability of SCINSEVs to detect extra- cochlear electrodes could be expanded to other cochlear implant companies despite differences in electrode array design and measurement software., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objectives: Determine whether asymmetric hearing loss (AHL) affects postoperative speech outcomes in cochlear implant (CI) patients., Study Design: Retrospective cohort study., Setting: Tertiary care hospital., Patients: Adult English-speaking patients with unilateral CIs implanted between 2014 and 2018 were stratified into NonAHL and AHL groups based on preoperative AzBio scores in quiet from the nonimplanted ear (0-50% vs. 51-100%, respectively)., Interventions: CI surgery in the poorer performing ear., Main Outcome Measures: Postoperative consonant-nucleusconsonant (CNC) word and AzBio sentence test scores in quiet and/or noise at +5 dB signal-to-noise ratio (SNR)., Results: Of 512 patients, 33 non-AHL and 27 AHL patients were included. Average ages were 65.6 and 63.6 years, respectively. As expected, preoperative AzBio scores in quiet from the nonimplanted ear were higher in the AHL group (95% confidence interval [95%CI]: 66.4-76.4%) than the non-AHL group at baseline (95%CI: 12.3-23.6%). In both cohorts, AzBio scores in quiet from the implanted ear improved from baseline, with 24-month scores (95%CI: 73.8 - 84.9%) being higher than preoperative scores (95%CI: 13.2-23.1%). There were also significant differences in AzBio scores in quiet between cohorts overall (p  = 0.0120) on mixed model analysis, with the AHL group performing ∼6.4% better than the non-AHL group; however, differences were not significant when scores were stratified by time. In addition, there were no significant differences in CNC in quiet and AzBio scores in noise at +5 dB SNR between cohorts (p  = 0.1786 and p  = 0.6215, respectively)., Conclusions: After CI, patients with AHL can achieve scores on word and sentence tests at least comparable to traditional CI candidates, supporting the expansion of CI candidacy to include patients with AHL., Competing Interests: Carly Misztal, Stefanie Peña, Diane Martinez, Stefania Goncalves, Ruixuan Ma, and Christine Dinh have no conflicts of interest. Sandra Velandia: Consultant for Cochlear Corporation. Meredith Holcomb: Consultant for Advanced Bionics, Cochlear Corporation, MED-EL, and Institute for Cochlear Implant Training. Simon Angeli: Consultant for Advanced Bionics. Fred Telischi: Consultant for Advanced Bionics, Cochlear Corporation, and MED-EL. The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL)., Study Design: Longitudinal, prospective cohort., Setting: Tertiary academic center., Patients: Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss., Interventions: Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software)., Main Outcome Measures: Change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 3-month post-CI., Results: Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computer-based training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range = 0.57-0.85) and global and domain-specific CIQOL scores, except entertainment (d-range = -0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d = 0.69[0.03,1.35]; CNCw: d = 0.80[0.14,1.46]; AzBio: d = 1.11[0.44,1.77]) and global and all domain-specific CIQOL scores (d-range = 0.05-1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß = 33.07[1,43,64.719]), AzBio (ß = 33.03[5.71,60.35]), and CIQOL-global (ß = 10.92[1.15,20.70]) score improvement., Conclusions: Our findings provide preliminary evidence-based recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Objective: To evaluate the impact of different open set sentence recognition tests in quiet, +10 dB signal to noise ratio (SNR), and +5 dB SNR in adult cochlear implant (CI) recipients above and below 65 years of age., Study Design and Setting: Multi-institution, prospective, non-randomized, single-subject repeated measures design., Patients: Ninety six adults more than or equal to 18 years old with postlingual bilateral sensorineural hearing loss., Interventions: Participants received a CI532 in one ear. Speech perception measures were evaluated before and 6-months after activation., Main Outcome Measures: Subjects completed consonant-nucleus-constant (CNC) words in quiet and AzBio sentences in noise using +10 and +5 dB SNR, and Montreal Cognitive Assessment (MOCA)., Results: Ninety six adult patients were enrolled (n = 70 older [≥65 yr], n = 26 younger [<65 yr]). There was no difference in CNC scores (CI alone 58.4% versus 67.5%, p = 0.0857; best aided 66.7% versus 76.1%, p = 0.3357). Older adults performed worse on AzBio +10 dB SNR compared with younger patients (CI alone 37.4% versus 56.9%, p = 0.0006; best aided 51.4% versus 68.2%; p = 0.01), and in AzBio +5 dB SNR (CI alone 7.7% versus 11.2%, p = 0.0002; best aided 15.3% versus 22.3%, p = 0.0005). The magnitude of change in AzBio +10 dB SNR was significantly less in older adults in CI alone (15.3% versus 22.3%; p = 0.0493) but not best aided (21.5% versus 31.3%; p = 0.105). The magnitude of change was drastically worse in AzBio +5 dB SNR for older adults (CI alone 6.7% versus 22.1%, p = 0.0014; best aided 9.5% versus 21.5%; p = 0.0142). There was no significant difference in MOCA between the two age groups., Conclusions: While both older and younger patients have similar outcomes with respect to CNC word scores in quiet, the addition of noise disproportionally impacts older patients. Caution should be exercised testing the elderly in noise; testing in noise may disproportionally impact performance expectations and should be more carefully considered when used for candidacy criteria and counseling. Future studies need to further investigate the disproportionate effect of noise on candidacy testing and its impact on how elderly patients are qualified., Competing Interests: Conflicts of Interests: M.A.S.—None; J.A.H.—Consultant Cochlear Ltd.; C.C.W.—Consultant for Stryker; J.L.M.—Consultant for Stryker; ND—None; C.A.B.—consultant for Advanced Bionics, Cochlear Ltd., Envoy, and IotaMotion, and has equity interest in Advanced Cochlear Diagnostics, LLC., (Copyright © 2021, Otology & Neurotology, Inc.)

Purpose: The objective of this study is to compare social competence skills in children with CI and their normal hearing peers., Methods: Forty-six children with normal hearing and 46 children with CI between the ages of 42 and 72 months were included in the control group and study group, respectively. Preschool teachers rated children's social competence in the classroom using the Social Competence and Behavior Evaluation-Preschool Edition. Three subscales constitute the structure of the SCBE-30 scale: anger-aggression, social competence, and anxiety-withdrawal., Results: The analyses showed that there were statistically significant differences between social competence scores of the study group and the control group. However, there was no statistically significant difference between anger-aggression scores and anxiety-withdrawal scores of the study group and the control group. There was a significant correlation found between anger-aggression score and the age of starting rehabilitation., Conclusion: Anger-aggression scores and anxiety-withdrawal scores were similar between children using cochlear implant and normal hearing peers, whereas children with CI show lower social competence abilities than normal hearing peers. Earlier beginning to the rehabilitation programs coincide with lower anger-aggression scores. To the best of our knowledge, this is the first study to reflect these findings more objectively, from the view of teachers.

Objective: 1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients., Study Design: Retrospective chart review., Setting: Tertiary referral center., Patients: One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively., Interventions: One hundred four subjects underwent cochlear implantation., Main Outcome Measures: Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI., Results: Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition., Conclusions: CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2020, Otology & Neurotology, Inc.)

Objective: To describe our institutional experience with cochlear implantation (CI) for rehabilitation of hearing loss in Neurofibromatosis type 2 (NF2) patients., Study Design: Retrospective review between 1989 and 2019., Setting: Tertiary-care center., Patients: Twenty-four patients (67% female, mean age 45.6years) with NF2. Management of their ipsilateral vestibular schwannoma included microsurgery (n=12), stereotactic radiation (n=5), and observation (n=7)., Interventions: Cochlear implantation., Main Outcome Measures: Ability to obtain open-set speech, daily device usage and long-term device benefit., Results: All patients achieved some degree of sound awareness with CI. Nineteen patients (79%) achieved open-set speech understanding with a mean word-recognition score of 43% (range 0-88%). Patients with tumors 1.5 cm or less demonstrated the better speech understanding, without significant differences among treatment modalities. For tumors greater than 1.5 cm, patients who underwent microsurgery had a lower rate of open-set speech understanding compared to those treated with radiation or observation. Regular daily device use in 83% of patients was found. Long-term use (>10years) was observed in several patients, though some ultimately required reimplantation with an auditory brainstem implant due to progressive tumor growth. Mean follow-up duration was 4.1 years (range 0.4-15)., Conclusions: Cochlear implantation can be an effective treatment for hearing loss in NF2 patients provided the cochlear nerve is intact, regardless of prior management for the ipsilateral tumor. The degree of benefit varies and is influenced by tumor size. Management strategies that preserve the cochlear nerve maximize the interval during which a CI could be of benefit to NF2 patients., (Copyright © 2020, Otology & Neurotology, Inc.)

Objective: To create and validate a Spanish sentence test for evaluation of speech understanding of Spanish-speaking listeners with hearing loss or cochlear implants (CI)., Study Design: Two thousand sentences were recorded from two male and two female speakers. The average intelligibility of each sentence was estimated as the mean score achieved by five listeners presented with a five-channel cochlear implant simulation. The mean scores of each sentence were used to construct 42 lists of 20 sentences with similar mean scores. List equivalency was then validated by presenting all lists to 10 CI users and in a 2-list comparison in a clinical setting to 38 CI patients., Setting: Tertiary referral center., Patients: Normal-hearing listeners (n = 5), CI users in a research study (n = 10), and CI patients (n = 38) in routine clinical follow-up., Intervention: Multiple sentence lists from a newly minted speech perception test., Main Outcome Measures: List intelligibility and equivalence across sentence lists., Results: Forty-two lists of sentences were equivalent when all lists were presented in random order to 10 adult CI recipients. The variability of scores observed on lists presented to the same listener in the same condition was captured using a binomial distribution model based on a 40-item list for 38 adult implant recipients., Conclusion: The Spanish AzBio Sentence Test includes 42 lists of 20 sentences. These sentences are roughly equivalent in terms of overall difficulty and confidence limits have been provided to assess the significance of variability in list scores observed within or across conditions. These materials will be of benefit when assessing native Spanish speakers in both research and clinical settings.

Objective: To evaluate the effectiveness of a 60/60 referral guideline for identifying patients who should be referred for a cochlear implant candidacy evaluation (CICE), which states patients should be referred if they demonstrate a best ear unaided monosyllabic word score less than or equal to 60% correct and if they demonstrate an unaided pure-tone average in their better ear that is greater than or equal to 60 dB HL., Study Design: Retrospective review of data from adults who participated in a CICE., Setting: A single tertiary medical facility., Patients: Five hundred twenty-nine patients who participated in a CICE., Intervention: CICEs included unaided threshold assessment, unaided speech recognition, and aided word and sentence testing., Main Outcome Measure: Ninety-five percent of patients who met traditional indications for a cochlear implant (n = 250) had a pure-tone average that was greater than or equal to 60 dB, while 92% had a better ear unaided monosyllabic word score that was less than or equal to 60%., Results: If used as a screening measure, the 60/60 measure resulted in a 96% detection rate and a 34% false-positive rate for identifying adults who would meet traditional indications for a cochlear implant., Conclusions: Hearing professionals should consider referring patients for a CICE when they meet the 60/60 guideline. It is hoped that provision of this guideline will result in greater numbers of adults being referred for CICEs, improving access to cochlear implants for patients who may benefit from this important technology.

Purpose: Despite the advances made in cochlear implantation techniques, the associated complication rates are still high. Here, we aimed to analyze cases, with extensive follow-up data, associated with a large sample of patients to identify complications related to cochlear implants and to present our surgical experience and the technique that we used in order to follow surgical rules/medical purpose to avoid any complications., Methods: We retrospectively examined cases involving 2597 patients (1342 males; 1255 females; age 1-88 years) who underwent cochlear implantation procedures between November 1995 and July 2019, and we classified complications as minor and major., Results: The mean age at the time of implantation was 6.48 (Min: 1/Max: 88) years. The cause of deafness was congenital in 76.5% of the patients and acquired in 16.8%. The overall rate of complications in the study was 3.7% (n = 97). The minor and major complication rates were 3.0 and 0.7, respectively. Further, while the most common minor complication we encountered was vertigo, the most common major complication was implant extrusion., Conclusion: Fixing the cochlear implant receiver-stimulator with the bone-recess technique and sealing the posterior tympanotomy site with a piece of muscle in order to follow surgical rules/medical purpose to avoid any complications. Following the insertion of the electrode into the cochlea, the muscle closure of the cochleostomy site or the round window restores the original anatomy and in order to follow surgical rules/medical purpose to avoid any complications. We have developed this highly effective technique with years of experience and have not had a major surgical complication in 5 years.

Objective: The aim of this study was to analyze the results of labyrinthectomy and cochlear implantation (CI) on hearing, vertigo, and tinnitus and evaluate the adequacy of labyrinthectomy and CI for the treatment of end stage Menière's Disease (MD)., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: Charts of 22 patients undergoing labyrinthectomy and CI in the same ear for intractable vertigo and hearing loss with both preoperatory and postoperatory documentation available, were reviewed., Intervention(s): Therapeutic., Main Outcome Measure(s): Auditory outcomes were assessed with pure tone and speech audiometry, and compared with the preoperatory audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the tinnitus handicap inventory (THI)., Results: Post-CI pure tone average had a statistically significant improvement (p = 0.035, paired t test). Speech audiometry resulted in a non-statistically significant speech discrimination score variation (p = 0.056, paired t test). Postoperatory THI had a statistically significant variation (p = 0.0001, paired t test). Sixty seven per cent of the patients had complete resolution of the vestibular symptoms in their operated ear, however, patients over 70 years old had significantly more failures as evinced by the postoperative DHI (p = 0.0109, Fisher's exact test)., Conclusions: Patients affected by end stage MD or secondary MD, with vertigo and severe hearing loss can successfully undergo labyrinthectomy and CI. Caution should be reserved in elderly patients for a risk of persistent instability. The CI confers significant benefit in hearing rehabilitation and tinnitus suppression.

Objectives: The HiFocus Mid-Scala electrode array (HFms) is designed to sit within the scala tympani without touching either the lateral wall or the modiolus. The aim of this study was to compare the HFms to the Helix perimodiolar electrode array., Method: Two groups of recipients with Helix (n = 22 ears) and HFms (n = 29 ears) electrode arrays were retrospectively identified and matched by age at implantation and duration of severe to profound deafness. Most comfortable listening levels (M), impedances, Freiburger Monosyllables in quiet, and Oldenburg sentences in adaptive noise were compared at 3, 6, and 12 months postimplant., Results: Median scores for monosyllables in quiet for the HFms group were significantly better than the Helix group at each test interval (p < 0.05). Speech perception in quiet also significantly improved from 3 to 12 months for both groups (p < 0.001). There was no significant difference between the groups for speech in noise. Impedances were significantly lower for the HFms group at 12 months (p < 0.05) except at the basal end and M levels were generally higher., Conclusions: The HFms group had better median performance for monosyllables in quiet than the Helix group at each test interval, although performance in noise was similar. For speech in noise, the HFms group appear to reach optimum performance quicker than the Helix group. Impedances were lower in the HFms group across the array, other than at the most basal end, and support our hypothesis that the HFms assumes a more lateral position within the cochlea than the Helix electrode, although our article did not include imaging data.

Background: Vestibular dysfunction is a complication of cochlear implantation (CI). Reports on the evaluation of vestibular function before and after CI are limited, especially in children. We investigated the effect of CI on vestibular function in pediatric patients. Patients and Methods: We routinely evaluated vestibular function before but not immediately after CI. Therefore, patients who underwent sequential bilateral CI were enrolled in this study. Seventy-three children who underwent sequential CI from 2003 to 2020 at our hospital were included. Since the vestibular function of the first implanted ear was evaluated before the second surgery for the contralateral ear, post-CI evaluation timing differed among the cases. The evaluation included a caloric test, a cervical vestibular-evoked myogenic potential (cVEMP) test, and a damped rotation test. The objective variables included the results of these tests, and the explanatory variables included the age at surgery, cause of hearing loss, electrode type, and surgical approach used. The associations of these tests were analyzed. Results: cVEMP was the most affected after CI (36.1%), followed by the caloric test (23.6%), and damped rotation test (7.8%). Cochleostomy was significantly more harmful than a round window (RW) approach or an extended RW approach based on the results of the caloric test (p = 0.035) and damped rotation test (p = 0.029). Perimodiolar electrodes affected the caloric test results greater than straight electrodes (p = 0.041). There were no significant associations among these tests' results. Conclusions: Minimally invasive surgery in children using a round window approach or an extended round window approach with straight electrodes is desirable to preserve vestibular function after CI. [ABSTRACT FROM AUTHOR]

Objective: Hearing loss is a highly disabling condition. Cochlear implantation is an established remedy if conventional hearing aids have failed to alleviate the level of disability. Unfortunately, cochlear implant (CI) performance varies dramatically. This study aims to examine the effects of duration of deafness (DoD) prior to cochlear implantation and the postoperative duration of implant experience with resulting hearing performance in postlingually deaf patients. Methods: A systematic literature review and two meta‐analyses were conducted using the search terms cochlear implant AND duration deafness. Included studies evaluate the correlation between the DoD and auditory performance after cochlear implantation using monosyllabic and sentence tests. Correlation coefficients were determined using Pearson's correlation and Spearman rho. Results: A total of 36 studies were identified and included data on cochlear implantations following postlingual deafness and postoperative speech testing of hearing outcomes for 1802 patients. The mean age ranged from 44 to 68 years with a DoD of 0.1 to 77 years. Cochlear implant use varied from 3 months to 14 years of age. Speech perception, which was assessed by sentence and monosyllabic word perception, was negatively correlated with DoD. Subgroup analyses revealed worse outcomes for longer DoD and shorter postoperative follow‐up. Conclusion: DoD is one of the most important factors to predict speech perception after cochlear implantation in postlingually deaf patients. The meta‐analyses revealed a negative correlation between length of auditory deprivation and postoperative sentence and monosyllabic speech perception. Longer DoD seems to lead to worse CI performance, whereas more experience with CI mitigates the effect. [ABSTRACT FROM AUTHOR]

Purpose: To study the audiological, rehabilitative and cognitive outcomes of cochlear implantation in patients with Fabry disease (FD). Method: This is a retrospective case study. Two adults with progressive hearing loss were followed up for over 3 years. Results: The patients had progressive hearing loss from the first decade of life. Preoperative evaluations indicated delays in speech perception and cognitive skills due to hearing loss. There was a significant increase in hearing thresholds and speech perception in both patients after the cochlear implantation. The cognitive skills and memory skills of the patient who started using the cochlear implant later in life continued to lag. Conclusion: In FD, hearing loss should be closely monitored and appropriate interventions should be selected early. Two patients from the same family showed the strong impact of early intervention on speech perception and cognitive skills. The study aimed to emphasize the necessity of speech perception and cognitive skills assessment during the follow-up of patients with FD. [ABSTRACT FROM AUTHOR]

Objective: Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.Data Sources: We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE.Review Methods: We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data.Results: We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing.Conclusion: Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018. [ABSTRACT FROM AUTHOR]

This systematic review of the literature reveals which pre-operative factors affect sequential cochlear implantation outcomes in adults. The findings can help health care prof-essionals provide evidence-based advice on the expected benefits from a second cochlear implant (CI). We searched PubMed, EMBASE, and the Cochrane database from November 1977 to August 26, 2017, using the terms "sequential cochlear implantation"; the most frequently cited predictors for unilateral cochlear implantation performance and other potential predictors for sequential implantation outcome; and "speech perception," "localization" as well as synonyms of all of the above. Ten studies were included. The effects of age, duration of hearing loss, time between implantations, preoperative hearing, etiology of hearing loss, hearing aid use and duration of follow-up on sequential cochlear implantation performance were studied. The literature has shown that duration of deafness, age at onset of deafness, etiology of hearing loss, and preoperative speech perception score are (inversely) related to unilateral cochlear implantation outcome in adults. One would expect that these factors would also affect sequential bilateral implantation outcome. However, the best available evidence to date shows that advanced age, a long duration of deafness, or a long interval between implantations should not be considered negative factors when considering sequential bilateral cochlear implantation. [ABSTRACT FROM AUTHOR]

Vestibular problems after cochlear implantation (CI) were explored by categorizing them according to clinical course and changes in objective vestibular function. The changes in vestibular function of 62 patients (66 ears) were analyzed and vestibular symptoms were divided into three categories by their time course and nature. Etiologies were determined by analyzing the symptoms in combination with changes in objective vestibular function, measured using the caloric and/or video head impulse test. Before surgery, vestibular function was normal in 31 cases (47.0 %), unilaterally hypofunctional in 14 (21.2 %), and bilaterally hypofunctional in 21 (31.8 %). Eight cases (12.1 %) reported dizziness before surgery. A total of 18 cases (27.3 %) experienced postoperative dizziness. Ten patients experienced immediate transient dizziness (including 2 cases of benign positional paroxysmal vertigo); four experienced immediate prolonged dizziness (including 3 cases of bilateral vestibular hypofunction); and four experienced recurrent episodic dizziness (including 3 cases of suspicious endolymphatic hydrops). The sums of the maximal slow-phase velocities (SPVs) of the implanted ears were changed from 22.70 ± 17.31 to 12.55 ± 12.02°/s after implantation ( p = 0.004) with very little changes in the other side (32.65 ± 24.85-31.40 ± 29.10°/s). Careful review of vestibular status is an important step, especially when deciding implantation in the only vestibular functioning ear or bilateral implantation. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the efficacy of preoperative and intraoperative steroid administration for inner ear protection in cochlear implantation (CI). Nineteen subjects who underwent CI were included in the study, and 10 subjects were enrolled as controls (steroid-administered group, n = 19; control group, n = 10). Dexamethasone (dexamethasone sodium phosphate, 5 mg/ml) was systemically administered preoperatively (1 ml) and topically applied during CI (0.5 ml). The extent of hearing preservation (HP) after CI and the change in the bithermal caloric response were evaluated. Hearing level was calculated using mean thresholds [(250 Hz + 500 Hz + 1,000 Hz + 2,000 Hz)/4]. Preoperative hearing thresholds were similar in the steroid-administered and control groups (100.92 ± 12.60 vs. 103.29 ± 14.39 dB, p = 0.650). The mean thresholds significantly increased in both groups after surgery (108.46 ± 14.08 dB, p = 0.006, for the steroid-administered group; 117.50 ± 6.34 dB, p = 0.027, for the control group), and the difference between the groups was also significant (p = 0.027). The postoperative shift in the hearing thresholds at frequencies of 500 and 1,000 Hz was significant in the steroid-administered group and that at the frequencies of 500, 1,000 and 2,000 Hz was significant in the control group. However, the extent of the shift in hearing threshold levels at each frequency was not significantly different between the groups. Preservation of hearing thresholds was compared between the groups, and there were significantly more subjects with complete and partial HP in the steroid-administered group than in the control group (p = 0.008). The preoperative caloric response was maintained after CI in the steroid-administered group. This study suggests that the perioperative use of a steroid could minimize the inner ear damage after CI. [ABSTRACT FROM AUTHOR]

Stapedotomy, though a common surgical procedure for otosclerosis, if inadequately performed, can cause dreaded complications of vertigo and profound hearing loss. Labyrinthectomy with cochlear implantation can be considered in cases of intractable vertigo, as numerous reports have shown that the cochlea still remains responsive to electrical stimulation postlabyrinthectomy. This report presents a case of otosclerosis, with severe to profound deafness and intractable vertigo poststapedotomy surgery, which was treated with simultaneous labyrinthectomy and cochlear implantation. This patient had good control of vertigo postoperatively and the Dizziness Handicap Index score pre-?and post-operative were 80 and 38, respectively, with significant improvement in speech perception. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine the influence of cochlear implantation on vestibular function. The function of the horizontal semicircular canal, the saccular function, and the incidence of vestibular symptoms were assessed before and after cochlear implantation. Twenty unilaterally cochlear implant patients were evaluated preoperatively, 1 and 6 months postoperatively, with caloric testing with electronystagmography (ENG) recordings and vestibular evoked myogenic potentials (VEMP) testing. A medical history was taken from every subject, noting the presence or absence of vertigo before and after the operation. A possible correlation between the appearance of postoperative vertigo and age, sex, implant side, preoperative caloric results and VEMP status, and postoperatively recorded changes in caloric and VEMP testing was also investigated. A statistically significant difference was found in the percentages of canal paresis ( p = 0.01) and the percentages of VEMP waveform absence ( p = 0.002) between the repeated measurements in the implanted side, whereas in the non-implanted side no difference was ( p > 0.05) found. Four patients complained of postoperative vestibular symptoms. In three of them the symptoms lasted less than 6 months postoperatively, but the fourth patient was still dizzy 6 months after cochlear implantation. No correlation was found between the above-mentioned factors and the occurrence of postoperative vertigo. In conclusion, although changes of the peripheral vestibular function of the implanted side were recorded in our patients, permanent vertigo was rare. Predictive factors for the occurrence of postoperative vestibular symptoms could not be identified. [ABSTRACT FROM AUTHOR]

Background: Deteriorated hearing affects speech perception and speech production, and negatively impacts on social interaction, employment, income, and, as a result, the quality of life of the elderly population. Lack of satisfaction with conventional hearing aids motivated part of them to turn to more sophisticated cochlear device systems. Objective: To investigate the outcome of cochlear implantation (CI) among elderly cochlear implant recipients. Methods: The medical records of 20 postlingual patients aged >65 years at the time of CI, who were followed up for a period of at least 12 months were retrospectively reviewed for age at the time of CI, the cause and duration of deafness, hearing aid experience, comorbidities, complications of the procedure and audiological outcome. Pre- and post-CI speech perception performance was tested using a battery of speech perception tests. Results: In addition to bilateral severe to profound hearing loss, all 20 patients had some comorbidities and 13 had more than 2 pathologies that are associated with hearing impairment. Major complications such as facial nerve paralysis and foreign body reaction were rare (n = 2). Minor complications such as disequilibrium (n = 5) and wound problems (n = 5) resolved spontaneously or were successfully managed conservatively. There were no complications associated with general anesthesia used during the CI procedure. Statistical analysis using the Wilcoxon Signed Rank Test showed significant differences (p < 0.01) between the pre- and postspeech perception categories. No significant correlations were found between the background data: unaided thresholds, aided thresholds, duration of profound deafness, duration of hearing aid use prior to CI, speech perception before CI and speech perception performance after CI using Pearson correlations. Conclusion: CI was found to be associated with significant hearing benefit in elderly candidates. However, every CI candidate must be informed about possible complications associated with the procedure, especially related to the vestibular system. At the same time, it should be made clear that life-threatening conditions are rare and that the surgery is usually safe. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this work was to determine the influence of cochlear implantation (CI) on vestibular canal and otolithic function. Between 1995 and 1999, 15 patients (6 females, 9 males; 9-77 years old) underwent a vestibular examination before and after CI. Electronystagmography was performed between 5 and 8 days after CI in 9 patients, and with a time delay of 2-24 months in 10 patients. Pre- and postoperative evaluation included electronystagmography with caloric (44°C, 30°C, ice-water) and pendular rotatory testing. Otolithic function was measured postoperatively using off-vertical axis rotation (OVAR) in six patients. Preoperative data ( n = 14) showed areflexia on caloric and rotatory pendular testing in deafness cases due to meningitis ( n = 2) and in 2/5 patients with sudden idiopathic bilateral deafness. Two patients suffering from an idiopathic deafness had a unilateral hyporeflexia. Vestibular function was normal in the other eight patients. Immediately following CI, among patients with normal preoperative canal function, three developed vertiginous symptoms with spontaneous nystagmus, which disappeared within days to weeks. Later, postoperative canal evaluation was normal in 5/8 patients (62%) with initially preserved vestibular function: areflexia was measured ipsilaterally to the implanted ear in 1 patient and contralaterally in 2 patients. Hyporeflexia was measured ipsilateral to the implanted ear in two patients. OVAR examination, performed 2-19 months after surgery, showed a preserved otolithic function in all 6 tested patients. Transient vertigo on electrical CI stimulation was described in only one patient during the first postoperative weeks. The following conclusions can be drawn. Patients with deafness due to meningitis had an eradicated vestibular function. In other etiologies, vestibular function was most often preserved. CI did not usually abolish vestibular function, but the canal function was disturbed temporarily in 20% of cases. Otolithic function was preserved in all six CI patients tested in this series. [ABSTRACT FROM AUTHOR]