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Hearing aids and cochlear implants are two major hearing enhancement technologies but yet share little in research and development. The purpose of this study was to determine whether hearing aid directional microphones and noise reduction technologies could enhance cochlear implant users' speech understanding and ease of listening. Digital hearing aids serving as preprocessors were programmed to omni-directional microphone, directional microphone, and directional microphone plus noise reduction conditions. Three groups of subjects were tested with the hearing aid processed speech stimuli. Results indicated that hearing aids with directional microphones and noise reduction algorithms significantly enhanced speech understanding and listening comfort. (C) 2004 Acoustical Society of America.

Maura K Cosetti,1,2 James B Pinkston,3 Jose M Flores,4 David R Friedmann,5 Callie B Jones,3 J Thomas Roland Jr,5,6 Susan B Waltzman5 1Department of Otolaryngology – Head and Neck Surgery, 2Department of Neurosurgery, 3Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, 5Department of Otolaryngology, 6Department of Neurosurgery, New York University School of Medicine, New York, NY, USA Objective: The aim of this case series was to assess the impact of auditory rehabilitation with cochlear implantation on the cognitive function of elderly patients over time. Design: This is a longitudinal case series of prospective data assessing neurocognitive function and speech perception in an elderly cohort pre- and post-implantation. Setting: University cochlear implant center. Participants: The patients were post-lingually deafened elderly female (mean, 73.6 years; SD, 5.82; range, 67–81 years) cochlear implant recipients (n=7). Measurements: A neurocognitive battery of 20 tests assessing intellectual function, learning, short- and long-term memory, verbal fluency, attention, mental flexibility, and processing speed was performed prior to and 2–4.1 years (mean, 3.7) after cochlear implant (CI). Speech perception testing using Consonant–Nucleus–Consonant words was performed prior to implantation and at regular intervals postoperatively. Individual and aggregate differences in cognitive function pre- and post-CI were estimated. Logistic regression with cluster adjustment was used to estimate the association (%improvement or %decline) between speech understanding and years from implantation at 1 year, 2 years, and 3 years post-CI. Results: Improvements after CI were observed in 14 (70%) of all subtests administered. Declines occurred in five (25%) subtests. In 55 individual tests (43%), post-CI performance improved compared to a patient’s own performance before implantation. Of these, nine (45%) showed moderate or pronounced improvement. Overall, improvements were largest in the verbal and memory domains. Logistic regression demonstrated a significant relationship between speech perception and cognitive function over time. Five neurocognitive tests were predictive of improved speech perception following implantation. Conclusion: Comprehensive neurocognitive testing of elderly women demonstrated areas of improvement in cognitive function and auditory perception following cochlear implantation. Multiple neurocognitive tests were strongly associated with current speech perception measures. While these data shed light on the complex relationship between hearing and cognition by showing that CI may slow the expected age-related cognitive decline, further research is needed to examine the impact of hearing rehabilitation on cognitive decline. Keywords: cognitive function, cognitive impairment, dementia, aging, hearing loss, cochlear implant, neuropsychological testing

A major concern regarding multichannel (multi-electrode) cochlear prosthesis usage has been the possibility of long-term deleterious physiological effects such as the degeneration of spiral ganglion cells, neuronal degeneration, and new bone formation. These effects, if present, would become evident in the deterioration of hearing sensation and performance of the cochlear implant recipient on a battery of audiologic tests. To date, five patients using the Australian multi-electrode multichannel cochlear implant have undergone a 1-year evaluation of the device. The assessment includes a check of electrical threshold and comfort levels for each electrode, sound field pure tone and speech thresholds, the MAC battery, vowel and consonant recognition tests, and speech tracking tasks. All results were compared to those obtained postoperatively following stimulation and a 3-month training period. Results to date have shown no deterioration in implant functioning in all patients tested. Periodic extensive monitoring of all implant recipients is advocated in order to evaluate the possibility of long-term effects. [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]

Objectives: Cochlear implant performance is dependent upon several factors including, but not limited to, patient demographics, surgical issues, programming and rehabilitation. A global survey of professionals involved in cochlear implant programming conducted several years ago found a lack of programming standardization across cochlear implant centers which appeared to affect patient outcomes across the centers completing the survey. Materials and Methods: Since devices have changed over the years, we sought to conduct an updated survey to evaluate current global cochlear implant programming practices in adults. Data captured in this updated global sample include demographic data including preoperative, surgical, performance outcomes and current programming methodology for all devices. Details regarding specific programming parameters for all devices will be summarized. Results and Conclusions: While statistical analyses are planned, preliminary data show a similar pattern to the previous study (Vaerenberg et al, 2014) revealing varying programming methods used both across continents and across centers. By in large, programming methods did not vary substantially from those reported previously despite advances in technology. We will report the results, compare them to the previous study, and outline similarities and differences between centers and attempt to define various methods applicable for different populations and devices in order to maximize performance. Additionally, since more implant recipients appear to be receiving services remotely or outside of the implanting center, we will attempt to evaluate the impact of these issues. The effects of these various factors will be examined with the intent of sharing this information across centers and suggesting possible best practices. [ABSTRACT FROM AUTHOR]

Objectives: To discuss the outcomes and decision making process for hearing rehabilitation in children with severe cochlear malformations. Material and Methods: Outcomes with cochlear implantation and auditory brainstem implantation will be discussed with a number of illustrative case examples. Pre and post operative results after CI and after ABI, including children with CI on one side and ABI on the other are presented. Results: Patients with severe cochlear malformation can receive good benefit from a cochlear implant. Those with thresholds and limited speech perception can also benefit from an ABI on the opposite side and bimodal us. The decision to implant with an ABI initially or later is difficult. Conclusion: Auditory Brainstem Implantation and Cochlear Implantation are both possible is children with severe cochlear malformations and cochlear nerve deficiency. It is our feeling that cochlear implantation early in life is the best first option followed by ABI on the opposite ear. Children with this bimodal means of rehabilitation seem to be our best performers. [ABSTRACT FROM AUTHOR]

Objective: To better understand cochlear implant (CI) performance after reimplantation with a different device manufacturer., Study Design: Multisite retrospective review., Setting: Tertiary referral centers., Patients: Patients older than 4 years who received a CI and subsequently underwent CI reimplantation with a different manufacturer over a 20-year period., Intervention: Reimplantation., Main Outcome Measure: The primary outcome was difference in the best CNC score obtained with the primary CI, compared with the most recent CNC score obtained after reimplantation., Results: Twenty-nine patients met the criteria at three centers. The best average CNC score achieved by adult patients after primary cochlear implantation was 46.2% (n = 16), measured an average of 14 months (range: 3-36 mo) postoperatively. When looking at the most recent CNC score of adult patients before undergoing reimplantation, the average CNC score dropped to 19.2% (n = 17). After reimplantation, the average 3- to 6-month CNC score was 48.3% (n = 12), with most recent average CNC score being 44.4% (n = 17) measured an average of 19 months (range: 3-46 mo) postoperatively. There was no statistically significant difference (p = 0.321; t11 = 0.48) identified in performance between the best CNC score achieved by adult patients after primary cochlear implantation, and the most recent score achieved after reimplantation (n = 12). Analysis of prerevision and postrevision speech performance was not possible in pediatric patients (<18 yr old) because of differences in tests administered., Conclusion: Patients undergoing reimplantation with a different manufacturer achieved CNC score performance comparable to their best performance with their original device., Competing Interests: The remaining authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Objectives: This study aims to synthesize current knowledge and outcomes related to pediatric auditory brainstem implantation (ABI) in children with severe inner ear malformations (IEMs). It highlights the clinical management practices, challenges, and potential future directions for consensus development in this field., Methods: A systematic review of findings presented at the Third International Pediatric ABI Symposium organized by the Hacettepe Cochlear Implant team between 3 and 5 September 2020 was conducted, incorporating data from 41 departments across 19 countries. Relevant clinical outcomes, imaging techniques, surgical approaches, and rehabilitation strategies were analyzed to identify key trends and variability in practices., Results: The review indicates that children receiving ABIs exhibit diverse auditory outcomes influenced by individual anatomical variations and developmental factors. Early implantation, particularly before the age of three, positively correlates with better auditory and language development. Multicenter experiences underscore the necessity of tailored decision-making, which considers both surgical candidacy and comprehensive rehabilitation resources., Discussion:: The variability in outcomes emphasizes the need for improved consensus and guidelines regarding eligibility, surgical techniques, and multidisciplinary rehabilitation approaches. Notable complications and the necessity for thorough imaging assessments were also identified as critical components affecting clinical decisions., Conclusion: A formal consensus statement is warranted to standardize best practices in ABI management. This will not only enhance patient outcomes but also guide future research efforts to address the remaining challenges in the treatment of children with severe IEMs. Enhanced collaboration among team members will be pivotal in achieving these objectives.

Objective: To assess the safety of cochlear implants (CIs) in children under 9 months of age to better understand expected postoperative complication rates, and to provide a preliminary look at efficacy., Study Design: Single-center retrospective review., Setting: Tertiary referral center., Patients: Children 5 to 8 months of age who received a CI between 2011 and 2021., Interventions: Therapeutic-CI., Main Outcome Measures: The primary outcome was 6-month postoperative complication rate. Secondary outcomes included length of stay, device explantation/reimplantation, rehabilitation supports, and hearing and language outcomes. Complications of children implanted under than 9 months of age was compared with a cohort of children implanted 9 to 18 months of age between the years 2011 and 2016 using a chi-squared test ( p < 0.05)., Results: One hundred six children under 9 months of age were implanted (204 CIs) at a mean age of 6.6 months (range: 5-8). Postoperative complications occurred in 28 patients (26%) and were often minor. There were no mortalities. There was no statistically significant difference in complications, including reimplantation rates, between patients implanted under 9 months of age and those implanted 9 to 18 months of age. Speech discrimination outcomes were excellent, and mean spoken language outcomes were near normative for typically developing children., Conclusions: Cochlear implantation can be a safe and effective treatment option for children 5 to 8 months of age. Early hearing screening and referral for infants to receive appropriate intervention will continue to play a critical role in optimizing speech and language outcomes., Competing Interests: Conflicts of interest and source of funding: Dr. J. Thomas Roland Jr. is a consultant for Cochlear Americas and received research funding for cochlear implant-related projects, which are not affiliated with this research., (Copyright © 2023, Otology & Neurotology, Inc.)

This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9-11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012-December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Evaluate rates of Advanced Bionics Ultra 3D/Ultra cochlear implant failure in the setting of a worldwide device recall and report surgical and auditory outcomes after revision., Methods: Retrospective chart review was performed for adult and pediatric patients implanted with at risk devices at our center from 2016 to 2020. Device failure rates, surgical, and auditory outcomes were recorded and analyzed., Results: Of 113 at-risk devices, 20 devices (17.7%) in 18 patients (two bilaterally implanted) were identified as failures. All devices were with mid-scala electrodes. Eleven patients (61.1%) were children and 7 (38.9%) adults. Twelve patients were found to have failing devices after reporting subjective performance decline; the remainder were prompted by manufacturer notification. All were revised, with the majority (83.3%) choosing the same manufacturer. All had uncomplicated original and revision insertions. Among adults, average word scores on the revised side were stable pre- to post-revision ( P  = 0.95)., Discussion: Patients with device failure due to this field action performed well after revision implantation. Patients with bilateral at-risk devices but evidence of unilateral failure may elect to undergo simultaneous empiric revision of the contralateral device. Three patients who elected to change device manufacturers on revision have variable results that require further investigation., Conclusions: Patients requiring revision for a device field action overall perform well. At-risk devices continue to require monitoring as a growing number are likely to fail over time.

Objective: To determine factors associated with infection, management, and resultant outcomes following pediatric cochlear implantation., Study Design: Retrospective cohort study with nested case series., Setting: Tertiary academic medical center., Patients: Children who underwent either unilateral or bilateral cochlear implantation between June 2011 and September 2016 and were under the age of 18 at the time of surgery., Intervention(s): Subjects were compared based on age, cochlea malformation, revision surgery, operative time, device manufacturer, and antibiotic use. Infections were compared based on location, time, bacteria, management, and resolution., Main Outcome Measure(s): Rate of infection, rate of device explantation., Results: There were 16 infections among 246 surgeries, an infection rate of 6.5%. There was a significant age difference between infected and noninfected patients overall (n = 246, 1.4 versus 4.3 years, p = 0.005), but not within the cohort of patients five or younger (n = 172, 1.4 versus 1.8 years, p = 0.363). The most common infectious complication was skin infection, followed by device infection. No cases of meningitis were seen. The most common organism was S Aureus. The implant was salvaged in 9 of 16 patients (56.3%), with higher rates in patients treated with IV versus oral antibiotics (70 versus 40%)., Conclusions: Postoperative infection is positively associated with younger age overall, but not in patients below the age of 5. With modern devices and surgical practices, risk of meningitis-though a concern-may be lower than cited in the literature. Prompt and aggressive therapy with IV antibiotics and operative intervention can allow for high rates of device salvage.

Objectives: The auditory experience of early deafened pediatric cochlear implant (CI) users is different from that of postlingually deafened adult CI users due to disparities in the developing auditory system. It is therefore expected that the auditory psychophysical capabilities between these two groups would differ. In this study, temporal resolving ability was investigated using a temporal modulation detection task to compare the performance outcomes between these two groups., Design: The minimum detectable modulation depth of amplitude modulated broadband noise at 100 Hz was measured for 11 early deafened children with a CI and 16 postlingually deafened adult CI users., Results: Amplitude modulation detection thresholds were significantly lower (i.e., better) for the pediatric CI users than for the adult CI users. Within each group, modulation detection thresholds were not significantly associated with chronologic age, age at implantation, or years of CI experience., Conclusions: Early implanted children whose auditory systems develop in response to electric stimulation demonstrate better temporal resolving abilities than postlingually deafened adult CI users. This finding provides evidence to suggest that early implanted children might benefit from sound coding strategies emphasizing temporal information.

Object: The aim of this study was to determine whether patients with neurofibromatosis Type 2 (NF2) who have intact ipsilateral cochlear nerves can have open-set speech discrimination following cochlear implantation., Methods: Records of 7 patients with documented NF2 were reviewed to determine speech discrimination outcomes following cochlear implantation. Outcomes were measured using consonant-nucleus-consonant words and phonemes; Hearing in Noise Test sentences in quiet; and City University of New York sentences in quiet and in noise., Results: Preoperatively, none of the patients had open-set speech discrimination. Five of the 7 patients had previously undergone excision of ipsilateral vestibular schwannoma (VS). One of the patients who received a cochlear implant had received radiation therapy for ipsilateral VS, and another was undergoing observation for a small ipsilateral VS. Following cochlear implantation, 4 of 7 patients with NF2 had open-set speech discrimination following cochlear implantation during extended follow-up (15-120 months). Two of the 3 patients without open-set speech understanding had a prolonged period between ipsilateral VS resection and cochlear implantation (120 and 132 months), and had cochlear ossification at the time of implantation. The other patient without open-set speech understanding had good contralateral hearing at the time of cochlear implantation. Despite these findings, 6 of the 7 patients were daily users of their cochlear implants, and the seventh is an occasional user, indicating that all of the patients subjectively gained some benefit from their implants., Conclusions: Cochlear implantation can provide long-term auditory rehabilitation, with open-set speech discrimination for patients with NF2 who have intact ipsilateral cochlear nerves. Factors that can affect implant performance include the following: 1) a prolonged time between VS resection and implantation; and 2) cochlear ossification.

Objectives/hypothesis: Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed., Study Design: Retrospective chart review., Methods: Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data., Results: Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients., Conclusions: Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population.

Objective: To evaluate hearing outcomes and effects of stimulation rate on performance with the Nucleus Freedom cochlear implant (Cochlear Americas, Denver, CO)., Study Design and Setting: Randomized, controlled, prospective, single-blind clinical study using single-subject repeated measures (A-B-A-B) design at 14 academic centers in the United States and Canada and comparison with outcomes of a prior device by the same manufacturer., Patients: Seventy-one severely/profoundly hearing impaired adults., Results: Seventy-one adult recipients were randomly programmed in two different sets of rate: ACE or higher rate ACE RE. Mean scores for Consonant Nucleus Consonant words is 57%, Hearing in Noise Test (HINT) sentences in quiet 78%, and HINT sentences in noise 64%. Sixty-seven percent of subjects preferred slower rates of stimulation, and performance did not improve with higher rates of stimulation using this device., Conclusions: Subjects performed well, and there was no advantage to higher stimulation rates with this device., Significance: Higher stimulation rates do not necessarily result in improved performance.

Objective: This study consisted of a within-subjects comparison of speech recognition and patient preference when subjects used two different cochlear implant speech processing strategies with a Clarion 1.2 (enhanced bipolar) device: Simultaneous Analog Stimulation (SAS), and Continuous Interleaved Sampling (CIS). These two strategies used two different electrode configurations: the SAS strategy used bipolar stimulation, whereas the CIS strategy used monopolar stimulation., Study Design: This was a multicenter study that used a within-subjects balanced crossover design. Experience with the two strategies was replicated in each subject using an ABAB design. Order of strategy use was balanced across all subjects., Setting: The study was carried out at several cochlear implant centers affiliated with tertiary medical centers., Patients: Subjects consisted of 25 postlingually deafened adults who received a Clarion cochlear implant., Interventions: Total involvement by each subject was 14 weeks. Speech perception testing and sound quality assessments were performed after use with each strategy., Main Outcome Measures: Primary outcome measures include speech perception data and patient responses to questionnaires regarding speech and sound quality., Results: Analyses revealed that performance did not differ significantly by the strategy encountered first as relative to the strategy encountered second and that the order in which a strategy was used did not appear to affect subjects' eventual preference for a particular strategy. Although speech recognition scores tended to be higher for CIS for most of the test measures at most of the test intervals, the analysis of variance to evaluate differences in strategy did not reveal a significant effect of strategy. Further analysis of scores obtained at the replication interval, however, revealed that scores obtained with CIS were significantly higher than scores obtained with SAS on the Hearing in Noise Test sentences in quiet and noise. In addition, significantly more patients indicated a final preference for the CIS strategy than for the SAS strategy. Importantly, both the analysis evaluating order and the analysis evaluating strategy revealed significant effects of evaluation period, indicating that time/experience with the implant had a significant effect on scores for each strategy, regardless of the order in which it was used (first or second)., Conclusions: This study demonstrates that important learning occurs during the first several weeks of cochlear implant use, making it difficult to adequately compare performance with different speech processing strategies. However, the finding that patients often prefer the strategy they understand speech the best with supports the clinical practice of letting adult patients select their preferred strategy without formally evaluating speech perception with each available strategy.

Objectives: Cochlear implant device failures and reimplantation have mainly been reported on in adults. The purpose of this study was to isolate precursors of device failures and assess the effects of reimplantation in children., Methods: From 1997 to 2003, 27 children underwent cochlear reimplantation at our institution. The pre-failure complaints were categorized and correlated with actual failure modes and postimplantation results. Speech-recognition tests were used to evaluate pre- and post-reimplantation performance., Results: Pre-failure length of usage ranged from 0 to 12 years. Symptoms including pain, intermittence, reduced performance, noise and the need for frequent device adjustments were associated with device failures, although not with a particular mode of failure. Post reimplantation performance was equal to but not immediately better than pre-failure results in children who received upgraded devices., Conclusions: Specific complaints, frequent need for device adjustments and reduced speech recognition can be precursors to device failures, underscoring the need for routine follow-up evaluations. Reimplantation with newer technology does not guarantee improved speech understanding and often requires an adjustment period to reach pre-reimplantation levels.

Objectives/hypothesis: The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of "upgrades" (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist., Study Design: Retrospective chart review., Methods: The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single-channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation., Results: Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation., Conclusions: Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.

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

Objective: To compare the short-term development of open-set speech perception between implementations of the spectral peak (SPEAK) strategy in adults using the Nucleus 22 (N22) Spectra processor and the Nucleus 24 (N24) system with the SPrint processor., Study Design: Two sets of patients with a follow-up period of 3 months were compared., Setting: This study was conducted at the New York University (NYU) Medical Center., Patients: Thirty-six profoundly hearing-impaired adults were included in this study., Intervention: Sixteen adults received the N22 cochlear implant with the Spectra speech processor and twenty adults received the N24 cochlear implant with the SPrint speech processor., Main Outcome Measures: Open-set speech perception for the patients with N22 implants was evaluated preoperatively and postoperatively using the following measures: NU-6 monosyllabic words, Iowa sentences, and CID sentences. CNC words, CUNY sentences, and HINT sentences were used to assess the patients with N24 implants., Results: Results revealed that the N22 and N24 cochlear implant recipients had significant open-set speech recognition 3 and 6 months after implantation. The apparent favorable absolute scores for the patients with N24 implants were equalized when a multivariate analysis was performed to account for their younger age at time of implantation and shorter length of deafness., Conclusions: The growth of open-set word and sentence recognition in similar between the N22 and N24 cochlear implants. Longitudinal studies are needed to determine if higher ceiling scores are present in the N24. Further exploration of monopolar versus bipolar stimulation is warranted.

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

Objective: To report early postimplantation speech recognition results in children who received Nucleus CI24M cochlear implants., Study Design: The study group consisted of 19 consecutively implanted children., Patients and Setting: Congenitally deaf children (20 months to 15 years old) were implanted with the Nucleus CI24M and followed-up at New York University Medical Center for a period of 3 to 12 months., Main Outcome Measures: Speech perception was evaluated preoperatively and postoperatively using the Early Speech Perception (ESP) test, the Glendonald Auditory Screening Procedure (GASP) word and sentence tests, Phonetically Balanced Kindergarten (PBK) monosyllabic word lists, Common Phrases test, the Multisyllabic and Lexical Neighborhood (MLNT, LNT) tests, and the Banford-Kowal-Bench (BKB) sentence test., Results: One-way analyses of variance revealed significant improvement in open-set speech recognition in children able to perform measurement tasks., Conclusions: The Nucleus CI24M cochlear implant provides significant benefit to children after short-term use.

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

Objective: To determine the viability of giving implants to children <2 years old and to assess the development of speech perception., Study Design: A prospective study with a follow-up period of 1-5 years., Setting: New York University Medical Center., Patients: The patients consisted of 11 consecutive profoundly deaf children, aged 14-23 months, who were given the Nucleus cochlear implant., Methods: Closed- and open-set speech perception were assessed preoperatively and postoperatively using the following measures: Early Speech Perception (ESP) test, the Northwestern University children's perception of speech test (NU-CHIPS), the Glendonald auditory screening procedure (GASP) word and sentence tests, the phonetically balanced kindergarten (PBK) word test, common phrases test, the multisyllabic lexical neighborhood test (MLNT), and the lexical neighborhood test (LNT)., Results: Paired t test was used to examine changes in scores from the preoperative test interval to the last available postoperative assessment. Results indicate that all patients had significant improvement from preoperative performance to the last postoperative evaluation and were using oral language as their means of communication. There were no medical or surgical complications., Conclusions: Children <2 years old receive substantial benefit from a multichannel cochlear implant with no increase in risk when compared with older children.

Objective: This study aimed to evaluate the change in performance when the Speak processing strategy replaced the Mpeak strategy., Subjects: Twenty-one veterans who participated in the original Department of Veterans Affairs Multicenter Cochlear Implant Study, received the Nucleus F0F1F2 processor (Cochlear Corp., Englewood, CO, U.S.A.) (WSP) and were subsequently upgraded to the Mpeak (MSP) processing strategy., Methods: Closed- and open-set speech recognition in quiet and in noise in auditory only conditions at the phoneme, word, and sentence levels were evaluated., Results: Changes in audiologic parameters were evaluated using a paired t-test for related samples. Statistically significant improvements in mean scores were found for all tests and were greatest for the speech-in-noise conditions. An examination of individual data revealed that 61% of the subjects improved for tests administered in quiet, whereas up to 69% of the subjects had improved performance in noise. Subjects with no open set speech discrimination using the Mpeak strategy showed no improvement with the Speak strategy., Conclusions: Cochlear implants can provide improved performance using modifications to external speech processor hardware and software without changing the internal implant.

Objective: To assess and document the development of open-set speech recognition in congenitally deaf children implanted with the Nucleus multichannel cochlear prosthesis at < 5 years of age., Study Design: The study group consisted of 38 consecutively chosen children in whom the decision to proceed with implantation had already been made., Patients and Setting: Congenitally profoundly deaf children were implanted with the Nucleus multichannel cochlear implant at < 5 years of age and followed at NYU Medical Center for a period of 1-5 years., Main Outcome Measures: Open-set speech perception was evaluated preoperatively and postoperatively using the following: the Glendonald Auditory Screening Procedure (GASP) word subset, the GASP sentence subtest, Phonetically Balanced Kindergarten monosyllabic word lists, Common Phrases test, Multisyllabic Lexical Neighborhood test, and Lexical Neighborhood test., Results: Correlation coefficients were calculated between scores at each interval and age at implantation; one-way analyses of variance were performed independently. Results showed that all subjects had significant open-set speech recognition at the time of the last postoperative evaluation. Thirty-seven of the children use oral language as their sole means of communication., Conclusions: Multichannel cochlear implants provide significant and usable open-set speech perception in congenitally deaf children given implants at < 5 years of age.

Objective: To address the surgical and habilitative issues raised by cochlear implantation in children with cochlear dysplasia., Study Design: The English-language literature is reviewed and the New York University Medical Center experience with three patients is detailed. Two hundred institutions performing cochlear implants were queried by questionnaire., Setting: Hospitals performing cochlear implantation., Patients: Pediatric patients with a cochlear implant in an ear with a dysplastic cochlea., Main Outcome Measures: Preoperative computed tomography analysis of cochlear anatomy was compared with operative findings, complications, and postoperative device use., Results: Facial nerve anatomy was anomalous in 16% of patients, and there were two surgical injuries. There were no cases of meningitis. All patients who received multichannel implants derive benefit and wear their devices., Conclusions: All degrees of cochlear dysplasia, ranging from incomplete partition to common cavity, can be safely implanted and auditory responses expected.

Purpose: To present the postoperative radiographic appearance of the multichannel cochlear implant and to suggest criteria for the radiographic evaluation of postimplant patients., Methods: One hundred forty-one patients, 73 female and 68 male, had multichannel cochlear implants inserted. One hundred thirty-five intraoperative radiographs, 31 postoperative radiographic examinations, and 10 postoperative CT examinations were retrospectively reviewed., Results: In 135 patients, a Stenver's or anteroposterior projection confirmed the normal placement of the implant by demonstrating the electrodes to be regularly spaced and gently curved within the first turn of the cochlea. The insertion depth was determined by counting the number of electrodes that projected medial to the cochlear promontory. In 5 patients in whom intracochlear placement of the electrode array could not be confirmed on plain radiographs, CT demonstrated the location of the electrode array. In 3 patients with postoperative infections, CT either correctly identified or excluded the presence of a collection beneath the implant., Conclusion: Plain radiographs of the temporal bone are sufficient for the postoperative treatment of the majority of postimplant patients. CT should be performed when plain radiographs cannot adequately show the location of the electrode array or if postoperative infection is suspected.

The development of new processing strategies has allowed for the improvement of auditory skills in cochlear implant recipients. This study examines the effects of a change in processing strategy on the individual recipients of the Nucleus cochlear prosthesis. Twenty-five subjects who had used the F0F1F2 processing strategy (WSP III) for 2 years were switched to the MPeak strategy (MSP) and retested immediately and after 3 months. Results revealed an improvement in speech recognition ability with the MPeak strategy in those subjects who were able to perceive speech with the F0F1F2 processing strategy.