cochlear implantation at king abdullaziz university hospital, riyadh: a multisystem prgram,...
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Cochlear Implantation at King Abdullaziz University Hospital, Riyadh: A Multisystem Prgram, (1995-2007)
Introduction
The KAUH Cochlear Implant Program started 1995. To date,96 cases have been implanted. Among those, 79 Nucleus, 11 Med-El and 6 Advanced bionics. All are long multi channel cochlear implants.
Candidates Selection
All the patients included in the program had bilateral profound hearing loss with monosyllabic word score of no more than 10% in best aided condition. Their general health was good. They were psychologically stable, with realistic expectation and they are willing to participate in post operative testing and rehabilitation.
Candidates Selection
Radiologic examination (CT,±MRI ) revealed patent cochlea and intact cochlear nerve in all cases. There were no outer or middle ear pathologies that may interfere with surgery.
Candidates selection
Out of all, there were 3 patients with CSOM.
During surgery there were (11) cases with different degrees of ? cochlear ossifications,? rotated cochleae, which were not discovered radiologically.
Evaluation Procedure
Evaluation Intervals: Preoperative evaluation with hearing aids and postoperative evaluation following initial stimulation with cochlear implant, then 3, 6 and 12 months postoperativly.
Hearing thresholds
Sound field warble tone thresholds for frequencies ranging from 250 Hz t0 8000 Hz were measured pre- and post- operatively, with the hearing aid and cochlear implant.
Speech perception tests
Evaluations were done in a calibrated free field, sound treated booth with the subject using their hearing aids before surgery at 70 – 80 dB SPL via a loudspeaker. Evaluations were done in monaural or binaural listening conditions before surgery. After surgery, monaural implant evaluations were performed.
Speech evaluation for children
Preoperative and postoperative evaluation include:
Lip-reading test. Listening Progress Profile. Receptive Language Skill test. Expressive Language Skill test.
Speech evaluation for adults
Minimal Auditory Capability test. (MAC )
Surgical Principles
Incision: Extended endaural(67cases) Minimal invasive ( 29cases )
Skin Incision
1 cm
3-4 cm
Pericranial Flap
1 cm
OriginalIncisionLine
1 cm
Surgery
Surgical Procedure
Surgical Procedure
Surgical Procedure
Results
A total number of 96 patients who met the criteria for implantation were implanted.
These were divided into 4 groups according to the type of implant used.
Summary of implanted groups
GroupCasesElectrodeChannelsSpeech strategyPeriod
Nucleus-22
14 Long
17mm22 SPEAK,CIS 1995-
1999
Nucleus-24
65 Long22mm
22 SPEAK,CIS& ACE
1998-2007
Med-El11 Long
31mm12 CIS& NofM 1999-
2003
Advanced bionics
6 Long 23mm
16 SAS& CIS2005-2007
Demographic findings in different groups
Group 1Group 2Group 3 Group 4
ImplantNucleus-22 Nucleus 24 Med-El Advanced bionics
Number 14 65 11 6
Age: childrenadult
0
14
50
15
7
4
4
2
Sex: malefemale
10
4
40
25
7
4
2
4
Speech: Pre.
Post.
O
14
50
15
7
4
4
2
Side: RtLt
5
9
21
44
3
8
3
3
Complications& follow upExplanted (1)
Thick skin (1)
Dizziness (1)
Gush (1)
Explanted (1)Dizziness (3)
Facial (1)Infection(3)
Ossification(7)Gush (2)
Reimplanted(2)
Explanted (1)Dizziness (1)
Ossification(1)
Tilted cochlea(2) ?ossification
Results
Among the 96 implanted patients there were 33 post-lingual and 63 pre-lingual cases.
The mean age of pre-lingual patients was 3 years & 6 months.
33; 34%
63; 66%
; 0%; 0%
Results
Out of 96 implanted cases we met 11 cases with different degrees of cochlear ossifications. All were implanted either partially or through scala vestibuli.
85
11
010
203040
506070
8090
NormalCochlea
OssifiedCochlea
Results
We met the following conditions either intra, or post-operative.
1 case of facial paralysis.(recovered in 3 months )
3 cases of lymphatic leak. 6 cases of incomplete
insertion(2-5 electrodes out).
3 cases of wound infection. 1 case of thick skin over the
implant 5 cases of post operative
dizziness for few days. 3 explanted cases. 2 reimplanted cases.
61
11 6 1 3 3 1 5 3 20
10
20
30
40
50
60
70Reimplantation(2)
Explantation(3)
Dizziness(5)
Thick skin(1)
Wound infection(3)
Leak(3)
Facial paralysis(1)
Partial insertion(6)
Ossification(11)
Normal(61)
Results
65%11%
6%1%3%
3%1%5%3%2% Normal(61)
Ossification(11)
Partial insertion(6)
Facial(1)
Leak(3)
Wound infection(3)
Thick skin(1)
Dizziness(5)
Explantation(3)
Reimplantation(2)
3 Explanted cases
Tow of them explanted after recurrent otitis media, ear discharge and device failure.
The third explanted after unexplained sever headache and tinnitus.
2 Reimplanted cases
Tow cases were reimplanted after incomplete insertion and torsion of the electrode.
No response was found. They performed well after
reimplantation.
Audiological Results
Pure-tone audiograms, measured before surgery and 6 months after surgery, showed improvement of free field tone threshold for all subjects in our program. The average gain in hearing was 40 dB. No statistical difference was found between groups of implants.
Audiological Results
Comparison between mean pure tone average at different frequencies before implantation and after getting stable map.
Frequency in Hz
500 Hz
1000 Hz
2000 Hz
4000 Hz
8000 Hz
Before
70dB90dB95dB100dB100dB
After35dB40dB40dB45dB40dB
Mean Pure Tone average before & after implantation
70
9095
100 100
3540 40
4540
0102030405060708090
100110
500Hz 1000Hz 2000Hz 4000Hz 8000Hz
Before
After
Listening progress profile
In a prospective longitudinal study of 21 pre-lingual children with age range from 3 to 7 years, a rapid marked improvement in the detection of sound and speech was evident at 6 months post implantation. At 36 months post implantation they reached the maximum score available in our test (LIP test).
Difficulties Faced
Program support and sponsorship. Follow up cases outside Riyadh. Varient family expectation and
support. Implanted cases outside our
program that asking for support.
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