20 Jahre bilaterale Cochleaimplantation – eine Analyse seither implantierter erwachsener Patienten

Abstract

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

Bilateral Cochlear Implantation in Children: Long-Term Outcome in the Adult Population With Special Emphasis on the Bilateral Benefit

“…If the scores of the unilateral test situation in quiet are compared to other studies, the results were similar (about 80%) (24,26,32,33). Regarding the bilateral test condition the scores were higher, which has already been demonstrated in this test in bilaterally implanted adults (34). The HSM sentence test in background noise revealed better results in the unilateral testing setup of about 55% compared to other studies, in which the scores were about 45% (24)(25)(26)32,34).…”

“…The HSM sentence test in background noise revealed better results in the unilateral testing setup of about 55% compared to other studies, in which the scores were about 45% (24)(25)(26)32,34). In only one study the increase in bilateral cochlear-implanted patients has been investigated reporting 18% from 47% to 65% in an adult population (34). In the present study a similar gain could be evaluated, but reaching scores of over 70%, which have not been reported in the literature using this test and under this condition until now.…”

“…Regarding the bilateral test condition the scores were higher, which has already been demonstrated in this test in bilaterally implanted adults (34). The HSM sentence test in background noise revealed better results in the unilateral testing setup of about 55% compared to other studies, in which the scores were about 45% (24)(25)(26)32,34). In only one study the increase in bilateral cochlear-implanted patients has been investigated reporting 18% from 47% to 65% in an adult population (34).…”

Active and Adequate Exposure of the Facial Nerve and Chorda Tympani Nerve to Improve the Safety of Cochlear Implantation

“…(6) As we all know, if dysgeusia was caused by unilateral chorda tympanic nerve injury after unilateral cochlear implant, contralateral chorda tympanic might compensate taste function several months later. However, with the popularization of bilateral cochlear implants, 15 preserving the integrity of the chorda tympanic nerve is even more important. Our approach is active and adequate exposure of the chorda tympanic nerve under direct vision, which can avoid the blindness of nerve injury, whether or not there are facial nerve and chorda tympanic nerve variation.…”

Kommentar der Schriftleitung

“…Voraussetzung ist jedoch, so die Autoren, eine große Erfahrung in der Mittelohr und Implantatchirurgie. Wichtig erscheint, dass die Verweildauer der Patienten trotz deutlich optimierter OP-Technik im Durchschnitt 4,7 Tage nicht unterbot [11,12]. Stephan Engel und Kollegen stellen ihre Erfahrungen zur transoralen videoendoskopischen Resektion von Kopf-Hals-Tumoren in 4-Hand-Technik (TOVR) in einem gut illustrierten Artikel vor [13].…”