Considerations for Cochlear Implantation of Children with Sudden, Fluctuating Hearing Loss

Sweetow, Robert W.; Rosbe, Kristina W.; Philliposian, Carey; Miller, Monica T.

doi:10.3766/jaaa.16.10.2

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…39 In addition, parents vary in terms of how much information they want about a trial. 40,41 A wish for more information has been associated with increased anxiety and less sense of control, 42 but if parents feel inadequately informed it can dissuade them from participating. 43 Anxiety may be moderated by trust in medical research and the relationship parents have with practitioners.…”

Section: Qualitative Interviews With Parents and Children With Cleft mentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

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Section: Qualitative Interviews With Parents and Children With Cleft mentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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“…All studies revealed pre‐operative hearing assessments, of which 13 specifically mentioned pure tone audiometry (PTA), all showing severe to profound hearing loss or anacusis. Three studies additionally also reported otoacoustic emission testing pre‐operatively, all reporting no response, which would suggest that the diseases primarily affect the cochlea and not the auditory nerve 6,28,29 . With the exception of Aschendorff (who did not report post‐op outcomes in 3 of 4 cases), 30 all studies gave post‐operative audiometric data for each individual case or as an average.…”

Section: Resultsmentioning

confidence: 99%

Hearing loss in inner ear and systemic autoimmune disease: A systematic review of post‐cochlear implantation outcomes

Lee

Biggs

Muzaffar

et al. 2021

Laryngoscope Investig Oto

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Objectives To assess outcomes following cochlear implantation (CI) in patients with hearing loss secondary to primary or secondary autoimmune inner ear disease (AIED). Methods A systematic review and narrative synthesis was completed according to PRISMA guidelines. Databases searched included MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Collection, and http://clinicaltrials.gov. No limits were placed on year of publication or language. Results A total of 551 studies were identified, of which 29 were included after removal of duplicates, and screening the title, abstract, and full text. All except one study were OCEBM grade IV. 114 of 115 patients displayed improvement in hearing following cochlear implantation. With implant use, roughly a third of these patients had hearing that improved over time, a third improved and plateaued, and a third remained stable. There was no additional risk of perioperative complications found in AIED patients compared what is generally accepted in general cochlear implantation, although two episodes of device failure after 6 months were noted, and four patients with secondary AIED displayed poor initial audiological outcomes. Conclusion CI in both primary and secondary AIED provides marked improvement in hearing. Early CI may be a valid management option, provide long‐lasting hearing in patients and reduce the side effects of long‐term systemic immunosuppressants. However, patients should be counseled residual hearing may be lost if there is cochlear ossification or fibrosis which may make implant insertion more traumatic. Level of Evidence NA.

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“…All 26 studies included were full articles ( 4 – 12 , 16 – 30 , 38 , 39 ). 23.0% (6/26) articles were case series (more than one patient) ( 10 , 18 , 20 , 24 , 25 , 38 ), 46.2% (12/26) were case reports (one patient) ( 4 , 5 , 9 , 17 , 21 – 23 , 26 – 29 , 39 ), and 30.8% (8/26) were cohort studies (longitudinal follow-up of one patient group) ( 6 – 8 , 11 , 12 , 16 , 19 , 30 ). Of the studies, 73.1% (19/26) studies were based internationally, and 26.9% (7/26) studies were based in the United States (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 10 studies ( 4 , 7 , 9 , 10 , 16 , 18 , 21 , 22 , 38 ) that published WRS before and after CI, 4 of them (with more than one case) ( 7 , 16 , 18 , 38 ) were combined for meta-analysis. All patients showed significant improvement in WRS after CI surgery (SMD = 5.5, 95% CI, 4.2-6.8, P < 0.0001) (40,41).…”

Section: Resultsmentioning

confidence: 99%

“…CT findings included ossification of the inferior segment of the cochlear basal turn ( 7 , 8 , 18 , 19 , 27 , 29 ) and slight cochlear narrowing ( 9 ). MRI findings included bilateral enhancement of the cochlear basal turn ( 8 , 10 , 20 , 22 , 26 , 28 , 38 ), partial ossification of the membranous labyrinth ( 27 ), and cochlear scarring ( 6 ).…”

Section: Resultsmentioning

confidence: 99%

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Cochlear Implantation and Perioperative Management in Autoimmune Inner Ear Disease

Deshpande

Aminpour

Cheng

et al. 2021

Otology &Amp; Neurotology Open

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Objective: To assess outcomes in autoimmune inner ear disease (AIED) after cochlear implantation (CI) through systematic review and meta-analysis. Databases Reviewed: PubMed, MedLine, Embase, and CINAHL Methods: Databases were queried for inclusion of AIED patients who underwent CI with outcomes recorded ≥3 months postoperatively. We examined demographics, pure-tone average (PTA), speech perception, preoperative imaging, intraoperative management, and postoperative complications. Results: Twenty-six articles encompassing 124 patients met inclusion criteria. Mean implantation age was 26.2 years (range 4–65 years) with average length of follow-up at 28.2 months (range 3–120 months). Meta-analysis demonstrated significant improvement in speech perception following CI. There was a statistically significant improvement in speech recognition score (SRS) (standard mean difference [SMD] = 6.5, 95% confidence interval [CI], 4.8-8.0, P < 0.0001) as well as word recognition score (WRS) (SMD = 5.5, 95% CI, 4.2-6.8, P < 0.0001) after CI. Anomalous preoperative radiologic manifestations were reported by 57.7% (15/26) studies. Disease activity–related intraoperative adjustment was noted in 57.7% (15/26) studies; common consequences were cochlear drill-out (53.3%), difficult round window insertion (26.7%), and scala vestibuli insertion (26.7%). Frequent postoperative complications noted in 26.9% (7/26) studies included systemic AIED flares (71.4%) and wound healing delay (42.9%). Conclusion: Findings of this systematic review of AIED cochlear implant literature demonstrate a lack of consistent reporting standards for PTA and speech perception as well as a lack of long-term follow-up. Despite these findings, meta-analysis suggests that CI is a viable treatment for improving speech perception in AIED patients.

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Considerations for Cochlear Implantation of Children with Sudden, Fluctuating Hearing Loss

Cited by 5 publications

References 20 publications

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Hearing loss in inner ear and systemic autoimmune disease: A systematic review of post‐cochlear implantation outcomes

Cochlear Implantation and Perioperative Management in Autoimmune Inner Ear Disease

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