New Frontiers in Cochlear Implantation: Acoustic Plus Electric Hearing, Hearing Preservation, and More

Mowry, Sarah E.; Woodson, Erika; Gantz, Bruce J.

doi:10.1016/j.otc.2011.09.001

Cited by 44 publications

(48 citation statements)

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“…Among these older patients, any increase in imbalance following surgery could lead to an increased risk of morbidity and mortality due to falls [Fuller, 2000]. Criteria for implantation have also expanded to include people with residual hearing, singlesided deafness, and who already have a contralateral implant [Mowry et al, 2012]. These patients typically gain less marginal benefit from an implant than patients with more severe hearing loss [Chen et al, 2013], making the risks of surgery, including imbalance, relatively more significant.…”

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Short-Term Risk of Falling after Cochlear Implantation

Stevens

Baudhuin

Hullar³

2014

Audiol Neurotol

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Cochlear implantation is a highly effective intervention for hearing loss, but insertion of an implant into the cochlea is often accompanied by loss of residual hearing function. Sometimes, postoperative testing also shows loss of function in the semicircular canals or otolith organs. The effect of this loss on equilibrium, particularly in the short term following surgery, and the risk of falling due to this loss is unknown. We prospectively measured balance in 16 consecutive adult cochlear implant patients before and 2 weeks after surgery. Subjects stood on a foam pad with eyes closed, feet together and arms at the side. The length of time over which this posture could be maintained was recorded up to a maximum value of 30 s indicating normal performance. Ten of 16 subjects reached a maximal time on preoperative testing. Nine of 16 subjects lost balance function after surgery. Four of the 10 subjects with normal preoperative balance function lost function. Subjects older than the age of 60 were more likely to lose balance function than younger subjects. We used previously published values relating balance performance on foam to risk of falling to calculate the fall risk among our subjects. The relative risk of falling increased after surgery by more than threefold in some patients. Imbalance after cochlear implantation may be much more common, particularly in the short term, than previously appreciated. This imbalance is accompanied by an increased risk of falling in many patients. Careful preoperative counseling before implantation and postoperative therapeutic intervention to improve comfort and reduce the chance of falling may be warranted, particularly in patients at a risk for injuries from falls (level of evidence: 2b). i 2014 S. Karger AG, Basel

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Short-Term Risk of Falling after Cochlear Implantation

Stevens

Baudhuin

Hullar³

2014

Audiol Neurotol

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“…However, the loss of residual acoustic hearing following cochlear implantation is an important clinical consideration when determining the most appropriate options for patients with severe hearing losses [2]. There are some patients with substantial low-frequency acoustic hearing up to 1500 Hz and severe to profound high-frequency hearing loss that do poorly with bilateral amplification who have not been considered as candidates for implantation using standard criteria [3]. …”

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Hearing Preservation in Cochlear Implant Surgery

Miranda

Sampaio

Lopes

et al. 2014

International Journal of Otolaryngology

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In the past, it was thought that hearing loss patients with residual low-frequency hearing would not be good candidates for cochlear implantation since insertion was expected to induce inner ear trauma. Recent advances in electrode design and surgical techniques have made the preservation of residual low-frequency hearing achievable and desirable. The importance of preserving residual low-frequency hearing cannot be underestimated in light of the added benefit of hearing in noisy atmospheres and in music quality. The concept of electrical and acoustic stimulation involves electrically stimulating the nonfunctional, high-frequency region of the cochlea with a cochlear implant and applying a hearing aid in the low-frequency range. The principle of preserving low-frequency hearing by a “soft surgery” cochlear implantation could also be useful to the population of children who might profit from regenerative hair cell therapy in the future. Main aspects of low-frequency hearing preservation surgery are discussed in this review: its brief history, electrode design, principles and advantages of electric-acoustic stimulation, surgical technique, and further implications of this new treatment possibility for hearing impaired patients.

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“…With these improved outcomes, cochlear implant (CI) candidacy guidelines for various companies have recently expanded to include individuals with HL in the moderate as well as the severe-to-profound HL range. In addition, advances in electrode design, technology, and surgical techniques have enabled preservation of hearing thresholds in the implanted ear (Gstoettner et al, 2004(Gstoettner et al, , 2006Machado de Carvalho et al, 2013;Mowry, Woodson, & Gantz, 2012;Turner, Gantz, & Reiss, 2008a;Usami et al, 2014).…”

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confidence: 99%

“…Hybrid and EAS are names derived by the manufacturer, Cochlear and MED-EL, respectively. Individuals using these multiple hearing modalities compared with use of a CI alone may demonstrate measurable improvements in speech perception both in quiet and in noise (Ching, Incerti, & Hill, 2004;Ching, van Wanrooy, & Dillon, 2007;Dettman et al, 2004;Firszt, Reeder, & Skinner, 2008;Flynn & Schmidtke, 2004;Gantz & Turner, 2003;Gstoettner et al, 2004;Most, Gaon-Sivan, Shpak, & Luntz, 2012;Mowry et al, 2012;Potts, Skinner, Litovsky, Strube, & Kuk, 2009;Straatman, Rietveld, Beijen, Mylanus, & Mens, 2010;Tuner et al, 2008a;Turner, Reiss, & Gantz, 2008b), sound localization (Ching et al, 2004(Ching et al, , 2007Firszt, et al, 2008;Flynn & Schmidtke, 2004;Potts et al, 2009), music perception (Bartov & Most, 2014;Flynn & Schmidtke, 2004;Mowry et al, 2012;Turner et al, 2008b), and voice recognition (Flynn & Schmidtke, 2004), as well as subjective benefits of access to binaural hearing and sound quality from combined acoustic and electric hearing (Ching et al, 2004;Firszt et al, 2008;Flynn & Schmidtke, 2004;Potts et al, 2009). However, the benefit of the addition of amplification to CI use is variable across individuals, particularly for speech perception, and an effective clinical protocol for programming of multiple hearing modalities has not yet been determined, as not every parameter has been investigated (Blamey & Saunders, 2008;Dorman, Spahr, Loizou, Dana, & Schmidt, 2005;Heo, Lee, & Lee, 2013;…”

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Effects of Removing Low-Frequency Electric Information on Speech Perception With Bimodal Hearing

Fowler

Eggleston

Reavis³

et al. 2016

J Speech Lang Hear Res

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a Purpose: The objective was to determine whether speech perception could be improved for bimodal listeners (those using a cochlear implant [CI] in one ear and hearing aid in the contralateral ear) by removing low-frequency information provided by the CI, thereby reducing acoustic-electric overlap. Method: Subjects were adult CI subjects with at least 1 year of CI experience. Nine subjects were evaluated in the CI-only condition (control condition), and 26 subjects were evaluated in the bimodal condition. CIs were programmed with 4 experimental programs in which the low cutoff frequency (LCF) was progressively raised. Speech perception was evaluated using Consonant-Nucleus-Consonant words in quiet, AzBio sentences in background babble, and spondee words in background babble. Results: The CI-only group showed decreased speech perception in both quiet and noise as the LCF was raised. Bimodal subjects with better hearing in the hearing aid ear (< 60 dB HL at 250 and 500 Hz) performed best for words in quiet as the LCF was raised. In contrast, bimodal subjects with worse hearing (> 60 dB HL at 250 and 500 Hz) performed similarly to the CI-only group. Conclusions: These findings suggest that reducing lowfrequency overlap of the CI and contralateral hearing aid may improve performance in quiet for some bimodal listeners with better hearing.

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New Frontiers in Cochlear Implantation: Acoustic Plus Electric Hearing, Hearing Preservation, and More

Cited by 44 publications

References 44 publications

Short-Term Risk of Falling after Cochlear Implantation

Short-Term Risk of Falling after Cochlear Implantation

Hearing Preservation in Cochlear Implant Surgery

Effects of Removing Low-Frequency Electric Information on Speech Perception With Bimodal Hearing

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