All Title Author
Keywords Abstract

Hearing Preservation after Cochlear Implantation: UNICAMP Outcomes

DOI: 10.1155/2013/107186

Full-Text   Cite this paper   Add to My Lib


Background. Electric-acoustic stimulation (EAS) is an excellent choice for people with residual hearing in low frequencies but not high frequencies and who derive insufficient benefit from hearing aids. For EAS to be effective, subjects' residual hearing must be preserved during cochlear implant (CI) surgery. Methods. We implanted 6 subjects with a CI. We used a special surgical technique and an electrode designed to be atraumatic. Subjects' rates of residual hearing preservation were measured 3 times postoperatively, lastly after at least a year of implant experience. Subjects' aided speech perception was tested pre- and postoperatively with a sentence test in quiet. Subjects' subjective responses assessed after a year of EAS or CI experience. Results. 4 subjects had total or partial residual hearing preservation; 2 subjects had total residual hearing loss. All subjects' hearing and speech perception benefited from cochlear implantation. CI diminished or eliminated tinnitus in all 4 subjects who had it preoperatively. 5 subjects reported great satisfaction with their new device. Conclusions. When we have more experience with our surgical technique we are confident we will be able to report increased rates of residual hearing preservation. Hopefully, our study will raise the profile of EAS in Brazil and Latin/South America. 1. Introduction Just over a decade ago people with sensorineural hearing loss had 2 main hearing (re)habilitation options: (1) a hearing aid (HA) if they had mild to moderate hearing loss and (2) a cochlear implant (CI) if they had severe to profound hearing loss. These 2 device options improved most users’ hearing. However, people who could hear in the low frequencies (up to 1000?Hz) but not the medium and high frequencies—the downward or “ski slope” audiogram—had too much high frequency hearing loss to benefit from their hearing aid(s) but were not CI candidates because surgeons feared the surgery would destroy their residual hearing. A solution for such people is electric-acoustic stimulation (EAS), a concept developed by von Ilberg and colleagues in 1999 [1]. EAS provides synergistic unilateral acoustic (via the HA) and electrical (via the CI) stimulation and provides its users with better hearing than they had had with their HA or HAs [2–4] and better hearing than enjoyed by unilateral CI-only users [1–5], especially in noisy environments [2–4, 6–9]. EAS also provides better sound quality and more natural hearing than unilateral CIs or HAs [4, 10]. These benefits are, however, only possible if surgeons do not damage the cochlea


[1]  C. von Ilberg, J. Kiefer, J. Tillein et al., “Electric-acoustic stimulation of the auditory system. New technology for severe hearing loss,” Journal for Oto-Rhino-Laryngology and Its Related Specialties, vol. 61, no. 6, pp. 334–340, 1999.
[2]  J. Kiefer, M. Pok, O. Adunka et al., “Combined electric and acoustic stimulation of the auditory system: results of a clinical study,” Audiology and Neurotology, vol. 10, no. 3, pp. 134–144, 2005.
[3]  A. Lorens, M. Polak, A. Piotrowska, and H. Skarzynski, “Outcomes of treatment of partial deafness with cochlear implantation: a DUET study,” Laryngoscope, vol. 118, no. 2, pp. 288–294, 2008.
[4]  W. Gstoettner, S. Helbig, C. Settevendemie, U. Baumann, J. Wagenblast, and C. Arnoldner, “A new electrode for residual hearing preservation in cochlear implantation: first clinical results,” Acta Oto-Laryngologica, vol. 129, no. 4, pp. 372–379, 2009.
[5]  B. J. Gantz and C. W. Turner, “Combining acoustic and electrical hearing,” Laryngoscope, vol. 113, no. 10, pp. 1726–1730, 2003.
[6]  B. J. Gantz, M. R. Hansen, C. W. Turner, J. J. Oleson, L. A. Reiss, and A. J. Parkinson, “Hybrid 10 clinical trial: preliminary results,” Audiology and Neurotology, vol. 14, supplement 1, pp. 32–38, 2009.
[7]  C. W. Turner, B. J. Gantz, C. Vidal, A. Behrens, and B. A. Henry, “Speech recognition in noise for cochlear implant listeners: benefits of residual acoustic hearing,” Journal of the Acoustical Society of America, vol. 115, no. 4, pp. 1729–1735, 2004.
[8]  W. K. Gstoettner, P. van de Heyning, A. O'Connor et al., “Electric acoustic stimulation of the auditory system: results of a multi-centre investigation,” Acta Oto-Laryngologica, vol. 128, no. 9, pp. 968–975, 2008.
[9]  R. H. Gifford, M. F. Dorman, A. J. Spahr, and S. A. McKarns, “Effect of Digital Frequency Compression (DFC) on speech recognition in candidates for combined Electric and Acoustic Stimulation (EAS),” Journal of Speech, Language, and Hearing Research, vol. 50, no. 5, pp. 1194–1202, 2007.
[10]  T. Lenarz, T. St?ver, A. Buechner, A. Lesinski-Schiedat, J. Patrick, and J. Pesch, “Hearing conservation surgery using the hybrid-L electrode: results from the first clinical trial at the Medical University of Hannover,” Audiology and Neurotology, vol. 14, supplement 1, pp. 22–31, 2009.
[11]  E. Lehnhardt and R. Laszig, “Specific surgical aspects of cochlear implant/soft surgery,” in Advances in Cochlear Implants, I. J. Hochmair-Desoyer and E. S. Hochmair, Eds., pp. 228–229, Manz, Vienna, Austria, 1994.
[12]  J. Kiefer, W. Gstoettner, W. Baumgartner et al., “Conservation of low-frequency hearing in cochlear implantation,” Acta Oto-Laryngologica, vol. 124, no. 3, pp. 272–280, 2004.
[13]  B. J. Gantz, C. W. Turner, K. E. Gfeller, and M. W. Lowder, “Preservation of hearing in cochlear implant surgery: advantages of combined electrical and acoustical speech processing,” Laryngoscope, vol. 115, no. 5, pp. 796–802, 2005.
[14]  W. K. Gstoettner, S. Heibig, N. Maier, J. Kiefer, A. Radeloff, and O. F. Adunka, “Ipsilateral electric acoustic stimulation of the auditory system: results of long-term hearing preservation,” Audiology and Neurotology, vol. 11, no. 1, pp. 49–56, 2006.
[15]  H. Skarzynski, A. Lorens, A. Piotrowska, and I. Anderson, “Preservation of low frequency hearing in partial deafness cochlear implantation (PDCI) using the round window surgical approach,” Acta Oto-Laryngologica, vol. 127, no. 1, pp. 41–48, 2007.
[16]  C. Arnoldner, S. Helbig, J. Wagenblast et al., “Electric acoustic stimulation in patients with postlingual severe high-frequency hearing loss: clinical experience,” Advances in Oto-Rhino-Laryngology, vol. 67, pp. 116–124, 2010.
[17]  O. Adunka, W. Gstoettner, M. Hambek, M. H. Unkelbach, A. Radeloff, and J. Kiefer, “Preservation of basal inner ear structures in cochlear implantation,” Journal for Oto-Rhino-Laryngology and Its Related Specialties, vol. 66, no. 6, pp. 306–312, 2004.
[18]  O. Adunka, J. Kiefer, M. H. Unkelbach, T. Lehnert, and W. Gstoettner, “Development and evaluation of an improved cochlear implant electrode design for electric acoustic stimulation,” Laryngoscope, vol. 114, no. 7, pp. 1237–1241, 2004.
[19]  W. Gstoettner, J. Kiefer, W. D. Baumgartner, S. Pok, S. Peters, and O. Adunka, “Hearing preservation in cochlear implantation for electric acoustic stimulation,” Acta Oto-Laryngologica, vol. 124, no. 4, pp. 348–352, 2004.
[20]  R. J. S. Briggs, M. Tykocinski, K. Stidham, and J. B. Roberson, “Cochleostomy site: implications for electrode placement and hearing preservation,” Acta Oto-Laryngologica, vol. 125, no. 8, pp. 870–876, 2005.
[21]  R. J. S. Briggs, M. Tykocinski, J. Xu et al., “Comparison of round window and cochleostomy approaches with a prototype hearing preservation electrode,” Audiology and Neurotology, vol. 11, supplement 1, pp. 42–48, 2006.
[22]  C. A. von Ilberg, U. Baumann, J. Kiefer, J. Tillein, and O. F. Adunka, “Electric-acoustic stimulation of the auditory system: a review of the first decade,” Audiology and Neurotology, vol. 16, supplement 2, pp. 1–30, 2011.
[23]  M. C. Bevilacqua, M. R. Banhara, E. A. da Costa, A. B. Vignoly, and K. F. Alvarenga, “The Brazilian Portuguese hearing in noise test,” International Journal of Audiology, vol. 47, no. 6, pp. 364–365, 2008.
[24]  S. Helbig, P. van de Heyning, J. Kiefer et al., “Combined electric acoustic stimulation with the PULSARCI100 implant system using the FLEXEAS electrode array,” Acta Oto-Laryngologica, vol. 131, no. 6, pp. 585–595, 2011.
[25]  S. Helbig, U. Baumann, M. Helbig, N. von Malsen-Waldkirch, and W. Gstoettner, “A new combined speech processor for electric and acoustic stimulation—eight months experience,” Journal for Oto-Rhino-Laryngology and Its Related Specialties, vol. 70, no. 6, pp. 359–365, 2008.
[26]  C. Arnoldner, W. Gstoettner, D. Riss et al., “Residual hearing preservation using the suprameatal approach for cochlear implantation,” Wiener klinische Wochenschrift, vol. 123, no. 19-20, pp. 599–602, 2011.
[27]  H. Skarzynski, A. Lorens, M. Zgoda, A. Piotrowska, P. H. Skarzynski, and A. Szkielkowska, “Atraumatic round window deep insertion of cochlear electrodes,” Acta Oto-Laryngologica, vol. 131, no. 7, pp. 740–749, 2011.
[28]  T. Pan, R. S. Tyler, H. Ji, C. Coelho, A. K. Gehringer, and S. A. Gogel, “Changes in the tinnitus handicap questionnaire after cochlear implantation,” American Journal of Audiology, vol. 18, no. 2, pp. 144–151, 2009.
[29]  D. M. Baguley, “New insights into tinnitus in cochlear implant recipients,” Cochlear Implants International, vol. 11, no. 2, pp. 31–36, 2010.
[30]  A. Kleine-Punte, K. Vermeire, A. Hofkens, M. de Bodt, D. de Ridder, and P. van de Heyning, “Cochlear implantation as a durable tinnitus treatment in single-sided deafness,” Cochlear Implants International, vol. 12, supplement 1, pp. 26–29, 2011.
[31]  M. Kompis, M. Pelizzone, N. Dillier, J. Allum, N. DeMin, and P. Senn, “Tinnitus before and after 6 months after cochlear implantation,” Audiology and Neurotology, vol. 17, no. 3, pp. 161–168, 2012.


comments powered by Disqus