ci2017 poster abstractsci2017 poster abstracts 3 | page sessions over a period of three months. pre-...

CI2017PosterAbstracts

AbstractID:21PosterNumber:44Title:CochlearImplantationinChildrenwithXLinkedDeafness:ACaseReportAuthors:NacimAitMesbah,MD,SaraBoutemeur,MD,NadiaYahi,MD;ENT,HOSPITAL,ALGIERS,Algeria.Abstract:Introduction:Nearlytwentypercentofpatientswithcongenitalsensorineuralhearingloss(SNHL)haveradiologicabnormalitiesoftheinnereardiscernableoncomputedtomography(CT)ofthetemporalbonePatientswithcongenitalX-linkedmixeddeafnesshaveshortenedcochlea,absentlaminacribrosa,andbulbousfundusofthelateralinternalauditorycanal.Theabsentbonebetweenthecochleaandinternalauditorycanalrepresentsadirectcommunicationbetweencerebrospinalfluid(CSF)ofthesubarachnoidspaceandperilymphwithinthecochleawhichmayresultinCSFleakoncethecochleostomyandpredisposepatientstoIACinsertionduringcochlearimplantation,facialnerveinjuryandsub-optimalperformanceoftheelectrode.Methods:Ourobjectiveistodescribethecasereport,surgicaltechnique,andspeechperformanceoutcomesinthispatientResults:IntraoperativeimpedancesandneuraltelemetrywereobtainedtoassessforanauditoryresponsetoelectricalstimulationNopost-operativediscoveryofelectrodemalpositionintheIACNopost-operativefacialparalysisorfacialstimulationbytheelectrod,vertigo,ataxia,dysmetriaorhemorrhage.Day2csfleakagefromhomolateralnostrilweperformedonlyonelumbarponctionpatientdemonstratedimprovedspeechperformancefollowingimplantation.Conclusion:X-linkeddeafnessmaysuccessfullyundergoCIwithexcellentpotentialforauditoryrehabilitation. AbstractID:22PosterNumber:125Title:EffectofDexamethasoneonIntracochlearInflammationandResidualHearingafterCochleostomy-AComparisonAccordingtotheAdministrationRouteAuthors:Ah-RaLyu,MS1,KwanHoKim,Aud2,Yong-HoPark,MD,PhD2;1MedicalScience,ChungnamNatl.Univ.,Daejeon,Korea,Republicof,2Otolaryngology,ChungnamNatl.Univ./Hosp.,Daejeon,Korea,Republicof.Abstract:Introduction:Dexamethasoneiswidelyusedsteroidthathasapotentanti-inflammatoryeffect.Althoughtherewereseveralreportsshowingthatdexamethasonesignificantlyreducedhearinglosswhenitappliedwithlocallyorsystemically,itisstillquestionablewhethersystemicorintratympanicinjectedsteroidwouldgothroughintothecochleaeffectively.Inthisstudy,weaimedtocomparetheeffectsofdexamethasonewhichadministeredwithdifferentrouteonintracochlearinflammationandresidualhearingaftercochleostomy.Methods:Guineapigswereusedfortheexperimentalstudywithbilateralcochleostomyandtheexperimentalgroupwereclassifiedwithcochleostomyonlygroup(CS),intracochleardexamethasone


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group(IC),intratympanicdexamethasonegroup(IT)andintraperitonealdexamethasonegroup(IP).Toevaluatethehearingthresholdshiftsineachgroupaftersurgery,Auditorybrainstemresponse(ABR)thresholdwererecordedaftersurgery.ThechangesofintracochleardexamethasoneconcentrationweremeasuredandintracochlearinflammatorychangeswereevaluatedwithqRT-PCRandhistopathologicstudies.Results:ResidualhearingsweremorepreservedinICandITgroupscomparedtoITandIPgroupandICrouteweremoreeffectivemethodfordexamethasonedeliveryintothecochleathanITandIProuteforthehighintracochlearconcentration.TheinflammatoryresponsesinthecochlearweredecreasedindexamethasonetreatedgroupcomparedtoCSgroupwithdifferentpatternattheearlystage.AuditoryHCsweremorepreservedinICandITgroupcomparedtoCSandIPgroupandICroutewassuperiorthanothersinthepointofviewofHCsurvivalandtheinflammatorytissueresponseinthecochleawaslesssevereinICandITgroupcomparedtoCSandIPgroup.Conclusion:Localdeliveryroutecouldinducemorehighconcentrationofdexamethasoneintheinnerearanditmightdecreaseintracochlearinflammationresponsewhichresultedinmorehearingpreservationthansystemicroute. AbstractID:26PosterNumber:13Title:DoestheAdditionofaGroupMusicInterventiontoTraditionalListeningandSpokenLanguageTherapySupporttheDevelopmentofSchool-readinessSkillsinPreschoolChildrenwithHearingLoss?Authors:GlynnisDuBois,PhDstudentDepartmentofSpeech-LanguagePathology,Univ.ofToronto,Toronto,Canada.Abstract:Introduction:Theoristshavespeculatedthatlanguage,reading,andmusicoverlapinmeaningfulstructuralandfunctionalwaysthatextendwellbeyondasimpleassociationwithaudition(Patel,2014;Tierney&Kraus,2014)andsuggestthattheseabilitiesmaybescaffoldedbytheskillsacquiredthroughsharingormakingmusic.Therehasbeensomeinvestigationintothoseaspectsofchildhoodmusicandmovementexposurethatmayhelptoscaffolddevelopmentintheareasofphonologicalawareness(Kraus&Chandrasekaran,2010;Moritz,etal,2013),vocabulary,andsocialskills(Gerry,Unrau&Trainor,2012).Musicalactivitiesmayalsohavesomeinfluenceonthedevelopmentofskillsrelatedtoexecutivefunctions.Structured,engagingactivitieswhichrequiretheabilitytofocusandcooperatewithothers,attendtoandsynchronizemovementtoarhythm,andengageinmusicmakinghaveproventobeeffective(Zachariou&Whitebread,2015).Evidencesupportstheideathatsincechildrenwithhearinglossmaybedelayedintheiraccesstospeechandlanguage,someoftheseskillsmayalsobelateindeveloping(Punch&Hyde,2011;Rinaldi,Baruffaldi,Burdo&Caselli,2013),consequentlyaffectinglateroutcomesinareassuchasliteracy(Nittrouer,Caldwell,Lowenstein,Tarr&Holloman,2012)andexecutivefunctions(Beeretal,2014;Kronenberger,Pisoni,Henning&Colson,2013).Asthispopulationmayalsohavechallengeswithbalance(Cushing,Papsin,Rutka,James&Gordon,2008;Livingstone&McPhillips,2011),andrehabilitationinmotorandbalanceskillhasshownsomepromiseinimprovingthisissue(Fernandes,Hariprasad&Kumar,2015),itispossiblethatactivitiesinmusicandmovementmightalsohaveapositiveeffectinthisarea.AsrecentadvancesinhearingtechnologyforthisgroupofchildrennowprovideschildrenwithHLaccesstobothspokenlanguageandmusic,thepotentialbenefitsoftheuseofmusicisnowbecominganinnovativeandexcitingfocusforresearch.Methods:Participantswillbematchedandplacedintoamusicandmovementgroup,acraft-basedgroupwithbackgroundmusic,oracontrolgroup.Theinterventiongroupswillattendtwelve,facilitated


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sessionsoveraperiodofthreemonths.Pre-andpost-interventionassessmentsfocusingonoutcomesinspeech,language,pre-literacy,audition,balance,andsocialskillswillbecompleted.Results:(preliminarydataavailableJune2017)Conclusion:Conclusion:(pendingresults) AbstractID:31PosterNumber:105Title:CochlearImplantandOrganTransplantationinChildrenAuthors:MagnusTeschner,MD,PhD,MBA,ThomasLenarz,MD,PhD,Marie-CharlotSuhling,MD;DepartmentofOtolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:CochlearImplantationindeafchildrencomesalongwithleavingofaforeignbody(device)inthetemporalbone.Organtransplantedimmunosuppressedchildrenmighthaveahigherriskforpostoperativecomplicationsandposesparticularchallengesinthetreatment.TheaimofthiscurrentInvestigationisthustoanalyzetheexperience,outcomesandcomplicationratesinchildrenwhounderwentdifferentorgantransplantationandcochlearImplantation.Methods:Chardrecordsofchildren(2-18yrs)between1999and2016wereanalyzedretrospectively.Intraoperativeandpostoperativecomplicationsandaudiologicalresultsaftercochlearimplantationwereassessed.Results:11childrenwithkidney-,liver-,lung-andhearttransplantationscouldbeincluded.Overall,thesurgeriesandthetreatmentsdidnotshowanyintraoperativecomplicationsorotherparticularities.Postoperatively3patientssufferedfromcomplications(1efflorescence,2wounddehiscence).4childrenunderwentstagedbilateralimplantation:1sufferedfromwoulddehiscence,onefromchronicotitis.Conclusion:CochlearImplantationinchildrenwithorganictransplantationisasafeprocedure.Nomajorcomplicationsshouldbeexpected.Acloseinterdisciplinarycooperationensuresgoodlong-termresultswithanycomplexindividualcases. AbstractID:33PosterNumber:113Title:TheModifiedRamboTranscanalApproachforCochlearImplantationinCHARGESyndromeAuthors:CameronC.Wick,MD1,AmyM.Moore,BS2,DanielE.Killeen,MD1,BrandonIsaacson,MD1;1Otolaryngology-HeadandNeckSurgery,Univ.ofTexasSouthwesternMed.Ctr.,Dallas,TX,2Univ.ofTexasSouthwesternMed.Sch.,Dallas,TX.Abstract:Introduction:CHARGEsyndromeisassociatedwithavarietyoftemporalboneanomaliesanddeafness.Thelackofsurgicallandmarksandfacialnerveirregularitiesmakecochlearimplantationinthispopulationachallengingendeavor.Theaimofthisstudyistodescribeasafeandefficacioustranscanalapproachforcochlearimplantationthatobviatestheneedtoperformamastoidectomyandfacialrecess.Methods:Retrospectivechartreviewfromatertiarycarepediatrichospital.ThreechildrenwithseveretoprofoundsensorineuralhearinglossassociatedwithCHARGEsyndromeunderwentatranscanalcochlearimplantationwithclosureoftheexternalauditorycanalviaamodifiedRambomeatoplasty.Ananalysisofthetemporalboneanomaliesandtechnicalnuanceswereassessed.Results:Themeanpatientagewas2.5years(range1.5-3.8years).Twoweremalesandtwowereleftears.Allpatientshadahypoplasticmastoid,lackeddevelopmentofallthreesemicircularcanals,and


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hadsomedegreeofcochleardysplasia.Afullcochlearimplantinsertionviaaroundwindowcochleostomywasachievedinallcases,eveninthepresenceofgrosslyabnormalmiddleearandfacialnerveanatomy.Therewerenointraoperativeorpostoperativecomplications.Themeanfollow-upwas12.4months(range3.9-25.2months).Allthreepatientsusetheirdevicedaily.Theirguardiansreportimprovedvocalizationandenvironmentalawareness.Objectivepost-implantationtestingisnotyetfeasibleduetotheirageandmedicalco-morbidities.Conclusion:ThetranscanalapproachwithmodifiedRambomeatoplastyclosureoftheexternalauditorycanalprovidesasafecorridorforcochlearimplantationinpatientswithCHARGEsyndrome.Thisapproachminimizesmuchoftheanatomicalvariationsassociatedwiththesyndromeandprotectsagainstelectrodeextrusion.Implantoutcomesinthispatientpopulationarestillvariableandlargelydependentonthepatient’sglobalcognitivecapacity. AbstractID:35PosterNumber:186Title:AuditoryNeuropathySpectrumDisorder:ProposedProfilesforImprovedAudiologicManagementAuthors:AlisonJ.Nachman,AuDAUDIOLOGY,UCSFBENIOFFCHILDREN'SHOSPITALOAKLAND,OAKLAND,CA.Abstract:AlisonNachman,AuDAbstract-TITLEAuditoryNeuropathySpectrumDisorder:ProposedProfilesforImprovedAudiologicManagementOBJECTIVES:Thisproposalcallsforacategorizationofauditoryneuropathyspectrumdisorder(ANSD)intosubtypesorprofilesbasedonetiologyinordertoassistwithaudiologiccareandmanagement.ChildrenwithANSDrepresentnotonetype,butaspectrumofdisordersorprofiles.Researchsupportsthemanagementandaudiologicoutcomesdifferbasedontheproposedsubtypes.WithfurtherclarificationonguidelinesformanagementofchildrenwithANSDwithmorespecificcategories,audiologistscanprovideimprovedcare.WithadeeperunderstandingofANSDsubtypes,improvedcarecanincludefasterreferralstocochlearimplantprogramswhenappropriatetoavoidunnecessarydelaysinspeechandlanguagedevelopment.METHODS:LiteraturereviewofANSDdescriptionandmanagement.Inaddition,currenthospitaldatabaseofchildrenwithANSDwithretrospectiveanalysisofcareandmanagement.RESULTS:UtilizingANSDprofiles,coupledwithcurrentGuidelinesforthemanagementofchildrenwithANSD,clinicianscanfollowamoreprecisemethodologytodeterminenextstepsinmanagementandcare.WhenchildrenwithANSDareprofiledbytheirmedicalhistoryorlackthereof,morespecificprotocolscanbeusedinadditiontothecurrentGuidelinesforIdentificationandManagementofInfantsandYoungChildrenwithAuditoryNeuropathySpectrumDisorder(2008).Previoussubtypeshavebeenproposedbasedonauditoryresponses,however,withmorespecificinformationregardingtheANSDprofile,onewouldnothavetowaituntilbehavioraltestingcanbeobtainedtoprovidethefamilywithprojectedpathwayforauditorymanagementandcare.Proposedsubtypesincludea.)Geneticetiology,b.)GeneticSyndromes(CharcotMarieTooth,Friedrich’sAtaxia,etc.)c.)Prematurity,d.)Hyperbilirubinemiae.)Unknownetiology(notpremature,nogeneticcomponentidentified,nootherperipheralneuropathies,nointra-cranialanomalies,andnormalneuralanatomy,)andlastlyf.)


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Anatomicetiology(cochlearnervehypoplasiaoraplasia).SpecificguidelinesformanagementareprovidedbasedontheANSDprofiles.ByprovidingaGuidelinefortypicaloutcomesbasedonthesuggestedprofiles,audiologistswillinturnbeabletoprovideimprovedmanagementandcareofthesepatientsandtheirfamilies.CONCLUSIONS:BydescribingchildrenwithANSDintosubtypesorcategories,audiologistscanprovidefamiliesandtherestofthemedicalteamwithamoreconfidentpathwayforthecareandmanagementoftheseoftencomplicatedcases.Withcompoundingyearsofexperienceofworkingwiththispopulation,professionalscanbetterhelptoserveandguidefamiliesalongthisjourney.ByofferingfamilieswithaprojectedpathwayofcarebasedonANSDprofilesthatismoredefinitivethanwhatisusuallyofferedtofamilies,delaysmaybeavoided. AbstractID:36PosterNumber:27Title:Tele-Mentoring:ProvidingComprehensiveCommunityCaretoCochlearImplantRecipientsAuthors:ShanaLucius,MA,CCC-SLP,LSLSCert.AVTSpeechPathology/HearingProgram,NationwideChildren'sHosp.,Columbus,OH.Abstract:Introduction:Asof2012,nearly400,000registeredcochlearimplantshadbeenimplantedworldwide(NationalInstituteonDeafnessandOtherCommunicationDisorders,2016).Ascochlearimplantshavebecomemorewidelyavailable,thereisaneedforprofessionaltrainingandmentorshipinruralareaswhereaccesstoqualifiedcochlearimplantservicesmaybelimited.Additionally,post-implantationtreatmentcanbechallenging,becausethereareonly700qualifiedListeningandSpokenLanguageSpecialists(LSLS)worldwide(agbell.org,2016).Technologyadvancesinthefieldhaveledtoanexpansionofthecandidacycriteriaforcochlearimplants.Ascochlearimplantprosthesescontinuetoadvanceandaswereachmoreindividualsinthehearinglosscommunity,supportserviceswillalsoneedtoexpand.Manyindividualsinthefieldhaveengagedin‘tele-practice’asadirectservicedeliveryoptionforspeechpathology,especiallyasameanstoexpandtreatmentforlowerincidencedisorderssuchashearingloss.Forstateswheretele-practiceisnotyetreimbursable,oneoptiontoimprovefollow-upcareis‘tele-mentoring.’Usingvideoconferencingequipment,speech-languagepathologistswithspecializedtrainingcanserveasaconsultantforaclinicianwhomaybeseeingaclientwithacochlearimplantforthefirsttime.Methods:Tele-mentoringsessionsrequireasecurenetworksuchasSkypeforBusiness™,awebcamonbothends,andaspeakerheadsetoraspeakerphoneonbothends.Thisposterwillpresentthreecasestudiestoshowhowtele-mentoringcanbeusedtopromoteimprovedserviceaccessforpersonswithcochlearimplants.Mentoringsessionsweresetuponaconsultativebasisat1month,3monthsand6monthspostcochlearimplantationactivationatthedirectionofthecaremanagementprovider,LSLSCertifiedprofessional.Speechandlanguagestandardizedtestingwascompletedatthetertiarycarehospital(large,urbanpediatrichospital)settingat6monthintervals.Ongoingweeklyauditorybasedspeechtherapysessionswereconductedclosertothepatient’shomebyalocal,certifiedspeech-languagepathologist.Results:Patient1:TG-chronologicalage22months Patient2:AC-chronologicalage24months Patient3:CD-chronologicalage10years


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Implantedat9months;Etiology:Connexin PatientisbeingworkedupforacochlearimplantEtiology:CMV;progressiveHL Implantedat10yearsEtiology:tumor,postcraniotomypostopbacterialmeningitisPre-CochlearImplantEvaluation,6monthspostactivation,and1yearpostactivationSpeech&LanguageTestingcompletedwithLSLSCert.AVT IntervaltestingcompletedwithLSLSCert.AVT,monthlysessionsattertiarycarehospitalduetopatientbeingfollowedcloselyforpossiblecochlearimplant(s) Pre-CochlearImplantEvaluation,1postopauditoryspeechsessioncompletedattertiarycarehospitalOngoing,weekly60minutesspeechtherapysessioncompletedatruralhospital40minutesfromhomewithmentoringcomponent:TherapygoalsestablishedbyLSLSprofessionalandcarriedoutbyruralSLP Ongoing,weeklysessionscompletedbyEarlyInterventionforHearingImpairedteaminthefamily’shomewithmentoringcomponent:TherapygoalsestablishedbyLSLSprofessionalandcarriedoutbyruralclinician Ongoing,shorttermauditorytherapy2x/monthfor3-6monthsconductedbyruraltherapist20minutesfromhomewithmentoringcomponent:AuditorygoalsestablishedbyLSLSprofessionalOutcomes:At1yearpostactivation;patienthascaughtuptosame-agedtypicallyhearingpeersonspeechandlanguagemeasures.Outcomes:Thiscollaborationhasallowedforaconsistentmessagetobesharedamongstprovidersworkingwiththefamily,familyispleasedwithservices,and“teamapproach” Outcomes:Patientwasimplantedon11/9/16andremoteclinicianreportedopensetspeechunderstandingwithleftcochlearimplantaloneandexcellentpatientsatisfactionwithreceivingservicesclosetohomeConclusion:Thesecasestudiesdemonstratedthattele-mentoringmaybeonewaytoimproveserviceaccessforchildrenwithcochlearimplantswholivefarfromthetertiarycarehospitalwheretheymay;otherwise,nothaveaccesstospeciallytrainedLSLScertifiedprofessionals.Costsandtimeassociatedwithtravelwerereduced,andallparticipantsdemonstratedpositiveoutcomesandexpressedthebenefitsofthismodelofcare.Thelocalprofessionals,reportedanimprovementintheirknowledgebaseandconfidenceinservicedeliveryforcochlearimplantpatients.Futureresearchisneededtoexaminelong-termperformanceoutcomesinthistypeofservicedeliverymodelandreimbursementfromMedicare/Medicaidfor“tele-health”including:remotecochlearimplantmapping,ENTfollow-up,troubleshooting,andongoingauralre/habilitation. AbstractID:37PosterNumber:163Title:AdolescentswithCochlearImplantsbeforetheAgeofFiveAuthors:KarinaFanelli,Audiologist,NormaPallares,Audiologist,VicenteDiamante,Otologist;CICPROFESORDIAMANTE,BUENOSAIRES,Argentina.Abstract:Introduction:Inthelast15yearswehadasignificantincreaseofcochlearimplants(CI)users.MaybeduetochangesincandidacycriteriaforCI,theimprovementintechnologies,clinicalmanageandsurgicaltechniquesanddevicessocialpayment.Allthat,allowustoregisterdifferenteventsalongprogressinpatientswithCIinauditory,language,social,academicandemotionalskills.Aftermanyyearsofprogrammingcochlearimplants,wehavedetecteddifferentbehaviorsinthoseadolescentswhoreceivedtheCIintheearlyyearsoflife.Theyreachdifferentperformanceinoralcommunication,emotionalandcognitiveabilities.AchievementsaredeterminedbylotsofvariablesasageatCI,


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modalityofauditorytherapyandhandicapsassociated.Butlotsofthempresentchangesintolerancetotheelectricalstimulation.Thepresentstudyfocusesoninformationregardingthechangesincomfortandthresholdlevelsinpre-linguallydeafadolescentswithCIusesincechildhood.HYPOTESIS:Pre-linguallydeafadolescentswithCIbeforetheageoffiveexperiencechangesinloudnesswiththeelectricalstimulationnearlyadolescence.OBJECTIVES:WesettwogoalstostudychangesinloudnessinadolescentCIusers:1-DetermineTandClevelssincethetune-upuntilthepresentinelectrode20-15-10-5-3-12-DescribesymptomsMethods:Tostudythismanifestation,wemadearetrospectivestudyof20pre-linguallydeafadolescentpatientswhoreceivedCIbeforetheageoffive.AllofthemwereimplantedattheCentrodeImplantesCoclearesProfesorDiamante-BuenosAires-Argentina.ThestatisticalanalysisofthechangesinthresholdandcomfortlevelswasdonewithGraphPadPrism6.Results:Inthatgroupofpatienteswefoundsymptomsasdiscomforttohighfrecuences,headachesandrejectionofuse.Inthepubertytheseappearedsuddenly.Resultwillbepresented.Conclusion:AdolescentswithCIpresentagreatvarietyofabilitiesandlimitationsthatmustbecontemplatedindividuallywithinanaveragecontextforthatgroup.Thepresentstudyshowsusthefrequentmanifestationofprogressiveintolerancetotheelectricalstimulationoncepubertyhasbeenreachedbychildrenimplantedearlierinlife.Forthisreasonweconsideritofgreatimportancetocarryoutstrictaudiologicalfollow-upinthisgroupofpatientsandtowarnthemaboutpossiblechangesinloudness. AbstractID:41PosterNumber:47Title:CochlearImplantinaPatientwithArnoldChiariSyndromeAuthors:MariaS.A.Amaral,M.D.1,DanielaS.F.Costa,SpeechTherapist2,AntonioC.Santos,MD.,PhD3,CamilaG.C.Barros,MD.,PhD.1,AnaC.M.B.Reis,PHD1,EduardoT.Massuda,MD.,PhD.1,MiguelA.Hyppolito,MD.,PhD.1;1DepartmentofOphthalmology,Otorhinolaryngology,HeadandNeckSurgery.,RibeirãoPretoMed.Sch.-ClinicalHosp.,Univ.ofSãoPaulo,RibeirãoPreto,Brazil,2DepartmentofOphthalmology,Otorhinolaryngology,HeadandNeckSurgery.,RibeirãoPretoMed.Sch.-ClinicalHosp.,RibeirãoPreto,Brazil,3DepartmentofOphthalmology,Otorhinolaryngology,HeadandNeckSurgery.,RibeirãoPretoMed.Sch.-ClinicalHosp.,Univ.ofSãoPaulo,RibeirãoPreto,Brazil.Abstract:CochlearImplantinapatientwithArnold-ChiariSyndromeSummaryIntroductionChiarimalformationisacongenitaldiseaseofunknownetiologycharacterizedbyherniationofposteriorfossacontentsbelowtheforamenmagnumlevel.Threetypesexist.ChiaritypeIImalformation(Arnold-Chiari)consistsofherniationofthetonsils,cerebellarvermis,IVventricleandalowerportionofthebulbthroughtheoccipitalforamen.Itusuallymanifestsasmyelomeningoceleinthethoracolumbarspine,hypoplasiaoftheposteriorfossa,herniationoftheencephaloninthecervicalspinalcanalandcompressivelesionsofthecranialnerves.Computedtomography(CT)andMagneticResonanceImaging(MRI)areessentialforthediagnosis,andthetreatmentissurgical.Decompressionoftheposteriorfossaandcervicallaminectomyaresufficientiftheventricularshuntispatent.Iftreatedbeforepermanentstructuraldamageoccurs88%ofpatientshavesignificantremissionofsymptoms.Method


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RevisionofthemedicalrecordsofpatientswithArnold-ChiariSyndromesubmittedtoCochlearImplantSurgery.Dataonageatthetimeofimplantation,gender,timeofhearingloss,pre-andpost-CIpatientaudiologicalcharacteristicsandpatientimaging(ComputerizedTomographyandMagneticNuclearResonance)wereobtained.ResultA6-year-oldfemale,withmeningomyeloceleandcongenitalhydrocephaluswithdeafnessat3yearsofageaftermeningitisandusedorallanguagewithadequatespeechdevelopment.ThepatientwasinCategory0ofhearingand2ofLanguage.ToneAudiometryrevealedbilateralprofoundsensorineuralhearingloss.TheMRIexaminationshowedadiffusereductionofthewhitematter,sharptaperingandarchingofthecorpuscallosumwithmarkeddilationofthesupratentorialventricles.(ChiaritypeII).ComputedTomographyoftheearsconfirmshypoplasiaofthebilaterallateralsemicircularcanalandthecochleatotheright.CochlearImplantSurgerywasindicatedandperformedontheleftearwiththeMedelImplant,ModelSONATAti100.Onactivation,performed1monthafterthesurgery,therewasnoresponseatlevelCinthespeechprocessorprogram.Fromtheactivation,thepatientpresentedgradualimprovementofhearingandcurrentlythechildis12yearsold,6yearsaftersurgery,performsspeechtherapy3xperweekandisinCategory6ofhearingand5ofLanguage.ConclusionDespitethepresenceofArnold-Chiarisyndrome(ChiariTypeII)andevenwithneurologicalalterationspresentedwithDVP,CIsurgeryhasgoodhearingresults. Abstract.PresentationRoleOrder:10AbstractID:45PosterNumber:129Title:TotallyImplantableCochlearImplant-NewIdeasAuthors:NicolaeC.Balica,Assist.Professor,HoratiuE.Stefanescu,Assit.Professor,MarioaraPoenaru,Professor,CaiusI.Doros,Assoc.Professor;ENTDepartment,"VictorBabes"Univ.ofMed.andPharmacyTimisoara,RO,Timisoara,Romania.Abstract:Introduction:Nowadaystherearesometechnicalproblemsregardingtotallyimplantablecochlearimplants.Insuchcasestherearemicrophoneproblemswhichareattachedundertheskinandpicksupalotofparasitenoises(bloodvesselspressureetc.).Methods:Microphoneproblemsmightbeovercomebyaninternaldetectorofincusmovementsduetointacttympanicmembraneandintactossicularchain.IncusmovementLASERassessmentmightbeanoption.Totallyimplantablecochlearimplantisplacedinthemastoidcavityanditisanchoredtothebone.Regardingtheautosustainedbatterytheremightbethefollowingsolutions:pressuremovementchargersattachedtotheSuperficialTemporalandOccipitalArteries,stretchingarcheschargersattachedtotheTemporalisandSternoCleidoMastoidMuscles.Results:ALASERassessmentsoftforincusmovementisneededtobedeveloped.ThesolutionefficiencyforpressuremovementchargersattachedtotheSuperficialTemporalandOccipitalArteriesandstretchingarcheschargersattachedtotheTemporalisandSternoCleidoMastoidMusclesisneededtobedeveloped(energyquantification,etc.).Conclusion:Thereisaneedforanimprovementintotallyimplantablecochlearimplants.


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AbstractID:46PosterNumber:48Title:RevisionCochlearImplantinChildrenAuthors:MariaS.A.Amaral,MD,MyriamD.Isaac,MD.,PhD,NataliaQ.Shigematsu,M.D.,AnaC.M.B.Reis,PhD,TatianaF.Gaia,PhD,EduardoT.Massuda,MD.,PhD,MiguelA.Hyppolito,MD.,PhD.;DepartmentofOphthalmology,Otorhinolaryngology,HeadandNeckSurgery.,RibeirãoPretoMed.Sch.-ClinicalHosp.,Univ.ofSãoPaulo,RibeirãoPreto,Brazil.Abstract:RevisionCochlearImplantSurgeryInChildren1.Introduction:TheCochlearImplant(CI)isauseful,revolutionarysensoryprosthesisinmedicinethatallowsthehearingtoindividualswiththisprofoundsensorineuralhearingloss,enablingthesensationofhearingandtherecognitionofspeechsounds.ThesurgeryofimplantationoftheCIinternaldeviceisnotentirelyfreeofrisksandmaypresentproblemsthatwillrequirerevisionsurgeries.2.MethodAretrospectivestudyofpatientsunder18yearsundergoingCochlearImplantSurgeryfrom2004to2015inapublichospitalinBrazil.Datacollectedtoageatthetimeofimplantation,sex,etiologyofdeafness,durationofhearingloss,audiologicalandorallanguagecharacteristicsofeachpatientinthepreandpostoperativeCI,iftherewasaneedforsurgicalrevisionandthereasonforthesame.3.ResultsTwohundredandsixtysurgerieswereperformedin236patientsyoungerthan18yearsfrom2004to2015.SevenpatientswithbilateralCI(2.69%)and10childrenrequiredrevisionsurgery(4,23%).Twenty-sevensurgerieswerenecessaryforthese10children(1performedbilateralCI),16ofwhichwererevisionsurgeries(6.15%).In2children,removaloftheCIwasnecessary,withoutreimplantation(onechildwithcochlearmalformation,probablyincompletetypeIpartitionandanotherduetotrauma).Regardingtheetiologyofthe8childrenwhoremainedwithCI,4hadcochlearcalcificationaftermeningitisfollowedbytrauma(1),malformationofthefacialnerve(1),failureoftheCIinternaldevice(1)andarevisionsurgerywasnecessarytoachildduetotwistingoftheelectrodebundle.4.ConclusionTherevisioncochlearimplantsurgeryisinfrequent,andthepatientmustbeinformedofthispossibility. AbstractID:52PosterNumber:175Title:OptimizingCIProgrammingusingClinicalMethodsofElectrodeDeactivationAuthors:SarahW.Kennett,Au.D.,Ph.D.Candidate1,SamuelR.Atcherson,Ph.D.1,CharlesFinley,Ph.D.2;1Univ.ofArkansasforMed.Sci.,LittleRock,AR,2AdvancedBionics,LLC,Valencia,CA.Abstract:Introduction:Whilecochlearimplants(CIs)areconsideredahighlysuccessfulmedicaldeviceforrestoringspeechunderstandingtohard-of-hearingindividuals,highindividualvariabilityofoutcomesremainsasignificantconcerninthefield.AnimportantfactorinCIperformancevariabilityistheeffectoftheelectrode-neuralinterface.Significantwithin-userandbetween-uservariabilityexistsinbothneuralsurvivalandphysicallocationoftheelectrodeinthecochlea.Becausetheelectrode-neuralinterfaceisnotwellunderstoodintheclinicaldomain,itisnotuncommonforclinicianstoassume


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homogeneityandprogramdeviceswithoutconsiderationforindividualvariation.Severalmethodsexistforidentifyingelectrodeswithpoorneuralinterface,anddeactivatingthoseelectrodesresultinimprovedoutcomes.Whilethesemethodsareeffective,theyarenotfeasiblefordirectimplementationintheclinic.Despitepositivetrendsinoutcomeswhendeactivatingpitch-confusedpairsusingavarietyofmethods,thisrecommendationisnotapartofcommonclinicalpractice.Methods:ThisprojectisdesignedtocompareclinicaloutcomesofconventionalCIprogrammingtoaresearchprogramwhereelectrodeshavebeendeactivatedidentifiedbyinabilitytodiscriminateadjacentelectrodes.Allmeasuresusedinthisstudyarestandardproceduresusingcommonclinicalequipmentandassessmentsastoeliminatethebarriertoclinicalpractice.Atotalof28adultswithcochlearimplantsfromCochlearCorporation,AdvancedBionics,andMed-Elwillbeincludedinthefullprotocol.Priortoanyprogramming,theMinimumSpeechTestBatteryandsubjectivequestionnaireswillbepresentedtoeachparticipant.Afterbaselinemeasuresarecollected,apsychometrictaskwillbepresentedtodetermineelectrodepairswithpitchconfusion.Thosewhodonotindicateanypitchconfusedelectrodeswillconcludetheirparticipationinthestudy.Thoseinthefullprotocolwillhaveimmediateretesting,exclusivelyusethenewprogramforanacclimationperiod,andreturnforrepeattestingofbaselinemeasures.Attheendofthestudy,participantsindicatetheirpreferredprogram.Results:Todate,wehavecollecteddataon15participantsand8hadpitchconfusedpairswhichresultedininclusioninourfullcriteria.Priortodatacollectionitwashypothesizedthatamajorityofparticipantswillhaveatleastonepitch-confusedelectrodepair,andthusfar8/15participantsfitthiscriterion.Wealsohypothesizedthatindividualswillperformbetterwiththeresearchprogramthanwiththebaselineprogram.Thishasalsobeenthecase,howeverwedonothaveenoughparticipantstoindicatestatisticalsignificanceatthispoint.Inaddition,itishypothesizedthatparticipantswillprefertheresearchprogramtothebaselineprogram.Thishasbeentrueof6/8participantswhohavecompletedtheentireprotocolatthetimeofthisabstractsubmission.Conclusion:Wedonothaveenoughdatatostatestatisticalconclusionsonanyofourresearchquestionsatthispoint,howeverpreliminarydatasupportacceptanceofallourresearchhypotheses.WeanticipateconclusionsbytheconferenceinJuly2017. AbstractID:54PosterNumber:150Title:ImprovingDeviceUseandExposuretoDifferentListeningEnvironments:UseofDatalogginginPediatricAdvancedBionicsRecipientsAuthors:IvetteCejas,PhD,AnnieP.Rodriguez,AuD;Univ.ofMiamiDept.ofOtolaryngologyEarInst.,Miami,FL.Abstract:ImprovingDeviceUseandExposuretoDifferentListeningEnvironments:UseofDatalogginginPediatricAdvancedBionicsRecipientsIvetteCejas,PhD1&AnnieRodrguez,AuD11UniversityOfMiami,Otolaryngology,Miami,FL,USA; Introduction:Dataloggingprovidesusefulinformationregardingthechild’severydayenvironmentandusetime,whichcanimpactoverallspeechandlanguagedevelopment.Itcanbeusedtoobjectivelymeasureandcounselfamiliesregardingtheirchild’shearingaiduse(Munozetal.,2014;Laplante-Levesqueetal.,2014).Sincethisfeatureisrelativelynewincochlearimplants(Cis),littleisknownaboutitsutilityinpediatricCIusers.


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ThepresentstudyinvestigatesthecorrelationbetweenparentreportsandtheinformationobtainedfromthedataloggingfeatureintheNaidaCIQseriessoundprocessors.Thisfeatureprovidesinformationregardingachild’sdailyusage,programusage,batterytypeandlife,lossoflock,timespentindifferentlisteningenvironments,aswellasamountofusageofdifferentfeatures(i.e.,directionalmicrophones,audio-streamingdevices,etc).Thestudywillreportontwophasesofdatacollection.Methods:Deviceusageinchildrenbetween18monthsand6yearsofageisbeingevaluatedovera7weekperiod.Familiesenrolledcompleteadailyonlinesurveytocapturetheirperspectiveoftheirchild’sCIusage,wearingconfiguration,andfrequencyanddurationofdifferentlisteningenvironments(noise,quiet,music).Datalogsaredownloadedeachweekandcomparedtothedataobtainedfromtheonlinesurveyforthatweek.Thisinformationisusedtocounselthefamilyonweartimeoptimizationandlisteningenvironmentexperiencesandtodetermineifanychangesinweartimeand/orlisteningenvironmentschangedfollowingcounselingsessions.Results:Datasofar(Phase1,n=3)showthatchildren(M=3years),onaverage,spentnotimeinquiet,5%innoise,73%speechinquiet,9%speechinnoise,and14%inmusic.Followingcounselingsessions,overallimprovementswerenotedindailyusageandnumberofunlockedevents.Batterytypeandslotusagefeaturescorrelatedwithparentalreportsonthesurvey.Phasetwoofthestudywillreportdataonfiveadditionalparticipants.Datapretopostcounselingwillbecomparedtodeterminewhethercounselingusingdataloginformationchangespatternsindeviceuseandlisteningenvironments.Differencesinlisteningenvironmentsanddeviceusebasedonageand/orschoolsettingswillbereported.Conclusion:Counsellingpositivelyinfluenceddailyusage.Parentsweresurprisedtofindthatchildrenspentthemajorityoftheirtimeinenvironmentswithspeechinquietinsteadofmostlynoiseenvironments.Themostcommontopicsdiscussedduringcounselingsessionsweredailyschedule,commutetime,routinefamilyactivities,andschoolenvironment.PhaseIIwillfollowfamiliesforanadditionalweekwithamoredetailedsurveyregardingtheirlisteningenvironments.Resultswillprovidemoredetailedinformationregardingdataloggingandparentreportsoftheirchild’slisteningenvironmentsanddeviceuse.LearningObjective:•DescribephaseoneandtworesultsofdataloguseinpediatricAdvancedBionicsNaidaCIQseriesrecipients•LearnaboutpotentialchangesindeviceuseandlisteningenvironmentsfollowingcounselingutilizingdatalogginginformationDisclosureofFinancialRequirements:ThisstudywassponsoredbyAdvancedBionics,LLC. AbstractID:59PosterNumber:80Title:ElectrodeMisdirectionintotheSuperiorSemicircularCanalAuthors:MinbumKim,MD,PhD1,JaeYoungChoi,MD,PhD2;1DepartmentofOtorhinolaryngology-Head&NeckSurgery,CatholicKwandongUniv.Med.Coll.,Incheon,Korea,Republicof,2DepartmentofOtorhinolaryngology,YonseiUniv.Coll.ofMed.,Seoul,Korea,Republicof.


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Abstract:Introduction:Amisplacedelectrodeisreportedtobeoneofthemostcommonmajorcomplicationsinthecochlearimplantation.Thepurposesofthisstudyweretoinvestigatethemisdirectionoftheelectrodeintothesuperiorsemicircularcanalduringcochlearimplantationandtosuggestsurgicalprinciplesforcorrectelectrodeinsertionthroughtheroundwindowmembrane.Methods:Inthisretrospectivecasereview,operativerecordsandpostoperativeimagesofcochlearimplantationsperformedatatertiarycarefacilityfrom1988to2010werereviewedResults:In3outof629cases,electrodeinsertionintothesuperiorsemicircularcanalwasfound.All3casesoccurredincochlearimplantationsusingtheroundwindowapproach,andnonewasfoundwhenusingthecochleostomyapproach.Insufficientexposureoftheroundwindowmembraneandintra-cochlearsofttissuewereregardedasthecauseofmisdirectionoftheelectrode.Theelectrodeswererepositionedappropriatelyintothecochleawithrevisionsurgeryinall3cases.Conclusion:Inordertopreventelectrodemisdirectionduringcochlearimplantationthroughtheroundwindow,theroundwindowmembraneneedstobeclearlyvisualizedbysufficientlydrillingbonyoverhangsandremovingsofttissuesaroundtheroundwindow. AbstractID:71PosterNumber:28Title:TheFamilyEnvironmentandCochlearImplantedChildrenAuthors:VioletaNecula,MD,PhD,AlmaA.Maniu,MD,PhD,MagdalenaChirila,MD,PhD,MarcelCosgarea,MD,PhD,Professor;Otorhinolaryngology,Univ.ofMed.andPharmacy,Cluj-Napoca,Romania.Abstract:Introduction:Theroleofcochlearimplantindeafchildrendevelopmentiswellknown.Howevertheresultsarehighlyvariableanddependsonseveralfactorssuchasageofimplantation,otherdiseases,thequalityofrehabilitationprocess.Butthemostimportantrolebelongstothefamily,familyenvironmentinwhichthechilddevelops.Methods:Thequestionnaire,,FamilyEnvironmentScale”wassentto98familieswhohadatleastonecochlearimplantedchildwhohadmorethan1yearofexperience.Oneoftheparentswasaskedtofilloutthequestionnairewhichincludealsogeneralinformationsaboutthechildandthefamily.Results:Atotalof58familiesrespondedtothequestionnaireandacceptedtoparticipateinthestudy.Meanvalueswerehighercomparedwithnormalfamiliesintheareasofcohesion,expressiveness,intelectual-culturalorientationandorganization,butthetheorganizatiionscoremeanvalueexceededthenormalvalues(between40and60).Theindependenceandtheconflictareashadlowervaluesthannormalfamiliesbutdidnoteceededthelowerlimitofnormal(40).Conclusion:Thefamiliesincludedinstudyareheavilyinvolvedintherehabilitationprocesswhichmeanvariouseducational,intelectualandculturalactivities.Rehabilitationprocessrequiresahugeeffortfromfamily,manysacrifices,hardworkandtrainingtoallmembers.Thehighdetermination,thecohesionandtheexcessiveorganizationmayexplainthelowlevelofindependenceofthesefamilymambers. AbstractID:76PosterNumber:151Title:CorticalResponsesofDeafblindChildrenoftheCubanCochlearImplantsProgramafterAuditoryRehabilitation


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Authors:LidiaE.CharrooRuiz,MD1,SandraBermejo-Guerra,MD2,AntonioPaz-Cordovés,MD3,ManuelSevila-Salas,MD3,BeatrizBermejo-Guerra,Md4,YesyMartínez-García,Nurse2,GerdaGonzález-Sánchez,Nurse2;1NEUROPHYSIOLOGYCLINCAL,NEUROSCIENCECENTEROFCUBA,HABANA,Cuba,2Audiology,MarfánHosp.,HABANA,Cuba,3Otology-Surgery,HernamosAmeijeirasHosp.,HABANA,Cuba,4Audiology,LaPraderaIntl.Ctr.,HABANA,Cuba.Abstract:Introduction:Thecochlearimplantsaregiventheopportunitytogainthesenseofhearingtodeafsubject.Littleisknowntheroleofcorticalplasticityasameanstoreactivatebrainfunction.Methods:ProspectivestudywithCorticalAuditory(CAEP)andevaluationofthemapstopographyofSomatosensoryEvokedPotentialsbystimulationofmedian(SEP-N20)andtibial(SEP-P40)nervesinagroupofcontrolchildrenanddeaf-blindpre-lingual.Electrophysiologicalfindingswerecorrelatedwiththeoutcomesafterimplantation.Results:CAEPshowedsignificantchangeswithauditoryrehabilitation,beingmorefrequentchangelatencyofP1peack,consistentwithrehabilitationresults.SSEP-N20showedevidenceoftheneuroplasticityafterrehabilitation.TopographicdistributionmapsoftheSSEP-N20showedreduceoftheexpansionpre-CI,theover-representationwaslessextensivewhileofSEP-P40noshowedchanged-strictlylocalizedinareaof-somestheticinformationrepresentationofthefoot.Althoughvisionandhearingareextraordinarilyimportantsensesinhumans,ourfindingssuggestthatsomatosensoryinformationplaysanimportantroleineverydaycommunicationindeaf-blindsubjects.Thesechildrenbasetheircommunicationontactilelanguageand,therefore,corticalsomatosensoryresponsechange,particularlyinthecontra-lateralhemisphere(areaofher/hisdominanthand).Asthecriteriaforcochlearimplantationinchildrenexpands,neurophysiologicalevidencesofneuroplasticitymayplayacriticalroleindeterminingwhetherimplantationmaybebeneficialinno-typicalpediatricpatients,forexampledeaf-blindchildren.So,nontraditionalmeasuressuchasthetopographicdistributionoftheSSEPplusCAEPmayshowindirectlyinfluenceoutcomesfollowingaudiologicalinterventionindeaf-blindchildren,suchasCI.Conclusion:OursfindingsshowthatCAEPandtopographicdistributionoftheSEPareinteresttothefunctionalstudyofsensorypathwaysandcorticalactivationindeaf-blindchildren.CAEPevidencechangeintheauditorypathwaycouldhelpcharacterizeoutcomeafterauditoryrehabilitation,whileSSEP-N20showelectrophysiologicalchanges,evidencesofbrainreorganizationafterrehabilitation.ChangesofthecorticalresponseoftheSEP-N20wasinterpretedasevidenceofnewbrainreorganization,effectthatmaytohavetheuseofthehandsforcommunicationinthesechildren,withconsequentimplicationstotheoptimaluseoftheCIduringrehabilitationauditory. AbstractID:77PosterNumber:124Title:ClinicalImplicationofUmbilicalCordDerivedMesenchymalStemCellsinPediatriccochlearImplantationPatientsAuthors:KyoungHoPark,MD,PhDOtolaryngologyHead&NeckSurgery,CatholicUniv.ofKorea,Seoul,Korea,Republicof.Abstract:Introduction:Umbilicalcordblood(UCB)&Wharton’sjelly(WJ)inumbilicalcordhavemesenchymalstemcells(MSC)thatcandifferentiateintovarioustissuecells.Thisstudywasperformedtoconfirmtheeffectoftransplantationofhumanumbilicalcordderivedmesenchymalstemcellsonfunctionalandmorphologicalregenerationofspiralganglionindeafanimalmodel.


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Methods:UCBandWJwerecollectedfrompregnantwomenafterobtainingconsent,andmesenchymalstemcellswereextracted.WetransplantedUCBMSCandWJMSCthroughthebrachialveinofthedeafenedguineapigs.Hearingtestwithauditorybrainstemresponse(ABR)conductedat1,3,and5weeks,andtheresultswerecomparedwithcochlearpathologicalfeatures.Results:Indeafanimalmodel,increasedABRthresholdanddecreasedspiralganglionneuronalcellswerenoted.AftertransplantationofUCBMSC&WJMSC,asignificantimprovementinhearingthresholdcomparedtocontrolgroup.Examinationofthecochlearmorphologicalfeaturesdemonstratedthatthetransplantedgroupshowedasignificantlyincreaseinspiralganglionneuron.Conclusion:IntravenoustransplantationofumbilicalcordderivedMSCcanregeneratespiralganglionneuronsandrestorehearingindeafanimalmodel.ThereforeautologousumbilicalcordderivedMSCtransplantationmayimprovefunctionalresultofcochlearimplantaioninpediatricpatients. AbstractID:78PosterNumber:49Title:CochlearImplantationinCharcot-Marie-ToothDisease:CaseReportandReviewoftheLiteratureAuthors:CharlesL.Anzalone,Jr.,MD1,AmyP.Olund,AuD2,MatthewL.Carlson,MD1;1Otorhinolaryngology-HeadandNeckSurgery,MayoClinic,Rochester,MN,2Audiology,MayoClinic,Rochester,MN.Abstract:1ABSTRACTINTRODUCTION:Charcot-Marie-Tooth(CMT)diseaseisaperipheralhereditaryneuropathyassociatedwithmotorandsensoryimpairmentandcanresultinprofoundsensorineuralhearingloss(SNHL).Currently,theroleofcochlearimplantationinthesettingofCMTandotherprogressiveperipheralneurodegenerativedisordersisnotwellestablished.METHODS:CasereportandreviewoftheEnglishliteratureRESULTS:A70-year-oldmalewithCMTwasreferredforevaluationofprogressiveasymmetricSNHLandreporteda15-yeardurationofdeafnessinvolvingtheleftear.AudiometrictestingconfirmedprofoundSNHLintheleftear,whiletherightearexhibitedmoderate-to-severeSNHL.Left-sidedcochlearimplantationwasperformedusingaconventionallengthlateralwallelectrode.Intraoperativedevicetestingfoundnormalimpedancelevelsthroughoutthearray;however,electricallyevokedauditorypotentialswereabsentonallelectrodes.Uponinitialactivation3weeksaftersurgery,thepatientreportedexcellentaccesstosoundinthecochlearimplantonlycondition.Hehasmadegoodprogressateachsubsequentvisit;speechperceptiontestingafterthreemonthsshowedimprovementfrom0%to27%onAzBiosentenceand28%onCNCwordtestingincochlearimplantonlycondition.CONCLUSION:WereportthethirdcaseofcochlearimplantationinapatientwithCMT.SNHLinCMTishypothesizedtoresultfromdisruptionofsynchronousactivityofthecochlearnerve.InpatientswithCMT,cochlearimplantationmayreconstitutesynchronousneuralactivitybywayofsupraphysiologicalelectricalstimulation.OurresultscorroboratetwoearlierreportsthatcochlearimplantationisaviableoptionforrehabilitationofSNHLinthisuniquesubsetofpatients.1


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AbstractID:87PosterNumber:211Title:ImplantationinChildrenUnder12MonthsofAge:TheEffectsofHiddenDisabilitiesAuthors:KaitlynM.Tona,Au.D.,DavidFriedmann,MD,J.T.Roland,Jr.,MD,SusanB.Waltzman,PhD;NYUCochlearImplantCtr.,NewYork,NY.Abstract:Introduction:Thepurposeofthisstudywastoexamineacohortofpatientswithbilateralseveretoprofoundhearinglosswhoreceivedcochlearimplantspriorto12monthsofagefortheincidenceandimpactofcognitive,behavioral,medicaland/orotherissuesthateitheraroseoversubsequentyearsorwerenotevidentpriorto12monthsofage.Methods:108childrenundertheageof12monthswithdiagnosedbilateralsevere-to-profoundhearinglosswereimplantedatourcenterbetween2000-2013.Etiologiesofhearinglosswereasfollows:33/108=genetic,20/108=Connexin26,innerearmalformations=9/108,meningitis=3/108,CMV=3/108,Waardenburg=1/108,CHARGE=1/108and38/108=unknown.Severalyearsfollowingimplantation,15/108(14%)ofthechildrenwerediagnosedwithadditionalissuesincludingglobaldevelopmentaldelays,attentiondeficithyperactivedisorder(ADHD),Ushersyndrome,cognitivedeficitsandautism,whichwerenotevidentpriortoimplantation.Preoperatively,thenatureandseverityofthehearinglosswasdeterminedusingobjectiveandsubjectivetestingincludingABRandplayaudiometryandtheIT-MAISwasadministeredtoparents.Inaddition,acommunicationevaluationwasperformedonthechildren.Evaluationswereperformedroutinelyfrom3-10yearspost-implantationusingage-appropriatespeechperceptionmeasuresincludingmonosyllabicwordtestsandsentencetestsinquietandnoise.Inaddition,communicationevaluationswereperformed.Allchildrenwereinappropriatetherapeuticandeducationalprogramsfollowingimplantation.Results:All108childrenobtainsignificantauditoryandlinguisticbenefitfromimplantationandweartheirdevicesonaregularbasis.Whileallofthe15childrendiagnosedwithadditionaldisabilitiesfollowingimplantationuseandreceivebenefitfromtheirimplants,theauditoryandlinguisticbenefitsvaryandarecommensuratewiththeseverityoftheirdisabilities.Inaddition,thedevelopmentofskillsinthisgroupwasoftenslowerthaninthosechildrenwhowerenotdiagnosedwithadditionaldisabilities.12/15childrenattendmainstreamschoolsandobtainadditionalassistancedependingontheirindividualneeds.Theremainingthreechildrenattendspecialschools.Thechildwithautismandonechildwithsevereglobaldevelopmentaldelaysarenon-verbal.Despitethefactthattheyhavenotdevelopedorallanguage,theydorespondtostimuliintheenvironmentandweartheirdevicesonaregularbasis.Conclusion:Childrenimplantedbelowoneyearofagebutdiagnosedwithadditionaldisabilitiesseveralyearsfollowingimplantationobtainedsubstantialthoughvaryingdegreesofbenefitfromtheirimplantsbutprovidetheabilitytoallowthemdeveloptotheirfullpotentialandbeconnectedtotheirsurroundings.Whileearlyimplantationiswarranted,itisimportanttoaddressthesepotentialissueswhencounselingfamilies. AbstractID:92PosterNumber:166Title:EvolutionofMappingandVestibularFunctionDuringAcuteLabyrinthitisinaPediatricPatientwithBilateralCochlearImplants


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Authors:SusanGibbons,Au.D.,MargaretKenna,MD,MPH,DennisPoe,MD,Ph.D.,GuangWeiZhou,Sc.D.,AmandaGriffin,Au.D.,Ph.D.,JacobBrodsky,MD;BostonChildren'sHosp.,Waltham,MA.Abstract:Introduction:Vestibulardysfunctioncanaffectpediatriccochlearimplant(CI)patients.VestibularsymptomssuchasvertigoandimbalanceareknowntooccurinsomeCIpatientsduringtheimmediatepost-operativeperiod.However,acutevertigoattackinimplantedchildrenoccurringremotelyfromthepostoperativeperiodhasnotbeenpreviouslywelldescribed.Methods:Casereportofa3-year-oldpatient.Retrospectivereviewofaudiological,vestibularandmedicalchartnotes.Results:Athree-year-oldgirlwithbilateralCIsexperiencedasuddenonsetofvertigoandimbalance,accompaniedbyachangeinhearingperformance.Shehadpreviouslyundergonerightcochlearimplantationat12monthsofageandleftcochlearimplantationat16monthsofage.Causeofthepatient’shearinglossisunknown,withnormalpre-operativeMRIresults.Cochlearimplantprogrammingfourdaysaftertheonsetindicatedasignificantincreaseinright-sidedelectrodeimpedances,resultinginnon-complianceacrossfouroutof22electrodechannels.Left-sidedimpedancesandstimulationlevelswerestable.Tympanometricmeasurementswerewithinnormallimitsbilaterally.Vestibulartestingeightdaysaftertheonsetshowedevidenceofasevereperipheralvestibularlossontherightside.Aprednisonetaperwasprescribed.Hersymptomsresolvedentirely10dayslater.Cochlearimplanttestingfollowingsteroidtreatmentindicatedrightelectrodeimpedancesandstimulationlevelshadreturnedtobaselinelevels.AudiologicalperformancetestingatthistimealsoindicatedstablerightCIdetectionthresholdsandwordrecognitionscores,incomparisontomeasurementsobtainedpriortotheepisode.Noresidualbalancedeficitswereevidentatthefour-weekfollow-upvisit.Conclusion:Wepresentapreviouslyimplantedchildwithsymptomsandevidencesofunilateralacutelabyrinthitisthatoccurredremotelyfromtheperioperativeperiod,resultinginbothdeteriorationinimplantfunctionandipsilateralperipheralvestibularloss.ChildrenwithCIsmaybeatanincreasedriskfordevelopinglabyrinthitisduetotheelectrodecreatingasustainedconduitbetweenthemiddleandtheinnerears.ImplantprogrammingstatusshouldbeassessedinatimelyfashionforpediatricCIrecipientswhoexperienceacuteonsetofvestibularsymptoms. AbstractID:94PosterNumber:140Title:EarlyExperiencewiththeNucleusKansoSoundProcessorAuthors:PhilipA.Segel,Master'sDegreeAudiology,ThomasBoismoreau,BSMechanicalEngineering,AnneliseMichel,MSBusiness;CochlearEMEA,Basel,Switzerland.Abstract:Introduction:AFirstExperienceProgram(FEP)oftheCochlearTMNucleusRKansoTM(CP950)SoundProcessorwasundertakentodeterminetheimpactofanOff-The-Earsoundprocessingunitontheclinicroutine.The3aimsofthisFEPwereto1)DeterminetheimpactofKansoontheclinicalcounsellingroutine,2)Determinetheimpactoftrainingonthecounsellingandfittingprocess.3)Obtainexperiencewithupgradesandinitialactivationswiththissoundprocessor.Methods:32clinicsin12countriesinEMEA(EuropeAfricaandMiddleEast)wererecruitedtoparticipateintheFEPoftheKansoSoundProcessorpostCEMark.Clinicianscompletedquestionnairesregardingthepre-operativecounsellingexperience,theinitialactivationexperienceandtheexperienceforupgradingexistingNucleusrecipientstothisnewformfactor.


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Results:Results-Training:96%ofcliniciansagreed/strongly-agreedthatthetrainingprovidedpreparedthemtocounselonKansoandfit/programtheprocessor.Results-Pre-operativeCounselling:Clinicianquestionnaireswerereceivedon152pre-operativecounsellingsessionswithagesrangingfromunderage12monthstoage80.WhenpresentedwithatraditionalBTEprocessorandanOff-theEarprocessor,patients/parentschosetheKansosoundprocessor48%ofthetime.KeyreasonsforchoosingKansoincludednotwantingaBTEunitbehindtheearanylonger,sizeandweightoftheprocessorandsimplicity.Cliniciansreportedthat43%thecounsellingsessionneededtobeincreasedduetohavingasecondprocessorchoice(Kanso).Results-InitialActivationExperience:40ofthe72candidatesthatchoseKansopre-operativelyhadbeenseenforinitialactivationatthecloseoftheFEP.30%ofactivationswithKansowereinchildren.Centersindicatedthatactivationappointments(mean4weeks)werenotbeingdelayedduetothefacttheprocessorwasanoff-the-earunit.WhenaskedtocompareaninitialactivationoftheKansoSoundProcessortotheNucleus6BTESoundProcessorcliniciansreportedthatthetimeneededwasequivalent(78%)ofthetimeandsomewhatshorter(22%)ofthetime.Results-UpgradeExperience:Clinicianquestionnaireswerealsoobtainedfor44upgrades.53%ofallupgradeswereinchildren.WhenaskedtocomparethetimespentupgradingrecipientstotheKansoSoundProcessortotheNucleus6BTESoundProcessorcliniciansreportedthatthetimeneededwasequivalent(55%)ofthetimeandeithersomewhatorsignificantlyshorter(37%)ofthetime.In88%oftheupgrades,cliniciansagreed/stronglyagreedthatthepatient/parentseasilylearnedtousetheKanso.Finally,whenaskedwhetherupgradingpatientstoKansowaseasy,cliniciansagreed/stronglyagreedwiththisstatement98%ofthetime.Conclusion:Theexperienceat32clinicsindicatedthatfittingtheKansosoundprocessorisnotasignificantlydifferentexperiencethanforCP900technology.Whilecounsellingmaytakelonger(moreproductstoshow/morechoicesfortherecipienttomake)theactualfittingisnodifferentorevenshorter.Whetherupgradeorinitialactivationcliniciansagreedthatpatients/parentseasilylearnedtouseKansoandoverallfittingKansowaseasy.Thus,theuseofanOff-The-Earsoundprocessorfitswellintotheclinicroutine/. AbstractID:95PosterNumber:173Title:SimulatingReducedCochlearImplantCurrentSpreadImprovesSpeechPerceptioninNormalHearingChildrenandAdults,YieldingPerformanceComparabletoThatofEarly-implantedChildrenAuthors:KellyN.Jahn,Au.D.,MishaelaDiNino,M.A.,JulieG.Arenberg,Ph.D.;SpeechandHearingSciences,Univ.ofWashington,Seattle,WA.Abstract:Introduction:Channelinteractionlikelylimitsspeechperceptionperformanceofcochlearimplant(CI)users.Thisstudyexaminedtheroleofchannelinteractionintheabilityofnormal-hearing(NH)childrenandadultstorecognizespectrallydegradedspeech.SimulationsofCIhearingthatvariedthenumberofprocessingchannelsandthedegreeofcurrentspreadwereemployed.TheaimwastoassessthedevelopmentofspeechperceptionasafunctionofspectralresolutionanddegreeofchannelinteractioninNHchildrenandrelatethosefindingstoNHadultsandcochlearimplantusers.Methods:NHparticipantsincludedchildren(age8-17years)andadults(age22-35years).TheCIlistenerswerepre-linguallydeafenedchildren(age11-17years).Speechstimuliweremedialvowelsandconsonants.Theywereprocessedusinganoise-bandvocoderwith8,12,and15channelsandsynthesisfilterslopesof15(foradultsonly),and30and60dB/octave(allNHsubjects).Steeperfilterslopes


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simulatedlesscurrentspreadandthereforelesschannelinteraction.ForCIusers,unprocessedspeechrecognitionwasassessedusingtheparticipants’everydaysettings.Results:ForNHparticipants,vowelandconsonantrecognitionimprovedwithincreasingfilterslopes.Childrencontinuedtobenefitfromreducedcurrentspreadbeyondthe30dB/octavefilterslope,whereadultperformanceplateaued.Foralllisteners,thenumberofchannelsdidnotimpactconsonantrecognition,whilevowelrecognitionimprovedwhenthenumberofprocessingchannelsincreasedfrom8to12,butnotfrom12to15.Ofnote,thispatternofvowelrecognitionwasobservedregardlessoffilterslopeforadultparticipants,butonlyoccurredinthesteepestfilterslopecondition(60dB/octave)forpediatricparticipants.ToanalyzetheCIdata,theimplantedearsweredividedintotwogroupsbasedonthemeanageofimplantation(5.36years).The‘early-implanted’groupconsistedofearsimplantedbeforethemeanandthe‘late-implanted’grouplaterthanthemean.Thus,someofthebilaterallyimplantedchildrenhadbothan‘early’anda‘late’implantedear.Early-implantedearsperformedthesameasNHadultsandchildrenlisteningtothevowelstimuliunderconditionswith12-15channelsandrelativelyreducedcurrentspread(30-60dB/octave).Late-implantedearsperformedthesameasNHadultsintheconditionwiththepoorestspectralresolution(8channels)andthebroadestcurrentspread(15dB/octave).Conclusion:ConsistentwithpreviousvocoderstudiesinNHadults,vowelrecognitionimprovedwhenthenumberofprocessingchannelsincreasedfrom8to12,whereasconsonantrecognitiondidnotchangewithnumberofprocessingchannels.Furthermore,recognitionofspectrallydegradedvowelsandconsonantsimprovedwithreducedcurrentspread,particularlyforchildren.ThedifferencesobservedbetweenNHchildrenandadultssuggestthatthedevelopmentofspectralresolutioncontinuesthroughadolescence,andthatchildrenmaybenefitmorefromreducedchannelinteractionthanadults.Additionally,late-implantedearsperformedsignificantlyworsethanearly-implantedears,andwerecomparabletoNHparticipantslisteningtothemostspectrallydegradedsimulationswiththebroadestcurrentspread.TheseresultsprovideevidencethatearlyaccesstoCIstimulationmaycontributetothedevelopmentofbetterspectralresolution. AbstractID:96PosterNumber:147Title:LongTermLanguageandSpeechPerceptionOutcomesinQuietandinNoiseforPediatricCochlearImplantUsers:TheInfluenceofAgeatImplantationAuthors:MelissaD.DeJong,Au.D.1,AlyceI.Breneman,Au.D.1,RuthE.Stoeckel,Ph.D.2,BeckyS.Baas,M.A.2,TaylorM.Brown,M.A.2;1ENT,MayoClinic,Rochester,MN,2MayoClinic,Rochester,MN.Abstract:Introduction:Studieshaveshownthatchildrenimplantedundertheageof12monthshavebetterreceptiveandexpressivelanguageoutcomesthanolderimplantedchildren,butsomeresearchhasshownthatthisdifferenceweakensovertime.Ageatimplantationalsoimpactsspeechperceptionskills.Researchsuggeststhatthesedifferencesalsoappeartoweakenovertime.Fewstudieshavelookedattheeffectsofageatimplantationonspeechperceptiononmoredemandingmeasuressuchassentencesinnoise.Objective:Toreviewreceptive/expressivelanguageoutcomesandspeechperceptiontestresultsovertimeincludinglisteninginnoiseforchildrenwithinitialactivationofthecochlearimplantundertheageof12months(Group1),from12to23months(Group2),andfrom24-41months(Group3).Methods:Retrospectivereviewofreceptiveandexpressivelanguagescoresaswellasspeechperceptiontestsinquietandinnoise.


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Results:ReviewofmeanexpressiveandreceptivelanguagescoresatthemostrecenttestpointindicatesthatchildreninGroup1achievedreceptiveandexpressivelanguagescoreswithintheaveragerangewhilechildreninGroups2and3achievedscoresat-1SDbelowthemean.Childrenineachgroupgenerallymadeprogressattherateofmaturation.Ontestsofspeechperception,thereisatrendfortheyoungerimplantedchildrentoreachceilinglevelsonwordandsentencetestsatearlierchronologicalagesandwithfewermonthsofcochlearimplantuse.Overtime,theolderimplantedchildrenachievedsimilarscoresonspeechperceptiontestsadministeredinquiet.Onmeasuresofsentencerecognitioninnoise,thereisatrendfortheearlyimplantedchildrentoperformbetterwiththedifferencecontinuingovertime.Conclusions:Testresultssupportearliercochlearimplantationformaximumdevelopmentoflanguageandforbetterauditoryskillsinmorecomplexlisteningenvironmentsatyoungerages.Datawillbeanalyzedtodetermineifthetrendsaresignificant. AbstractID:98PosterNumber:137Title:AdaptiveBehaviorinYoungChildrenPreandPostAuditoryBrainstemImplantationAuthors:AmyMartinez,M.A.1,CarrenJ.Stika,Ph.D.2,LaurieS.Eisenberg,Ph.D.1,EricWilkinson,M.D.3;1USCCarusoFamilyCenterforChildhoodCommunication,Univ.ofSouthernCalifornia,LosAngeles,CA,2SpeechLanguageandHearingSciences,SanDiegoStateUniv.,SanDiego,CA,3HuntingtonMed.Res.Inst.s,Pasadena,CA.Abstract:IntroductionTheauditorybrainstemimplant(ABI)iscurrentlybeinginvestigatedintheUnitedStatestodeterminesafety,feasibility,andearlyefficacyinyoungchildren.InourPhaseIclinicaltrial,childrenages2to5yearsareenrollediftheyarenotcandidatesforordonotdemonstratebenefitfromcochlearimplants(CI)duetocochlearnervedeficiencyorseverecochlearmalformations.ManychildreneligibleforanABIexhibitadditionaldeficitsthatmayimpedeprogresswithasensorydevice,orinterferewiththeirabilitytocooperateintestingandprogramming.InanattempttobetterunderstandthepotentialbenefitsoftheABIandruleoutotherconfoundingfactors,enrollmentinourstudyislimitedtochildrenwithnodemonstrablecognitiveand/ordevelopmentaldelays.ResultstodatesuggestthatprogressinauditoryskilldevelopmentwiththeABIisslowerandlessconsistentthanitisfortypicalCIusers.Childrenmayormaynotbesuccessfulindevelopingspokenlanguageasaprimarymodeofcommunication.However,thesechildrenmaydemonstrateimportantbenefitsinotherdevelopmentaldomains.OnecomponentofthetrialistodeterminewhethertheABIcanpromoteadvancesinadaptivebehavior(conceptual,social,andpracticalskillsnecessaryforpeopletoliveindependentlyandtofunctionsafelyandappropriatelyindailylife).ResearchislimitedontheadaptivebehaviorsofchildrenwhoreceiveCIsbutnonehasaddressedtheABI.MethodsTheVinelandBehavioralScales–2ndedition(Vineland-II)isasemi-structuredparent/caregiverinterviewthatassessesadaptivefunctioninginfourdomains:Communication,DailyLivingSkills,SocializationandMotorSkills.AclinicalpsychologistfamiliarwithdevelopmentalnormsforyoungchildrenadministeredtheVineland-IIatpre-operativebaseline,12-,and24-monthspostABIactivation.FiveofninechildrenenrolledinthestudymettheinclusioncriteriaandunderwentABIsurgery.Results


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BaselineVineland-IIscoresindicatedthatthechildren’sadaptivebehaviorswerewithintheaveragetomoderatelylowrangecomparedtotypicallydevelopingpeers.Within12to24monthsofABIuse,incrementalimprovementswereevidencedintheDailyLivingSkillsdomain,suggestingthatthechildrenareacquiringindependentlivingskillscomparabletothosedemonstratedbytheirnormalhearingpeers.Advancesweremadeinfinemotorskills;however,littleornoprogresswasshownforgrossmotorskills,perhapsduetocongenitalvestibularanomaliesobservedinthesechildren.NegligiblegrowthwasobservedintheCommunicationandSocializationdomains.ConclusionTheVineland-IIrevealedadistinctivepatternofstrengthsandweaknessesfoundfrequentlyinchildrenwithprofoundhearingloss;i.e.,relativeweaknessesincommunicationandsocializationskillsandrelativestrengthsindailylivingskills.Thesefindingsmayreflectgeneraldeficitsintheseareas,orthelimitedsensitivityoftheVineland-IItomeasureincrementalgainsachievedduetothelanguage-basednatureofthetestitems. AbstractID:100PosterNumber:148Title:InfluenceofElectrodeArrayInsertionDepthonLong-TermHearingPreservationandSpeechPerceptionAuthors:AndreaL.Bucker,AuD1,MeredithL.Anderson,AuD2,MargaretT.Dillon,AuD2,EnglishR.King,AuD1,EllenJ.Deres,AuD1,KevinD.Brown,MD/PHD2,HaroldC.Pillsbury,MD2;1DepartmentofAudiology,UNCHlth.Care,ChapelHill,NC,2Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC.Abstract:Introduction:InitialinvestigationsofElectric-AcousticStimulation(EAS)reportedpostoperativehearingpreservationwithashallowelectrodearrayinsertion.Postoperativehearingpreservationprovidedtheopportunitytocombinecochlearimplantandhearingaidtechnologiesinanipsilaterallisteningcondition,resultinginimprovedspeechperception.Studiesreviewingsurgicalproceduresinthesecaseshaveofferedrecommendationstoincreasethepotentialforpostoperativehearingpreservationusingvaryingelectrodearraylengths.Insertiondepthhasbeenshowntoberelatedtospeechperceptionwithintheinitialmonthsoflisteningexperienceforconventionalcochlearimplantrecipients,wherehearingpreservationwasnotachieved.Thepresentreportassessedwhetherinsertiondepthinfluenceslong-termhearingpreservationandaidedspeechperceptioninconventionalcochlearimplantrecipients.Methods:Thisstudyreviewedlong-termhearingpreservationandaidedspeechperceptioninadultcochlearimplantrecipientswithelectrodearraysofferingdifferentinsertiondepths.Unaidedairconductionthresholdsintheimplantedearandaidedspeechperceptionwereassessedatthepreoperative,1-,6-,and12-monthpost-initialactivationintervals.Subjectsweredividedintogroupsbasedontheirspecificelectrodearray.Allsubjectsreceivedafullinsertionoftheirdeviceandwereprogrammedusingbehavioralmappingprocedures.Postoperativehearingpreservationandaidedspeechperceptionwerecomparedbetweenelectrodearrays.Results:Therewasnosignificantdifferencebetweencohortsforhearingpreservation,thoughvariabilitywasnoted.Apotentialconfoundingvariablewasflooreffectsinthepreoperativeresidualhearingforthesubjectsimplantedwiththelongestelectrodearray.Allsubjectsexperiencedasignificantimprovementinaidedspeechperceptionascomparedtopreoperativefindingswithconventionalamplification.Therewerenodifferencesinspeechperceptionbetweencohortsatthe12monthinterval.


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Conclusion:Hearingpreservationcanbeachievedwithelectrodearraysofferingdifferentinsertiondepths.Electrodearrayselectionwasnotpredictiveofpostoperativespeechperceptionabilitieswithupto12monthsoflisteningexperience.Considerationoflong-termoutcomesisneededashearingpreservationproceduresexpandtothepediatricpopulation.AbstractID:102PosterNumber:41Title:AttentiontoInfant-directedSpeechinDeafInfantswithCochlearImplantsAuthors:YuanyuanWang,Ph.D.1,TonyaBergeson,Ph.D.2,ShanaLucius,MA3,DerekHouston,Ph.D.1;1Otolaryngology,TheOhioStateUniv.,Columbus,OH,2TheUrbanChalkboard,Carmel,IN,3NationwideChildren'sHosp.,Columbus,OH.Abstract:Introduction:Veryyoungnormal-hearing(NH)infantspreferandlearnbetterfrominfant-directedspeech(IDS)overadult-directedspeech(ADS)(e.g.,Cooper&Aslin,1990;Fernald,1985;Maetal.,2011;Singhetal.2009),becauseIDStendstoexhibitexaggeratedacoustic-prosodicproperties,suchasslowerspeakingrate,higherpitch,widerpitchrange,andlongerpauses,relativetoADS(FernaldandSimon,1984;Fernaldetal.,1989;Werkeretal.,1994).Infantswhoreceivecochlearimplantations(CIs)mayshowdifferentsensitivitytoIDSversusADSduetoearlyauditorydeprivationanddegradedauditoryinputafterwards(Geersetal.,2011;Holtetal.,2012;Pisonietal.,2000).Forexample,inonestudywefoundthatCIinfants’sustainedattentiontospeechdifferedfromthatofNHinfants(Yangetal.,inpreparation).Therefore,thepurposeofthepresentstudywastodeterminewhetherinfantswithCIs,liketheirNHpeers,preferlisteningtoIDSoverADS.Methods:Usingthecentralfixationprocedure,wetested46infants-12prelinguallydeafinfantswhoreceivedCIsbefore2yearsofage(meanchronologicalage=27.24months;meanhearingage=11.88months;CIgroup),22NHinfantswithmatchedhearingexperience(mean=11.68months;NH-HEMgroup),and12NHinfantswithmatchedchronologicalage(mean=27.55months;NH-CAMgroup)-ontheirlisteningpreferenceinthreeblocks:IDSvs.ADS,IDSvs.Silence,andADSvs.Silenceblock(thelasttwoservedasbaseline).Wecalculatedtheaveragelookingtimestodifferenttypesofstimuli(IDS,ADS,orSilence)withineachblockforeachinfant.ToassessCIinfants’developmentallanguageskills,weadministeredthePreschoolLanguageScale(PLS;Zimmerman,Steiner,&Pond,2002)approximately18monthsafterimplantation.Results:IntheIDSvs.ADSblock,boththeCIandNH-HEMgroupspreferredIDSrelativetoADS,p=.010andp=.003,respectively;however,theNH-CAMgrouplookedequallylongtoIDSandADS;intheIDSvs.Silenceblock,allthethreegroups,ingeneral,lookedsignificantlylongertoIDSthantosilence,p<.001.IntheADSvs.Silenceblock,boththeNH-HEMandNH-CAMgroupslookedsignificantlylongertoADSrelativetosilence,p=.001andp=.019,respectively;however,theCIgroupdidnotshowanypreference,seeFigure1.TheregressionanalysesdemonstratedthatCIinfants’IDSpreferencequotient(calculatedbydividingtheaveragelookingtimedifferencestoIDSandADSbythetotalamountoflookingtimetobothIDSandADSforeachCIinfant)intheIDSvs.ADSconditionwasthesinglebestpredictorofPLSAuditoryComprehension,p<.001,andPLSExpressiveCommunication,p=.052.Conclusion:Theresultsshowedthat1)similartoNH-HEMcontrols,CIinfantspreferIDSoverADS;and2)thedegreeofIDSpreferencepredictslanguagedevelopmentinCIinfants.ThesefindingssuggestthatinfantswithCIsmayhaveaccesstotheinformationprovidebyIDSforthepurposeoflanguageacquisition.Theymayalsoinforminterventionstrategiesbyindicatingwhatkindofinputismosteffectivefordeafinfantstoattainage-appropriatelanguageskills.


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Abstract.PresentationRoleOrder:27AbstractID:103PosterNumber:18Title:IdentificationandManagementofChildrenwithUsherSyndromeSyndromeAuthors:JolieFainberg,M.A.1,MelissaK.Chaikof,B.A.2,SusanTrotochaud,B.A.3,NancyParkin-Bashizi,M.A.,COMS,CVRT4;1Audiology,AtlantaSpeechSch.,Atlanta,GA,2Usher1FFndn.,Boston,MA,3Usher2020Fndn.,Atlanta,GA,4VisionRehabilitationServicesofGeorgia,Atlanta,GA.Abstract:Introduction:UsherSyndromeisararegeneticdisorderthatistheleadingcauseofdeaf-blindnessintheworld.ItwasnamedforaScottishOphthalmologistfromtheearly1900s,CharlesUsher,whorecognizeditasasyndromethroughanumberofhispatients.Althoughitisrare,onlyabout45,000peopleintheU.S.,itisdevastatingforthosewhoareaffectedbyit.Causedbyanautosomalrecessivegene,itmanifestsitselfinthreeclinicaltypes.Methods:Parentsrelyonaudiologistsforinformationandguidanceinworkingwiththeirchildrenwhohavehearingloss,sotheaudiologistisoftenexpectedtocounselandhelpparentsthroughtheirchoicesanddecisions.ThepurposeofthispaperistoeducatetheaudiologistaboutUsherSyndromeanditsrelevancetonewlyidentifiedchildrenandtheirfamilies.Wewilldescribethesymptomsandsub-typesofUSHwithregardtohearing,visionandbalanceincludingspecificinformation.Results:EarlydiagnosisiscriticalforchildrenwithUshersyndrome.Whilethereiscurrentlynocure,thebesttreatmentinvolvesearlyidentificationsothateducationalprogramsandassistivetechnologiescanbeginassoonaspossible.Early,bilateralcochlearimplantationisaneffectivetreatmentforchildrenwithseveretoprofoundhearingloss.Conclusion:Early,bilateralcochlearimplantationinchildrenwithUsherSyndromeisaneffectivetreatmentforchildrendiagnosedwithseveretoprofoundhearingloss.ItisimportantfortheaudiologisttobefamiliarwithUsherSyndromeastheyguidefamiliesofchildrenwithhearingloss.Fromourexperiences,weofferasuggestedprotocoltofacilitateearlyidentificationofthisdisorder. AbstractID:105PosterNumber:193Title:TheElectricalStapedialReflexThresholdOverTime.Authors:CachePitt,AuD,McKayKunz,BS,KarenMuñoz,EdD;UtahStateUniv.,Logan,UT.Abstract:TheElectricalStapedialReflexThresholdOverTimeIntroduction:ThepurposeofthisstudywastoinvestigatechangesintheelectricalstapedialreflexthresholdwithinandacrosspatientsovertimeandtoidentifytherelationshipbetweentheelectricalstapedialreflexthresholdlevelsandupperlimitofloudnesslevelsforthethreecochlearimplantmanufacturersavailableintheUnitedStates.Methods:ThestudywascompletedusingaretrospectivefilereviewofcochlearimplantrecipientsusingdevicesfromAdvancedBionics,Cochlear,andMedELwhowereseenbetweenJanuary2013andDecember2015.Demographicinformationalongwithanyavailableelectricstapedialreflexthreshold


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andupperlimitsofloudnesslevelswererecordedfor113malesand93femalerecipients(N=206).Recipientsrangedinagefrom13monthsto86years(mean=18years;standarddeviation=21).Results:ThemeandifferenceinupperlimitsofloudnesslevelstotheelectricstapedialreflexthresholdforCochlearwas19clinicalunitswithastandarddeviationof11units.ForAdvancedBionicsthemeandifferencewasadecreaseof10%clinicalunitswithastandarddeviationof39%and3.4%withastandarddeviationof11%forMedEl.Foreachmanufacturertheelectricstapedialreflexthresholdmeasurementswereconsistentovertimeduringthetimeframeofthestudy(2013-2015).MedElhada0.4unitdecreaseperyear(SD=5.7)whileCochlearhadadecreaseof1.4unitsperyear(SD=8.3)andAdvancedBionicshadadecreaseof3unitsperyear(SD=45.6).Conclusion:ThisstudysupportstheclinicalrelationshipbetweeneSRTandbehaviorallysetupperlimitsofloudnessforCochlear,AdvancedBionics,andMed-Elmanufacturers.Italsoprovidessupportthattheelectricalstapedialreflexthresholdisconsistentovertime,elicitingconfidencethatlittlechangewilloccuroverextendedperiodsoftime. AbstractID:109PosterNumber:25Title:ProportionofNounsandVocabularySizeinYoungCIRecipientsAuthors:JongminJung,PhD1,DerekHouston,PhD1,JessicaReed,PhD1,LauraWagner,PhD2;1Otolaryngology-HeadandNeckSurgery,TheOhioStateUniv.,columbus,OH,2DepartmentofPsychology,TheOhioStateUniv.,columbus,OH.Abstract:Introduction:Researchhasshownthatyoungcochlearimplant(CI)recipientsproducetheirfirstwordsrapidlyafterCIactivation(Ertmer&Inniger,2009;Fagan,2015).However,theachievementofthispromisingmilestoneoffirstwordscanbefollowedbyprotractedordelayeddevelopmentofvocabulary(Nott,Cowan,Brown,&Wigglesworth,2009a).Aclassicapproachtounderstandingvocabularydevelopmenthasbeentoexaminethecompositionofchildren’slexicons,withaparticularfocusonearlynouns(Batesetal.,1994;Nelson,1973;Rescorla,Mirak,&Singh,2000).Childrenwithagreaterproportionofcommonnounsarehypothesizedtoshowmorerapidgrowth.OnlyNottandcolleagues(2009b),however,haveexaminedthevocabularycompositioninCIrecipients(23oftheir24participantswithhearingloss(HL)hadCIs.ChildrenwithHLintheirstudyproducedasmallerproportionofnounsthanchildrenwithnormalhearing(NH)whencontrollingforvocabularysize.However,theydidnotinvestigatetheeffectofthevocabularycompositiononvocabularysizeinpediatricCIpatients.ThecurrentinvestigationisapreliminaryanalysisoftheassociationbetweentheproportionofearlynounsandvocabularysizeinyoungCIrecipients.Methods:Atotalof141MacArthurCommunicativeDevelopmentInventory:WordsandGestures(CDI:WG;Fenson,etal.,2007)werecollectedfrom29youngCIrecipients(rangeofageatimplantation:8to24months;mean=16.13months,SD=4.37)acrosstheirfirstyearofCIuse.Participantsreceivedcreditforanywordintheirexpressivevocabularyregardlessofmodality(e.g.,signorspokenlanguage)asreportedbycaregivers.Theproportionofnounstototalvocabularysizewascalculated.Results:Theresultsofrepeatedmeasuresusingmixed-designANOVAindicatedthattherewasnoeffectofCIexperienceontheproportionofnouns(F[8,65.761]=1.378,p=.223).Bycontrast,thepartialcorrelationanalysiscontrollingCIexperiencesshowedaweakbutsignificantassociationbetweentheproportionofnounsandtotalvocabularysize(r=.280,p=.012).Conclusion:Ourpreliminaryfindingssuggestedthattheproportionofnounshasapotentialtobeanearlypredictorofthefuturevocabularyoutcomes.TherelationshipsbetweenthenounproportionandvocabularyoutcomesinyoungCIrecipientsmustbestudiedfurther.ComparingCIrecipients’


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proportionofnounswiththenormsforchildrenwithNHcouldhelpusbetterunderstandthevocabularygrowthinyoungCIrecipients. AbstractID:112PosterNumber:19Title:TheNaturalHistoryandRehabilitativeOutcomesofHearingLossinCongenitalCytomegalovirus:ASystematicReviewAuthors:KyleT.Fletcher,MD1,TianshiLiu,BS2,ErinM.Wolf,PhD2,MariaMuthoka,MBChB3,MatthewL.Bush,MD1;1Otolaryngology-Head&NeckSurgery,Univ.ofKentucky,Lexington,KY,2CollegeofMedicine,Univ.ofKentucky,Lexington,KY,3DivisionofOtolaryngology–HeadandNeckSurgery,DepartmentofSurgery,Univ.ofNairobiColl.ofHlth.Sci.,Nairobi,Kenya.Abstract:Introduction:CongenitalCytomegalovirus(cCMV)infectionisacommoncauseofpediatrichearinglossyetthenatureofthehearingloss(onset,progression,andfluctuation)ispoorlyunderstood.Furthermore,thefactorsaffectingsuccessfulauditoryrehabilitationoutcomesofchildrenwithcCMVareunknown.ThepurposeofthisstudywastosystematicallyreviewtheliteratureregardingthenaturalhistoryandrehabilitativeoutcomesofsensorineuralhearinglossfromcCMVinfections.Methods:AsystematicsearchwasperformedinPubMed,PsychINFO,CINAHL,andWebofSciencetoidentifypeer-reviewedresearch.Inclusioncriteriawere:1)studiesaddressingtimingofonset,progression,and/orfluctuationofhearingincCMV2)resultsofcochlearimplantationinthecCMVpopulation3)documentationofcCMV(asopposedtopost-natalCMV)viaappropriatetesting(driedbloodspot,cordblood,urineorsalivacultureorpolymerasechainreaction)4)hearinglossdocumentedby2separateaudiologicalassessments.Exclusioncriteriawere:1)casereportsornon-originalresearch,2)languageotherthanEnglish.Results:Thirty-sixarticleswerereviewed.StudiesthatreportedonuniversalscreeningidentifiedcCMVin0.2–1%ofnewbornsandofthosenewborns8-22%hadhearingloss.SensorineuralhearinglosswasmoreprevalentinchildrenwithsymptomaticcCMV(growthretardation,prematurity,microcephaly,chorioretinitis,seizures,and/orotherneurologicalabnormalities)comparedtoasymptomaticcases.Post-nataldevelopmentofhearinglosswas9–68%ofcasesofcCMVandageofonsetrangedfrom3monthsto16years.CochlearimplantationinchildrenwithcCMVsignificantlyimprovesexpressiveandreceptiveoutcomes;however,symptomaticchildrenandthosewithcognitiveimpairmentshavepooreroutcomesthannon-cCMVCIrecipients.ThisislimitedliteraturecomparingrehabilitationoutcomesincCMVandnon-cCMVCIrecipients.Conclusion:LateonsetandprogressivehearinglossisseeninchildrenwhodevelophearinglossfromcCMV.Frequentaudiologicfollow-upisnecessaryconsideringthenaturalhistoryofcCMVhearingloss.Universalscreeningshouldbepursuedduetothenumberofasymptomaticchildren,atbirth,whodeveloplateonset/delayedhearingloss.Cochlearimplantationisaneffectivemeansofimprovingspeechandlanguageskillsinthispopulation. AbstractID:114PosterNumber:203Title:PerceptionofInterauralTimeDifferenceswithCochlearImplantswithaFocusontheOngoingFineStructure


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Authors:TobiasRottmann,Dipl.-Ing.,ThomasLenarz,Prof.Prof.Dr.,AndreasBüchner,Prof.Dr.;DepartmentofOtolaryngology,Med.Univ.ofHannover,Hannover,Germany.Abstract:Introduction:Codingstrategiesforcochlearimplants(CI)whichtransferinadditiontotheenvelopeoftheincomingsignalalsotheongoingfinestructurewereintroducedintothemarketsometimeago.However,thepossibilityofbilaterallyimplantedCIuserstoperceiveinterauraldifferencesinthesignalfinestructurehasnotbeeninvestigatedindetailsofar.Inprinciple,afinestructurecodingstrategyreproducethefinetemporalinformationoftheacousticinputsignalontheelectricalside,sothatanITD(interauraltimedifference)perceptiononbasisofthefinestructurecouldbepossible.TheaimofthisstudyistoevaluatetheITDcodingeffectivenesswithastandardCIScodingstrategyandafinestructurecodingstrategy,aswellasmakingacomparisonbetweenthetwo.Methods:Forthispurpose,twobinauralstimuliwithinterauraltimedifferenceswerepresentedinalateralizationexperimenttothebilaterallyimplantedsubjects.Bothprocessorsareconnectedviathedirect-intoasoundcardofacomputerwhichgeneratesthesignals.Themethodofconstantstimuliisused,sothatsevenfixedITDsintherangeof50to600µsarerepeatedlypresented.Differentelectrodeconfigurationswithone,fourandtenactiveapicalelectrodepairsweremeasuredtoinvestigatetheeffectcrosstalktheintra-cochlearelectrodecontacts.Results:Elevensubjectswereincludedinthestudy.SevenofthesesubjectsweresensitivetoITDs.Theyshowedgoodresultswiththefinestructurestrategyinthesinusoidscondition.WiththeCISstrategyhowever,theyonlyreachedITDsintherangeofchancelevel.WiththemuchbroaderpinknoisesignalevenwiththeCISstrategyamoderateITDperceptionwasobserved,probablycausedbyITDcuesintheenvelopeoftheprocessedsignal.HowevertheperformancewiththefinestructurestrategywasbetterthanwithCISinmostofthecases.WealsoobservedthatingeneraltheITDsensitivitydecreasedwithanincreasingnumberofactiveelectrodes.Conclusion:Inthosepatients,whowereabletoperceiveITDcues(<600µs)resultswiththefinestructurestrategyweresuperiorcomparedtotheCISstrategy.However,ourpreliminaryresultsalsosuggestthatchannelinteractionbetweenintracochlearelectrodesmighthamperITDperceptioninCIsubjects. AbstractID:115PosterNumber:209Title:RemoteSupportforFirst-&Follow-Up-FittingsofCochlearImplantsinChildrenAuthors:KellySchepers,BH1,KarinBauer,BSc1,StefanoMorettini,PhD2,AlexanderMöltner,Dip.Ing.(FH)3,RudolfHagen,Prof.Dr.med.Dr.h.c.4;1StiftungHör-Sprachförderung,CICSüd,Würzburg,Germany,2MED-ELElektromedizinischeGeräteGmbH,Innsbruck,Austria,3MED-ELElektromedizinischeGeräteDeutschlandGmbH,Starnberg,Germany,4KlinikundPoliklinikfürHals-,Nasen-undOhrenkrankheitenderJulius-Maximilians-Univ.,Würzburg,Germany.Abstract:Introduction:Tele-healthisabroadtermfortheapplicationofinformationandtelecommunicationtechnologiesinthedeliveryofhealthservicesincaseswhereusersareseparatedfromhealthcareprovidersbysomedistance.Cochlearimplantaudiologyisfairlyspecialized,andisthereforeoftenonlyavailableinlargercitiesorvia‘outreach’services,whichinvolveaspecialistaudiologisttravellingtodifferentsites.Thiscanplacearealburden(intermsoftimeandexpense)onsubjectswholiveinremoteorrurallocations,andtheirfamilies.Hughesetal.(2012)notedthatmostclinicalCIprogramsrequire8-10visitstotheCIcenterwithinthefirstyearofdeviceuse,andannualorsemi-annualvisitsthereafter.Often,asubject’svisitsinvolve


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travellingconsiderabledistance,withtheresultthattheyoftenarrivetiredattheCIclinic.RemotedeliveryofCIfittingservicesviatele-healthisthereforeanattractiveoptionandhasthepotentialtoimproveaccesstoservicesandtoreducetheburdenonfamilies.Methods:Whilepriorstudiesonsubjectivepreferenceforremoteorface-to-facefittingsessionshavebeenperformed,thisstudyisthefirstofitskindtoprovideaprospectiveandcontrolledassessmentofthesafetyandperformanceofaremoteprogrammingoptionforCIfittinginchildren.Accordingly,inthisstudyChildrenwhoarebilaterallydeaforborderingondeafness,receivingorusingacochlearimplantwererecruited.Thisstudyaimedtocomparetheoutcomesofelectrophysiologicaltesting,fittingparameters,puretoneaudiometryandspeechintelligibilitymeasureswithinsubjectswhoreceivedacochlearimplantandunderwenttheimplantfittingprocedures.Specifically,subjectswerefitvia2procedures(remoteandface-to-face)andelectrophysiologicalparameters,puretoneaudiometryandspeechintelligibilityoutcomeswereassessedacutelyaftereachsessioninastandardaudiologicaltestsetupatthestudycenters.Inadditioneachfittingsessionwasappraisedbytheremoteexpert,localhost,andthesubjectviaanadhocdesignedquestionnaireandthetotaltimeinminutesneededtoperformeachtypeofsessionwasrecorded.Results:Initialdatagatheredonsubjectsreceivingafollow-upfitting,showageneralgoodacceptanceandapositiveappraisaloftheremotesettingbythesubjectsthemselvesandtheprofessionalsinvolved.Likewise,fittingmapsgeneratedwitheithersettingdidnotdiffersignificantlyandinitialdataontheoutcomesofthetwoset-upsonspeechintelligibilityshowsimilarperformancesforwhatconcernsubjectsreceivingfollow-upfittings.Inaddition,boththeremoteandthelocalfittingcouldbeperformedinasimilaramountoftimewithoutexperiencingmajordelaysorinterruptions.Conclusion:RemoteCIfittingwasgenerallywell-receivedbyCI-usersandmedicalprofessionals.Subjects’performanceonaudiologicaltestsafterremotefittingwasnotsignificantlydifferentthanafterstandardface-to-facefitting.Additionally,remotefittingdidnottakelongertoperformthatface-to-facefitting. AbstractID:118PosterNumber:222Title:ImprovingtheTransitionExperienceforTeenswithCochlearImplantsTransferringTheirCarefromaPediatricSettingtoanAdultSettingAuthors:JanetOlds,PhD1,ElizabethShaw-Pickard,M.Sc.,AUD(C)1,ShelleyArmstrong,M.Sc.,AUD(C)2,JoAnneWhittingham,MSc3,ElizabethFitzpatrick,PhD4,DavidR.Schramm,MD5;1Psychology,Children'sHosp.ofEasternOntario,Ottawa,Canada,2Audiology,TheOttawaHosp.,Ottawa,Canada,3AudiologyLab,Children'sHosp.ofEasternOntarioRes.Inst.,Ottawa,Canada,4FacultyofHealthSciences,Univ.ofOttawa,Ottawa,Canada,5FacultyofMedicine,Univ.ofOttawa,Ottawa,Canada.Abstract:Introduction:Overthelast25years,cochlearimplants(CI)havebeenavailableforchildrenwithseveretoprofoundhearingloss,andthesepatientsarenowtransitioningfromthepediatrictoadultsettinginsignificantnumbers.Whileyouthwitharangeofchronichealthconditionsfacechallengesinmakingthetransitiontoadultsettings,someofthechallengesintransitionfortheCIpopulationareunique.Forprovidersinadultsettings,pediatricCIrecipientswhotransitiontocarearearelativelysmallproportionoftheircaseloadandhavedifferentpatientcharacteristics,whicharechangingaspediatricCIpracticesevolve.Thesedifferencesincludecommunicationdifficultiessecondarytolateragesofimplantationofearlyrecipients,complexmedicalanddevelopmentalneeds,aswellaspatientswithbilateralCIandbimodaldevices,allwhichneedtobeconsideredintransition


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planningatbothpatientandsystemlevels.WehaveconductedresearchontransitionfrompediatrictoadultCIcentersinasinglegeographicarea,withtheoverarchinggoaltoimproveservicesforCIrecipientstransitioningfromthepediatrictoadultsettingandtoreducenegativeimpactsassociatedwithtransitionforbothpatientsandproviders.Theobjectiveofthisstudyistoexaminechallengesinservicedeliveryassociatedwithtransition,documentchangesinpracticeimplementedtoreducethesechallenges,andevaluatetheeffectivenessofthesechanges.Methods:AsetofrecommendationsforimprovedservicedeliverywerederivedusingthefollowingMethods:literaturescanandreview;focusgroupsconductedwithpatients,families,healthprofessionalsandotherstakeholders;healthserviceutilizationdata.Recommendationswerethenprioritized,anevaluationframeworkdeveloped,andchangesatsystem-andpatient-levelsimplementedinastepwisefashion.Evaluationofeachcomponentoftheframeworkhasbeendevelopedandimplemented.Results:Recommendationsforimprovedservicedeliveryincluded:formalizingcommunicationbetweenprograms;viewingtransitionasaprocessandidentifyingwhenitiscomplete;providingpatientswithfamiliaritywiththenewcenterbeforethetransferofcare;involvingcommunityservices;implementingtoolstosummarizehealthinformationandtoassessyouthreadinesstotransition;formalizingproceduresforconfidentialityandcommunication;educatingpatientsaboutequipment,industryandcommunityresources.Plannedevaluationofchangestoaddressindividualcomponentshasindicatedimprovedutilization,andpositivestakeholderfeedback,aswellasadditionalareasforimprovement.Conclusion:TheresultsfromthisstudyindicatedimprovementsinthetransitionfrompediatrictoadultservicesforCIpatientswithinahealthserviceevaluationframework.Evaluationoffurtherchangeswillcontinuetobeanimportantcomponentofservicedeliveryanditsimprovement. AbstractID:119PosterNumber:97Title:AetiologyandOutcomesinPaediatricReimplantationAuthors:ChristopherRaine,MB.BS.,FRCS.,ChM.,JaneMartin,MED,CatherineTotten,MSc.,IqbalKhan,FRCS,DavidStrachan,FRCS;DeptOtolaryngology,YorkshireAuditoryImplantService,Bradford,UnitedKingdom.Abstract:Introduction:Cochlearimplantsareoneofthemostsophisticatedandreliabledevicesinsertedintothehumanbody.Despitebeingconstructedtoveryhighspecificationsthehumanbodyisa‘hostile’environmentforelectroniccomponents.Variousreasonsforimplantfailurehavebeenrecognized.Itisessentialthatsuchfailuresarerigorouslyreportedandthereneedstobecloseco-operationwithmanufacturersinordertocontinuetoimprovedesign.Methods:Allpatients’demographicsandoutcomesareprospectivelyenteredintoourdepartmentaldatabase.Thisallowsforretrospectiveevaluationofoutcomes.Between1991and2016-559childrenhavebeenimplantedwithbilateralimplantationbeingtheroutinesince2009(atotalof747implants).Thedatacollectedincludedageofinitialimplantationandsubsequentfailure,surgicaldetails,preandpostoperativeassessmentsand,whereappropriate,CategoriesofAuditoryPerformance(CAP)&MeaningfulAuditoryIntegrationScale(MAIS),withaminimumof6monthspostoperativefollowupafterre-implantation.Reasonsforimplantfailure,onceofficialreportshadbeenreceivedfromthecompanies,wereclassifiedaccordingtotheEuropeanConsensusStatementResults:Of747implants55episodeswereidentified(7.36%)-13withbilateralCI;42unilateral.Datawasavailableforallbilateralandin39oftheunilateralcases.1childwasnotreimplanted;7childrenhadinsufficientdataorhadmovedawayfromourservice.Therewerenosurgicalcomplications.


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Statisticallythe13bilaterallyimplantedchildrenshowedcontinuedimprovementwithapositivecorrelation(0.89).3patientsregressedonCAPscoreforashortperiodhoweverthemajority(36)remainedstaticorimprovedwithapositive(correlation0.88).MAISschoolscoresshowedpositiveimprovement.Withregardtotheoverallcauseofre-implantation;5.5%relatedtoinfectionand/orextrusion;9%relatedtoimplantperformance;9%withdecrementlossofperformancerelatedtotrauma;76.5%relatedtodevicefailure.Ofthelattergrouptherewasaclearhistoryoftraumain20%;Youngerimplanteeswithahistoryoftraumaweremorepronetofailure(p=0.023),similarlytheageatfailurewasrelatedtotrauma(p=0.035).Conclusion:Whilstsuddenfailureisusuallyquicklydiagnosedagradualdecrementaldeclinecanbeverydifficulttoidentifyinyoungerchildren.Ifimplantedchildrenarefailingtoprogressthenimplantintegrityshouldbetested.Surgicalreimplantationissafeandifperformedassoonaspossibleproduceslittlelossinfunction.Singlesidedimplanteesdoremainstableorcontinuetoprogressandallbilateralimplanteesprogressed(astheyretainedonefunctioningimplant).Traumainyoungchildrenisasignificantcontributoryfactordespitetherobustengineeringofimplants. AbstractID:120PosterNumber:39Title:RhymeAwarenessinChildrenwithCochlearImplants:InvestigatingtheEffectofaDegradedAuditorySystemonLanguageandLiteracyDevelopmentAuthors:LinyeJing,M.A.1,KatrienVermeire,Ph.D.1,AndreaMangino,M.S.2,ChristinaReuterskiöld,Ph.D.1;1NewYorkUniv.,NewYork,NY,2NorthwellHlth.HearingandSpeechCtr.,NewHydePark,NJ.Abstract:Introduction:Successfulliteracylearningisthemostimportantachievementforachildinschool.Decodingofwrittenwordsismostlydependentonphonologicalprocessingskills.Phonologicalawarenessskillsareaprerequisitefortheabilitytodecodewrittenwordsaswellastheabilitytosoundoutwordsandlearntospell.Rhymeawarenessisaphonologicalawarenessskillessentialforchildren'sliteracydevelopment.Vocabularyisviewedasasupportsystemforthedevelopmentofarangeofphonologicalprocessingskillsinyoungchildren.DeCara&Goswami(2003)foundthatnormalhearing(NH)five-year-oldchildrenwithlargervocabulariesweremoresuccessfulinidentifyingrhymingwordsfromdenseratherthansparserhymeneighborhoods.Childrenwithweakervocabularyskillsdidnotshowthesameresults.Inchildrenwithcochlearimplants(CIs),literacyischallenging.Littleisknownabouttherelationshipbetweenvocabularyskills,phonologicalawarenessskillsandphonologicalneighborhooddensityinchildrenwithCIs.SterneandGoswami(2000)alsofoundthatchildrenwithCIsrelyonorthographytoahighdegreewhenmakingrhymejudgments.ThecurrentstudyinvestigatesperformanceusingarhymeodditytaskinchildrenwithCIsandNHpeers.Researchquestionsinclude:1.DochildrenwithCIsshowsimilaraccuracyasNHchildren?2.DochildrenwithCIsshowsimilarsensitivitytorhymeneighborhooddensityasNHchildren?3.DovocabularyskillspredictaccuracytothesamedegreeinchildrenwithCIsandNH?4.DoorthographicpatternsinfluenceperformanceinchildrenwithCIstoahigherdegreethaninNHchildren?Methods:4.5to7.5yearoldchildrenwithCIsand4.5to5.5yearoldNHchildrenwillparticipateinstandardizedscreeningforvocabulary,readingskills,nonverbalintelligence,workingmemory,andgenerallanguageability.Intherhymeodditytask,participantswilllistento3words(2rhyming+1non-rhyming)andidentifythenon-rhymingword.Halfofthestimulicomefromdenserhymeneighborhoodsandhalffromsparseneighborhoods.Therhymesareeitherspelledcongruently(feed/need)orincongruently(role/goal).


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Results:PredictedresultsarethatchildrenwithCIswilldemonstrateloweraccuracythantheirNHpeers.However,performanceforCIandNHchildrenwillbesimilarlyinfluencedbyneighborhooddensityandvocabularyskills.ResultswillbediscussedconsideringcurrentresearchonphonologicalawarenessskillsandliteracydevelopmentinchildrenwithCIs,andtheeffectsofstatisticalpatternsinlanguagelearning.Conclusion:TheresultsfromthisstudywillprovidebetterunderstandingoffactorsinfluencingthedevelopmentofreadingandwritingskillsinearlyimplantedCIchildren. AbstractID:122PosterNumber:153Title:AnIntegratedApproachtoObtainElectricallyEvokedStapedialReflexThresholdinPediatricCochlearImplantPatientsAuthors:KerriA.Corkrum,AuD,ErinChristianson,PhD,MargaretMeredith,AuD,SusanNorton,PhD;ChildhoodCommunicationCenter,SeattleChildren'sHosp.,Seattle,WA.Abstract:Introduction:Creatingavalidcochlearimplant(CI)mapinapediatricpatientcanbechallenging.Objectivemeasuressuchaselectricallyevokedstapedialreflexthresholds(eSRT)havebeenshowntocorrelatewithmostcomfortableelectricalstimulationlevels(M-levels).Traditionally,measuringeSRTiscumbersomebecausemultiplepiecesofequipmentandmorethanoneclinicianareneededforyoungerpatients.Recently,anintegratedapproachtoobtaineSRTthatcanrecordandstoredatadirectlyintheCIprogrammingsoftwarewasdeveloped.Theobjectivesofthisstudywere:1)totestthefeasibilityofanintegratedapproachtoobtaineSRTinapediatricCIcohortduringroutineclinicvisits;and2)toevaluatetherelationshipbetweeneSRTlevelsandbehavioralM-levels.Methods:ESRTswereattemptedinpediatricCIpatients(N=32ears)duringroutineclinicalfollowupvisits.Themajorityofthesepatientswerenotabletoreliablyperformloudnessscalingbutwereoftenabletoprovidesometypeofdescriptivefeedbackduringbehavioralmapping.Allpatientswereimplantedwithdevicesfromthesamemanufacturer.TheequipmentusedtoobtaineSRTincludedalaptopcomputer,acustominterface,andatympanometer.ESRTswereattemptedforfourfocusedelectrodeclusters(Band1apicalcluster,Band2and3mid-arrayclusters,Band4basalcluster)witha678Hzprobetone.Results:ESRTwassuccessfullyobtainedin72%(23/32ears)oftheearstested.ThreepatientshadbilateralCIs.Themeanpatientagewas10.0years(range=1.8-18.2years).Patientshadatleast4monthsCIexperiencepriortotheeSRTevaluation(mean=4.7years,range=0.4-11.1years).Forall23earsatleast1eSRTresponsewasobtained.DescriptivestatisticswereusedtocompareeSRTstobehavioralpre-eSRTM-levelsandpost-eSRTM-levelsforeachofthefocusedelectrodeclusters.Correlations(r)betweeneSRTsandmeanbehavioralpre-eSRTM-levelsforclustersofadjacentelectrodesrangedfrom0.472to0.796.Correlations(r)betweeneSRTsandmeanbehavioralpost-eSRTM-levelsrangedfrom0.711to0.890.ThehighestcorrelationsbetweeneSRTandpre-eSRTM-levels(r=0.796)andpost-eSRTM-levels(r=0.890)werefortheBand4basalelectrodecluster.TherewerenostatisticallysignificantdifferencesbetweeneSRTsandmeanbehavioralpre-andpost-eSRTM-levelsforBand1andBand4.TherewasalsonosignificantdifferencebetweeneSRTsandmeanbehavioralpre-eSRTM-levelsforBand3.ForBand2boththepre-andpost-MlevelsweresignificantlydifferentfromtheeSRTs.Conclusion:ThisstudydemonstratedthatitisfeasibletoobtaineSRTswiththeintegratedsysteminapediatricCIcohortduringroutineclinicvisits.Forthemajorityofpatientstested,theresultsofthisstudyshowedgoodcorrelationsbetweeneSRTandmeanbehavioralM-levels.


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AbstractID:127PosterNumber:120Title:InfantExplorationBeforeandAfterCochlearImplantation:BehavioralResponsetoSoundAuthors:MaryK.Fagan,PhD1,TylerJ.Drake,BS2;1CommunicationSciences&Disorders,ChapmanUniv.,Irvine,CA,2CommunicationScience&Disorders,Univ.ofMissouri,Columbia,MO.Abstract:Introduction:Infants’earlyadaptationtocochlearimplantsvarieswidely,withsomeinfantsshowinginterestinsoundshortlyaftercochlearimplantationwhileothersdonot.Behavioralmeasuresofattentiontosoundaftercochlearimplantationareimportantforidentifyinginfantswhorequireadditionalfollowupandearlyintervention.However,fewobjectivemeasuresofinfantbehaviorhavebeenreported.Methods:Participantswere43infants,27hearinginfantsand16infantswithprofoundhearingloss.Infants(hearinganddeaf)were9.9monthsold(SD=1.3;n=26)atTime1,beforeinfantswithprofoundhearinglosshadreceivedcochlearimplants,and17.7monthsoldatTime2(SD=2.9;n=31),followingcochlearimplantation.AllinfantsparticipatedatTime1or2,withasubset(n=14)participatingatbothtimepoints.Meanageatcochlearimplantationwas12.9months(SD=2.3),meanageatimplantactivationwas14.0months(SD=2.2),andmeandurationofimplantuseatTime2was4.2months(SD=2.6).Infantswerepresentedwithtwosetsof12objectsthatdidordidnotproducesoundwhenmanipulated.Objectswerepresentedoneatatime.Behavioralmeasuresfocusedontimeelapsedbetweenobjectpresentationandsoundgenerationbyhearinginfantsandinfantswithprofoundhearingloss,withorwithoutcochlearimplants.Results:For9-month-oldinfantswithprofoundhearinglosswhohadnotyetreceivedcochlearimplants,latencybetweenobjectpresentationandmanipulationgeneratingsoundwasmorethantwiceaslongasforage-matchedhearinginfants.However,betweengroupdifferences(hearinganddeaf)inlatencywerenolongersignificantat17monthswheninfantswithprofoundhearinglossusedcochlearimplants.Conclusion:Potentially,behavioralmeasuresofinfants’interestingeneratingsoundduringplaycanbeusedtoidentifyinfantsatriskforsuboptimalfunctioningwithcochlearimplants. AbstractID:129PosterNumber:108Title:PainFreeMRIScansInCochlearImplanteesAuthors:IngoTodt,MD,GritRademacher,MD,SvenMutze,Prof.,PhilippMittmann,MD,ArneErnst,Prof.;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:Introduction:TheperformanceofMRIscansincochlearimplanteesiscurrentlylimitedsinceitisfrequentlyassociatedwithsideeffects.Theoccurrenceofunclearpostoperativevertigo,cochlearimplantperformancelosswithintactcochlearimplantsystem,reasonablesuspicionoftheoccurrenceofbraintumors(e.g.acousticneuroma)orcentralinfarciationbringstheclinicanintoadiagnosicdilemasinceanMRIscancanbeindicated.BesideMRIscanrelatedartifacts,dislodgingmagnetscanbeproblematic.Butthemostfrequentproblemisascanrelatedpainwithanoccurrencerateof70%to


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100%.ItwastheaimofthisstudytoevaluatetheoccurrenceofpainincochlearimplanteeswithimplantsystemsincludingspecificsystemmodificationstohandleMRIscansat1.5T.Methods:Inaprospectivecasestudyof6implanteesanMRIscanwasperformedandthedegreeofpainwasevaluatedbyavisualanalogscale.Scanswereperformedfirstlywithanddependingofthedegreeofuncomfortness/pain,withoutaheadband.3implanteeswerecarrierofascrewfixationofthecochlearimplant.3implanteeswerecarrierofacochlearimplantwithaninternaldiametricallymagnetizedmagnet.MRIobservationswereperformedwitha1.5Tscanner.Results:InallpatientsMRIscanswereperformedwithoutanydegreeofpainevenwithoutaheadband.Conclusion:MRIscanningincochlearimplanteescanbeperformedwithoutanypainThisfindingallowsanexpandingofMRIscanningindicationsifspecificcochlearimplantsareused. AbstractID:130PosterNumber:109Title:ExperiencesWithMRIScansInVSB503ImplanteesAuthors:IngoTodt,MD,GritRademacher,MD,SvenMutze,Prof.,PhilippMittmann,MD,ArneErnst,MD;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:Introduction:TheperformanceofMRIscansinVSBimplanteesislimitedsinceitisassociatedwithsideeffects.BesideMRIscanrelatedartefacts,pain,FMTmovementsrelatedchangesofthetransferfunctionhavebeenfound.Theoccurrenceofe.g.unclearvertigo,suspicionoftheoccurrenceofbraintumorsorcentralinfarciationbringstheclinicianintoadiagnosticdilemmasinceanMRIscancanbeindicated.IncontrasttothepreviousVSB502systemtheVSB503containsspecificMRIrelatedchanges(screwfixation,tripolarFMT).ItwastheaimofthisstudytoevaluatethesideeffectsofMRIscansinVSB503implanteesat1.5T.Methods:InaprospectivecasestudyofsevenimplanteesanMRIscanwasperformedandthedegreeofpainwasevaluatedbyavisualanalogscale.ScanrelatedPTAchangesandaudioprocessorfittingchangeswereinvestigated.Scanswereperformedfirstlywithanddependingofthedegreeofuncomfortness/pain,withoutaheadband.MRIobservationsweremadewitha1.5Tscanner.Results:InallpatientsMRIscanswereperformedwithoutanydegreeofpain,changeinPTAandAPfittingevenwithoutaheadbandConclusion:MRIscanningcanbeperformedwiththeVSB503withoutcomplications.Limitationspersistsintermsofmagnetartefacts. AbstractID:133PosterNumber:62Title:LongtermExperienceswithCIandLabyrithectomyinSingleSidedMeniere'sDiseaseandDeafnessAuthors:GunnarDoobe,MD,PhilippMittmann,MD,ArneErnst,Prof.,IngoTodt,MD;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:Introduction:SurgicaltreatmentofsinglesidedMeniere´sdiseaseanddeafnessbylabyrinthectomyandcochlearimplant(CI)hasbeenshowntobeaudiologicallyandposturallysuccessfull.ConcernspersistintermsofthelongtermcontrateraloccurrenceofMenieresdiseaseandvertigocontrolaswellasforintracochlearstructuralchanges.TheobjectivewastoinvestigatethelongtermoutcomeofMeniere’sdiseasepatientstreatedwithcochlearimplantationandvestibularlabyrinthectomy.


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Methods:Inthisretrospectivestudyeightpatientswithinitiallysingle-sidedMeniere’sdiseasetreated4-6yearsagowithcochlearimplantationandvestibularlabyrinthectomywereevaluatedintermsofaudiologicaloutcome,occurenceofMenieresdiseaseonthecontralateralside,persistingvestibulardysfunction(DizzinessHandicapInventory(DHI))andcomplications.Results:Audiologicaloutcomeshowedspeechunderstandingintherangeofregularcochlearimplantrecipientsformostofthepatients.NopatientdevelopedMenierediseasesonthecontralateralside.DHIvaluesremainedlowindicatingahighdegreeofvertigocontrol.Twopatientsdevelopedadecompensatingtinnitus.OnepatientdevelopedanongoingincreasingshiftofthestimulationthresholdConclusion:LongtermresultswithCochlearimplantationandvestibularlabyrinthectomyunderlinetheeffectivenessintermsofaudiologicalandvestibularrehabilitation.Complicationsliketinnitusgenerationandstimulationlevelshiftmightindicateintracochlearchangesrelatedtothelabyrinthectomy. AbstractID:135PosterNumber:187Title:PostOperativeComplicationsofCochlearImplantationAuthors:AitMesbahNacim,MD,BoutemeurSarah,MD,AfiriZhira,MD,YahiNadia,MD;ENT,HOSPITAL,ALGIERS,Algeria.Abstract:Introduction:Thepurposeofthispresentationistostudyamajorpostoperativecomplicationofthecochlearimplant:theexplantation,toanalyzeitscauses,tocheckifitcorrespondstothedataoftheliteratureandtrytoproposesomeprecautionsinordertopreventthem.Methods:Itisaretrospectivemonocentricstudyatkouba’shospital(ALGIERS).Thestudyconcernsthepediatricpopulation(under18yearsold)overaperiodextendingfrom2006to2015,463childrenwereimplanted.Wereviewedthe21casesoftheexplantedchildrentodeterminetheircauses.Results:Ofthe21childrenexplanted(4.53%),theaverageagewas4yearswithextremesof1to6years,therewasanalmostequalnumberofboysandgirls(11boys,10girls).Thetimeofexplantationwasonaverage36monthswithextremesof1yearto8years.Thecausesofimplantremovalwereclassifiedaccordingto“theEuropeanConsensusStatementonCochlearImplantFailuresandExplantationsof2005“.Therewere3maincauses.Themostcommonreasonforremovalwastechnicaldevicefailure51.14%(n=12),followedbytrauma33.33%(n=7)andinfections9.52%(n=2).Amongtheseexplantedchildrenthemajoritieswerereimplanted(17cases),4childrenwerenotreimplanted,thereimplantationwashomolateralfor15childrenandcontralateralintwochildrenrespectivelywithaninexhaustibleinfectionandanossifiedcochlea.Conclusion:Cochlearimplantationisasafesurgicaltechniquefortherehabilitationofneurosensorydeafness.Duringwhichthetrainingandskillsofthesurgeonplayaveryimportantrole.Adatabaseofcochlearimplantfailuresmustbeestablishedforallimplantcenterstoprovidetheinformationneededtoimprovethequalityofcochlearimplants. AbstractID:136PosterNumber:223Title:CIandMRICompatibility-SurveyofInformationGiventoPatientsandImplicationsAuthors:ChristopherRaine,FRCS.,ChM.,JaneMartin,MED,CatherineTotten,MSc.,DavidStrachan,FRCS.;


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DeptOtolaryngology,YorkshireAuditoryImplantService,Bradford,UnitedKingdom.Abstract:Introduction:Cochlearimplantshaverevolutionisedthemanagementofpatientswithseveretoprofoundsensorineurallosses.PreoperativeinvestigationsinvolveradiologicalassessmentofthecochlearbyMRIscan,CTimagingorboth.Forparentsandpatientsoneofthemainfocusesisunderstandingandhopefullyhavingsurgery.Inourunitpatientshavechoiceofdevices.Thereasonsforvariedarequitevaried.Issuessuchasaccessoriesandwatercompatibilityappeartobesignificantfactorstothepatientsandfamilies.Clinically,itisclearlyunderstoodthatthemagneticcomponents,andtoacertaindegreetheinternalelectronics,haveacompatibilityissuewithMRIscanning.Somedevicesrequireremovalofmagnets.Others,areconditionalto1.5Tesla.Nomatterwhatsystemisusedsignificantvoidsanddistortionsareproducedbythemagnetwhenimagingthebrain.ThereisahighchancethatachildwouldrequireanMRIduringhis/herlifetime.InformationfromGermanyindicates114MRI/1000inhabitantswithheadscansusingCT/MRIbeingfairlyequal(55%v45%).SpineandextremitieshavehigherproportionofMRI.Theaimofthispaperistoinvestigatewhatinformationisgivenpreimplanttoensureinformedconsentisgiven.Howissuesaremanagedintheacuteandnon-acutesituationwillbereviewed.Methods:AsurveywassenttoallUKimplantcentresaskingthemaboutthegivingofinformation,formalsurgicalconsent,theirexperienceofdealingwithpatientspotentiallyneedingandactuallyhavingMRIscans.Finalquestionsfocusedonanysubsequentissuesthatarose.Resultswereusedtocompareourpracticeandsubsequentmanagement.Results:16centreswereapproachedand14replied.-IsdepartmentalinformationgivenaboutMRIscanning?69%No-Which/howisMRIrelatedinformationisgiven?-Verbal38%,-BCIGsafetyguidelines35%,-Manufacturesliterature23%,-Nospecificadvice4%.-Specificallymentionedatsurgicalconsent?Yes46%-Inthepast12months;median(range)-Whatexternalrequestforadvicehasbeenreceived?-3(1-25)-WhatnumberofactualknownMRIscanshaveyourpatientshad?-2(1-10)severalcentresdidnotknow.-Whatreportedissueshavebeenreported?-demagnetised1;displacement2.Conclusion:MRIscanningcanbeperformedwithoutsideeffects.However,theredoesseemtobearangeofpatientexperiencesandvariedoutcomes.Asaresultofourownexperiencefornon-acuteimagining;onechild,whodevelopedaneurologicalemergencyatanotherhospital,despitetheoreticallyfollowingmanufacturersprotocolhadmagnetdisplacementwhilstunderGA.Fortunately,thebilateralvoidsdidnotmaskthecentralmeduloblastoma.UrgentexchangeofthemagnetstotitaniumblankswasperformedasrepeatedMRIscanswouldbenecessaryinthefuture.FromthesurveyreasonsbehindtheneedforanMRIscanshouldalwaysbeinvestigated.WouldotherimagingsuchasCT+/-contrastbemoreappropriate?Also,clearlyweneedtopaymoreattentiontoconsentingwithfutureMRIscanning.Alsotodevelopaconsistenteffectiveapproachtoreducerisk. AbstractID:137PosterNumber:14Title:CommunicativeProfile:ComparisonBetweenChildrenUsingHearingAidsandThoseUsingCochlearImplantsAuthors:TarekM.ElDessouky,MD,AhmedAli,MSc,SafinazNagib,MD;ENT,FacultyofMed.BNSUniv.,BeniSwifEgypt,Egypt.Abstract:Introduction:PurposeofthisstudywastocomparethefunctionalbenefitofthecommunicativeskillsofEgyptianchildrenwithunilateralcochlearimplants(CI)inrelationtothoseusing


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bilateralhearingaids(HA)inordertocomparetheroleofeachamplificationdeviceonthecommunicativeabilitiesofseveretoprofoundsensorineuralhearingimpairedchildren.Methods:Studyincluded60childrenwithanageaverageof3to7years.Allchildrenweretypicallyfittedwithhearingaids.Whenhearingaidsweredeemedtobeinadequateandlanguagedevelopmentwaspoorafteroneyearofregularrehabilitation,childrenunderwentevaluationforcochlearimplantcandidacy.A2ndlanguageassessmentwasdoneafter12monthsoflanguagetherapytodetecttheprogressofthelanguagedevelopment.Thena3rdlanguageassessmentwasdoneafteranother12monthsofrehabilitationeitherwithhearingaidsorwithcochlearimplant.UsingModifiedPreschoolLanguageScale&SubjectiveSpeechIntelligibilityforassessment.Thelanguageimprovementquotient(LIQ)wasusedtocomparebetweentheratesofprogressinlanguageinordertoovercomethebiasofagematchingResults:GroupAisthehearingaidsusersfor2years,GroupBwhousedhearingaidsfor12monthsthenshiftedtocochlearimplantation.ThereceptiveLIQandtotalLIQwerehigheringroupAthangroupBbeforeCIuse.However,therewasnosignificantdifferenceinexpressiveLIQ.CIusersshowedsignificantlyhigherimprovementwhencomparedtoHAusersduringoneyearofrehabilitationinalllanguagequotients.Conclusion:TherewasnosignificantdifferencebetweenbothgroupsinanyoftheLIQs.Thismeansthattheamountofimprovementingroup(B)inthesecondyearwiththeCIwasabletoovercomethelagofthefirstyearinthisgroup.ComparisonbetweenbothgroupsregardingmeanofSubjectiveSpeechIntelligibilityTestshowsnosignificantdifference. AbstractID:138PosterNumber:9Title:EarlyLinguisticDevelopmentsofSimultaneousBilateralCochlearImplanteesAuthors:JaeYoungChoi,MD,PhD,MichelleJ.Suh,MD;OtolaryngologyandHeadandNecksurgery,Yonseiuniversitycollegeofmedicine,SouthKorea,Seoul,Korea,Republicof.Abstract:Introduction:Weanalyzedtheresultsofreceptiveandexpressivelanguageperformanceofsimultaneousbilateralcochlearimplanteesincomparisonwithpatientsusingbimodalstimulation(unilateralcochlearimplantation+Hearingaid).Methods:Fifteenpediatricpatientsunderwentsimultaneousbilateralcochlearimplantation(SbCI)andninepatientsusingbimodalstimulation(CI+hearingaid)wereenrolled.CIswereperformedby24monthsofage.TheresultsofIT-MAIS,CAP,averageDevelopmentalquotient(DQ),theratioofAgeequivalenttoChronologicalageofexpressive,receptivelanguagescoreatpostoperative1yearandthePercentageofConsonantsCorrect(PCC)indexatageof4inCIuserswereanalyzed.Results:InSbCIgroup,asignificantimprovementaftersurgerywasnotedinCAPscores(Δ4.58±0.1)overbimodalgroup(Δ3.7±0.53,P=.012)at12monthsafterCI.IT-MAISscoresofsimultaneousCIgroup(Δ36.17±4.09)alsorevealedsignificantgainoverthebimodalgroup(Δ30.17±2.19,P=.004).TheDQofreceptivelanguagewashigherinSbCIgroupthanbimodalgroup(87.6±15.4vs.75.5±12.0%,p=.023)atpostoperative12months.Moreover,earlySbCIwasassociatedwithbetterreceptivelanguageskills.PCCindexatage4showedhigherinchildrenwithbilateralstimulationoverbimodalstimulation.(88.5±13.2vs.62±15.8,p=.0138)Conclusion:OurstudyshowsthatdeafchildrencanachievebetterresultswithearlybilateralsimultaneousCIinlanguageskillsthanthoseofunilateralCIuserswithhearingaid.EvenwithinSbCI


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group,earliersurgeryachievesbetteroutcomeofit.Herein,theanalysesrevealedthatearlylanguagedevelopmentalsuccessisachievedwhenearlierbilateralsimultaneousinterventionisconducted AbstractID:142PosterNumber:191Title:LongTermCross-ModalPlasticityinAuditoryandVisualSensoryCorticesafterHearingDeprivationintheAdultRatAuthors:MariannyPernia,Graduate1,SheilaEstevez,Graduate1,IgnacioPlaza,Graduate1,AgustindelCañizo,MDPhD2,JulioRodrigo,PhD3,MiguelA.Merchan,MDPhD1;1InstituteofNeuroscience,UNIVERSITYOFSALAMANCA,SALAMANCA,Spain,2DepartmentofOtorhinolaringology,UNIVERSITYOFSALAMANCA,SALAMANCA,Spain,3MedElSpain,Madrid,Spain.Abstract:Introduction:Cross-modalreorganizationsintheauditoryandvisualcorticeshavebeenreportedafterhearingandvisualdeficitsmostlyduringthedevelopmentalperiod,andtheymayunderlaysensorycompensationmechanisms.However,thereareveryfewdataontheexistenceorthenatureandtimelineofsuchreorganizationeventsduringsensorydeficitsinadulthood.Methods:Inthisstudywelookedatlong-termchangesinactivity-dependentimmediateearlygenesc-FosandArc/Arg3.1andtheAMPAglutamatereceptorsubunitsGluR2/3inauditoryandneighboringvisualcorticalareasafterbilateraldeafnessinyoungadultrats,15and90daysaftercochlearpuncture.Results:Thenumberanddensityofc-Fos-immunoreactiveneuronsintheauditorycortex(AC)showedasignificant,long-lastingdecrease15dayspostlesion(dpl).However,at90daysdpl,asignificantrecoveryinnumberanddensityvaluesofc-FosimmunoreactiveneuronsandanincreaseinGluR2/3immunostainingsupportslong-termrecoveryincellactivityintheAC.Furthermore,increasedc-Fos,Arc/Arg3.1immunoreactivityinthevisualcortex90dplsuggestsoveractivationofthissensorycorticalarea.Conclusion:Thesefindingssupportplasticcompensatoryrebalanceofactivitybetweentheauditoryandvisualcorticesafterauditorydeprivationintheadult.Whethertheseresultsinbehavioralpotentiationofvisualdrivesonauditoryregionsofthecortexinadulthoodremainstobeexplored.AbstractID:143PosterNumber:200Title:ConsonantandVowelRepetitionandConfusioninCochlearImplantUsersMeasuredbyNonsenseSyllableTestsAuthors:ArneK.Rødvik,MSc,JanneV.K.Torkildsen,Associateprofessor,JuhaT.Silvola,MD,PhD;Facultyofeducation/Deptofspecialneedseducation,Univ.ofOslo,Oslo,Norway.Abstract:Introduction:Theaimsofthisstudywere1)toinvestigatehowwellusersofmulti-channelcochlearimplants(CIs)canrepeatvowelsandconsonantsinaphonemeidentificationtestusingmono-andbisyllabicnonsensewordsasstimuli,2)toevaluatehowageatimplantationanddurationofimplantuserelatetotheseresults,3)toassesshowtheresultsonnonsensesyllabletestscorrespondtoperformanceonrealwordmonosyllabletestsandscoresontheSSQquestionnaire(SSQ=speech,spatialandqualitiesofhearingscale),and4)toexaminewhichconsonantsandvowelsaremostseldomandmostfrequentlyconfused.Methods:ThephonemeidentificationtestwasconductedbyplayingCVC(consonant-vowel-consonant)andVCVnonsensesyllablestotheimplantedparticipantsinananechoicchamber.Recordingsoftheparticipants’repetitionsweretranscribedphoneticallybytwoindependent,trainedphoneticians.


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Includedparticipantswere40adults(16yearsandabove)and38childrenwithCIs,andnormal-hearing(NH)controlgroupsof20adultsand30children.Onlyparticipantswitharealwordmonosyllablescoreabove50%wereincluded.Results:FortheNHcontrolgroups,themeanscoreofthephonemeidentificationtestwas94%(SD=3%)correctrepetitionsfortheadultsand78%(SD=8%)forthe6-year-olds,whichprovidedasignificantdifferenceinmeansof16%(95%confidenceinterval;range:12to20%;p<0.001).TheSSQscorewas8.8(SD=0.7)fortheadultsand9.3(SD=1.0)forthechildren.Preliminaryresultsforthecochlearimplantedparticipantsshowedameanscoreofthephonemeidentificationtestof48%(SD=11%)fortheadultsand56%(SD=8%)forthechildren.TheSSQscorewas4.7(SD=1.4)fortheadultsand6.1(SD=1.8)forthechildren.Theresultssectionwillbecompletedbeforetheconference.Conclusion:ThesignificantlyhighermeanscoreofthephonemeidentificationtestfortheNHadultsthanfortheNHsix-year-oldswasexpected,sinceadultshaveamoredevelopedphonemiclexiconandhigherphonemicawarenessthanchildren.Thephonemeidentificationscoreofapproximately50%fortheCI-usersgaveadesirablediscriminationslope,indicatingthatthetestisofsuitabledifficultyforthisgroup.Wefoundnoceilingeffectofthephonemeidentificationtest,neitherintheNHgroupnorintheCIgroup,confirmingtheusefulnessofthistest. AbstractID:147PosterNumber:144Title:CochlearImplantation:OutcomesinChildrenwithCochlearNerveDeficiencyAuthors:AnnieRodriguez,Au.D.,MelissaAuchter,Au.D.;Univ.ofMiamiEarInst.,Miami,FL.Abstract:Introduction:Cochlearimplantationinchildrenwithcochlearnervedeficiency(CND)isanareathathasnotbeenfullyexploredandremainsindebate.CND,whichincludesbothcochlearnervehypoplasiaandaplasia,occursinapproximately12-18%ofearsaffectedwithsensorineuralhearingloss(Huanget.al,2011).Inthepast,CNDhasbeenacontraindicationforcochlearimplantation;howeverrecentstudieshaveshownsomepatientswithCNDachieveopen-setwordunderstandingandshouldbeconsideredpriortopursuinganauditorybrainstemimplant(ABI)(Buchmanet.al2011).Todate,littleisknownabouttheoutcomesandbenefitsofpediatriccochlearimplantpatientswithCND.Methods:Pre-operativeimaging(MRI/CTScan)aswellaspre-operativeaudiometricthresholdsandspeechperceptionscoreswerereviewedandcomparedtopost-operativeneuralresponsetelemetrydata(NRT)andpost-operativeaudiometricthresholdsandspeechperceptionscores.Results:Despitelackofvisiblenervetracingonimaging,allthreecasespresentedwithNRTmeasurements,thoughmeasurementswerefoundtofluctuatebetweenvisits.Post-operativeaidedthresholdswereobservedtoimproveinallpatients.Speechperceptionscoreswerealsofoundtoimprovewhentestingcouldbecompleted.Variabilityinimprovementwasnotedbetweenpatients.Conclusion:Basedonthepreliminarydatafoundinthesecasereports,cochlearimplantationshouldnotbeeliminatedasapotentialoptionforpatientsdiagnosedwithCND.ResultsfoundinthesethreecasessuggestthatcochlearimplantationmaybeaviableoptionforchildrenwithCND.Auditoryprogresswasnotedinallthreecasesanddespiteimagingdata,nerveresponseswereseenthroughNRTmeasurements. AbstractID:148PosterNumber:164


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Title:EvaluationofanAutomaticSystemtoRecordandAnalyzeElectricallyEvokedCompoundActionPotentialsAuthors:LutzGaertner,PhD1,AndreasBuechner,PhD1,ThomasLenarz,MD1,KonradE.Schwarz,PhD2,StefanB.Strahl,PhD2,AngelikaDierker,PhD2,PhilippSpitzer,PhD2;1DepartmentOfOtolaryngology,HannoverMed.Sch.,Hannover,Germany,2R&D,MED-ELGmbH,Innsbruck,Austria.Abstract:Introduction:Themeasurementofelectricallyevokedcompoundactionpotentials(ECAP)providesabasisforprogrammingthespeechprocessorofacochlearimplant(CI)especiallyinveryyoungchildrenwhocannotgivesufficientfeedbackabouttheirhearingimpressions.AnovelautomaticECAPrecordingsystemwhichisbasedonacombinationofinformationthatwasunusedsofarinstandardclinicalsoftwarewasevaluatedagainsthumanexperts.Methods:In21cochlearimplants234measurementsoftheamplitudegrowthfunction(AGF)havebeentakenusinganewrecordingparadigmwherethecurrentamplitudewasincreasedinquasi-continuousstepsanddifferentrecordingelectrodeshavebeenused.FiveexperiencedaudiologistsdeterminedtheECAPthresholdinthesemeasurements.TheresultswerecomparedtoanewautomaticanalysismakinguseofaphysiologicalbasedECAPclassifierbasedonfiringprobabilityoftheauditorynerve.PeakpickingoftheN-andP-peaksoftheECAPresponsewereimprovedbysurfaceanalysisoftheAGF.ThresholdestimationwassupportedbyfittingasigmoidalmodeltotheAGF.Results:Pearson’scorrelationcoefficientrbetweenthethresholdsestimatedbythehumanexpertsandtheautomaticsystemwasintherangeof0.78to0.91withamedianof0.83.ThecorrelationcoefficientRbetweenthethresholdsestimatedbydifferenthumanexpertswasintherangeof0.84to0.92withamedianof0.88.Conclusion:ThenovelautomaticECAPrecordingsystemleadstothresholdswithinthoseestimatedbyhumanexperts. AbstractID:153PosterNumber:172Title:HowDoesRestrictedSpeechPerceptioninNoiseAffecttheQualityofLifeofChildrenwithCochlearImplants?Authors:MariaHuber,PhD,ClaraHavas,MD;ParacelsusMed.Univ.Salzburg,Salzburg,Austria.Abstract:Introduction:Cochlearimplantation(CI)allowshearingimpairedchildrenthedevelopmentofspeechunderstandingandspeechproduction.However,childrenwithCIhavemoreproblemsthannormalhearingpeerstoperceptspeechinadverselisteningsituations,despitethefactthatnowadaysmostofthemwereimplantedataveryyoungageandmanyofthemaresuppliedwithCIsonbothears.Comprehensionproblemsinnoisysituationsmayimpairthe(oral)communicationwithotherpersons,whichinturnforthelongtermmayhavenegativeeffectsonthesubjectivewellbeingofyoungCIusers.Additionally,listeninginnoisemaybemoredemandingforyoungCIusersthanfornormalhearingpeers,withfatigueasaconsequence.OuraimwastoevaluatetheimpactoftheabilityofspeechperceptioninnoiseofyoungCIusersontheirQualityofLife(QoL)respectivetheirHealthRelatedQualityofLife(HRQol).Methods:ForthissystematicreviewwelookedatpapersaboutQoL,HRQoLandspeechperceptioninnoiseofchildrenandadolescentswithcochleaimplants.Inclusioncriteriawerea)anageoftheCIusersrangingbetween4and18years,b)qualityoflifeinstrumentsarevalidatedforchildrenandadolescents,c)speechperceptioninnoisewasexaminedwithstandardizedaudiologicaltests,d)originalresearch


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ande)thepaperwaswritteninEnglish.TheliteratureresearchwasconductedinPup-Med,ScienceDirectandWebofKnowledge(ThomasReuters).Results:28paperswerefoundasrelevant.Ninepaperscorrespondedtocriteriaa)b)d)ande).Onlyfourpapersoutof28weredealingwithspeechperceptioninnoiseandQoL/HRQoLofchildrenandadolescentswithCI.Finallyonlytwopaperscorrespondedtoallcriteria.ThefirstpaperfoundsignificantcorrelationsbetweenspeechperceptioninnoiseandHRQoL(schooldomain).ThesecondpaperdidnotfoundsignificantcorrelationsbetweenspeechperceptioninnoiseandQoLoutcomes.However,bilateralimplantedchildrenscoredbetterinspeechperceptioninnoisethanchildrenwithunilateralCI.Furthermore,sequentialbilateralcochlearimplantationinchildrenwasfoundtoimproveQoL.Conclusion:Insummary,onlyfewstudiesaredealingwiththerelationshipbetweenspeechperceptioninnoiseandthequalityoflifeofchildrenwithcochlearimplants.ItisimportanttostudytheeffectsofrestrictedspeechperceptioninnoiseofchildrenwithCIontheirqualityoflife. AbstractID:154PosterNumber:118Title:TheRoleoftheDepartmentofChildrenandFamilyServices(DCFS)inSupportingFamiliesofChildrenwithSevereHearingLossAuthors:JeffreyW.Yu,MDOtolaryngology,Univ.ofIllinoisatChicago,Chicago,IL.Abstract:Introduction:Introduction:Childrenidentifiedwithseveretoprofoundhearinglossrequireinterventionsfrommultipleservicestohelpdeveloplanguageandcommunication.Thegoalistoensurethatthesechildrenhaveearlyandfullaccesstoameansofcommunication.Thismayincludetherapyfororalspeech-languagedevelopmentorsignlanguage,orboth.Auralrehabilitationincludestherapieswithhearingaidsand/orcochlearimplantation.Thecomplexityofcareforthesechildrenoftenposechallengestoparentsandcaregivers,especiallythosewithsocialandeconomicchallenges.Familiesoftenrequireextrasupportandassistancetoovercomebarrierswithaccesstocare.Whenachilddoesnothaveaccesstotheseinterventions,itiscontroversialastowhetherthisfitsthedefinitionofneglect.ThechildprotectiveserviceswhichisreferredtoastheDepartmentofChildandFamilyServicesinthestateofIllinoiscanprovideassistanceinensuringfamiliesaresupported.CliniciansoftenfeelconflictedaboutenlistingtheassistanceofDCFSbalancingthecriticalnatureofearlylanguagedevelopmentandthefamily’srighttochoosethebestcourseofinterventionfortheirchild.Methods:Methods:Caseseriesofthreepatientswillbepresented.TheroleoftheIllinoisDepartmentofChildren(DCFS)andFamilyserviceswillbediscussedineachcaseandhowtheagencyinfluencedthecaseandwhetheritultimatelyimprovedoutcomes.Results:Results:TheDepartmentofChildrenandFamilyservicesassignacaseworkertoeachfamily.Theyserveasasupporttoparentsofchildrenwithhearinglosstohelpattendanceformedical,audiologyandspeechtherapyappointments.Conclusion:Conclusions:ContactingtheDepartmentofChildrenandFamilyservicesshouldbeconsideredwhenallotheravenueshavebeenexhausted.ThedecisiontoinvolvedDCFSneedstoinvolveamultidisciplinaryteamthatcanconsiderthefamily’semotion,socialandeconomicstate.Thecasemanagercanbeaninvaluablerecoursetoensureattendancetoappointmentandschoolenrollments. AbstractID:156


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PosterNumber:37Title:CaseSeries:DoesTimingofCochlearImplantationasTreatmentforSingleSidedDeafnessAffectOutcomes?Authors:MichelleK.Shannon,AuD,CCC-A,KristaM.Winner,AuD,CCC-A,ChristineM.Schafer,AuD,OliverF.Adunka,MD,FACS,UrsulaM.Findlen,PhD;NationwideChildren'sHosp.,Columbus,OH.Abstract:Introduction:Thecandidacyforcochlearimplantationhasrecentlyexpandedtoincludepatientswithresidualhearingandpatientswithsingle-sideddeafness(SSD).ResearchregardingtheuseofcochlearimplantationforSSDislimitedbythenumberofparticipants.Nevertheless,thepublisheddatasupportscochlearimplantationforsingle-sideddeafnessduetoimprovementinspeechunderstandinginquietandnoise,soundlocalizationandsuppressionoftinnitus(Tokitaetal.,2007;Friedmannetal.,2016).TheeffectofdurationofhearinglosspriortoimplantationhasbeenaddressedintheSSDpopulationbuthasnotbeeninvestigatedfully.Thiscaseseriescomparesthe1-yrpost-cochlearimplantationoutcomesfortwoteenagerswithSSDhavingsignificantlydifferentdurationsofhearingloss.Methods:Twopatientsreceivedcochlearimplants(CI)astreatmentforsingle-sideddeafness.CaseAwas15yearsoldatimplantationwithalong-termhistoryofhearingloss.CaseBwas18yearsofageatimplantationwitha3-yeardurationofhearinglossfromatraumaticaccident.Atthe1-yearpostinitialstimulationappointmentspeechperceptiontestingwascompletedforeachpatient.AcomprehensivespeechtestbatteryusingCNCwordsandspatiallyseparatedspeechinnoisetestingwasutilized.TestingwascompletedwiththeCIon(intervention)andwiththeCIoff(nointervention).Results:ResultsrevealedCaseAperformedat36%onCNCwordsandCaseBperformedat48%withtheimplantedearalone.ThescoresonCNCwordswerenotsignificantlydifferent(Carney&Schlauch,2007).CaseAperformedbetteronAZBiosentencespresentedinnoisewhenusingtheCIandnormalhearingear(87%)comparedtothenointerventioncondition(65%).CaseBperformedsimilaronAZBiosentencespresentedinnoisewhenusingtheCIandnormalhearingear(87%)comparedtothenointerventioncondition(85%).ThecasesperformedthesameonAZBiosentencesinnoiseintheinterventioncondition.Conclusion:Durationofhearingloss(13yearscomparedto3years)didnotaffectspeechperceptionscoresat1-yrpostimplantation.ThisindicatesthatdurationofdeafnessmaynotexcludeapatientasacandidateforcochlearimplantationastreatmentforSSD.Further,CaseAhadthelongerdurationofdeafness,butexperiencedgreaterbenefitwhencomparingtheinterventionandnointerventionconditions,suggestingthateventhosewithlongerdurationsofdeafnesscanshowsignificantbenefitfrombaseline.Itisacknowledgedthatalargerstudyneedstobecompletedtofullydetermineifdurationofdeafnessshouldbeafactorindeterminingcandidacyforcochlearimplantationinthispopulation. AbstractID:163PosterNumber:96Title:HearingPreservationinChildrenFollowingCochlearImplantationAuthors:NeilS.Patel,MD,NicoleM.Tombers,RN,MelissaD.DeJong,AuD,AlyceI.Breneman,AuD,BrianA.Neff,MD,ColinL.W.Driscoll,MD,MatthewL.Carlson,MD;Otorhinolaryngology,MayoClinic,Rochester,MN.Abstract:Introduction:


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Presently,therearefewstudiesevaluatingtherateofhearingpreservationaftercochlearimplantationinchildren,asonlyrecentlyhasimplantationofchildrenwithgreaterdegreesofresidualhearingbecomemorewidelyaccepted.Asaresultofimprovementsintechnology,programmingstrategies,andsurgicaltechnique,thenumberofchildrenwithlowfrequencyresidualhearingwhoundergocochlearimplantationhassteadilyincreased.Atthesametime,thevalueofelectroacousticstimulationhasbeendemonstrated,reinforcingthevalueofatraumaticsurgicaltechniquestopreservecochlearfunction.Theobjectiveofthecurrentstudyistoreportpediatrichearingpreservationresultsfollowingcochlearimplantationwithconventionalfull-lengthelectrodes.Methods:Aretrospectivereview(2000-2016)atatertiaryreferralcenterwasperformedofallpediatricpatientswitha≤75dBpreoperativelow-frequencypuretoneaverage(LFPTA;250-500Hzaverage),whounderwentcochlearimplantationwithaconventionallengthelectrode.Thedegreeofhearingpreservationwasdeterminedaccordingtothe2013HEARRINGgroupguidelines.Results:Atotalof43ears,in35pediatricpatients,metinclusioncriteria.Themeanageattimeofimplantationwas8.6years(range1.4-17.8yrs),20(57.1%)patientswerefemale,and25(58.1%)caseswereleft-sided.ThemeanpreoperativeipsilaterallowfrequencyPTAandstandardPTA(500,1000,2000,3000Hzaverage)were54.2dB(range15-75dB)and82.2dB(range25-102.5dB),respectively.ThemeanlowfrequencyPTAandstandardPTAshiftscomparingthepre-andfirstpostoperativeaudiogramwere∆25.2dB(range-5–92.5dB)and∆18.3dB(range-8.8–100dB),respectively.Overall,17(39.5%)earsdemonstratedcompletehearingpreservation,19(44.2%)earspartialhearingpreservation,and7(16.3%)exhibitednomeasurableacoustichearingaftersurgery.Intotal,26(60.4%)earsmaintainedfunctionallow-frequencyhearing(i.e.,≤80dBLFPTA)basedontheinitialpostoperativeaudiogram.TherewasnostatisticallysignificantdifferenceintheinitiallowfrequencyPTAshiftcomparinglateralwallandperimodiolarelectrodes(∆22.2vs∆28.1;p=0.44),cochleostomyandroundwindowinsertions(∆25.2vs.∆24.7;p=0.95),orstatisticallysignificantassociationbetweenageatimplantationandlowfrequencyPTAshift(r=0.174;p=0.26).Conclusion:Varyinglevelsofhearingpreservationwithconventionallengthelectrodescanbeachievedinover80%ofpediatricsubjects.Thesedatamaybeusedtoguidepreoperativecounselinginpediatricpatientswithresidualacoustichearing.Additionally,thefavorableratesofhearingpreservationachievedinchildrenprovidefurtherevidencefortheexpansionofpediatriccochlearimplantcandidacytoincludepatientswithgreaterdegreesofresidualhearing. AbstractID:168PosterNumber:3Title:ExaminingSpeechandLanguageCharacteristicsinaCohortofChildrenwithCochlearImplantsandChildhoodApraxiaofSpeechAuthors:BeckyBaas,M.A.,RuthStoeckel,Ph.D.,TaylorBrown,M.A.;MayoClinic,Rochester,MN.Abstract:INTRODUCTIONTheprevalenceofdevelopmentaldisabilities,includingspeechandlanguageimpairments,inchildrenwithcochlearimplantshasbeenestimatedat30-40%(Wiley,etal,2005;Birman,etal,2005).IntheretrospectivereviewofcochlearimplantpatientswithGJB2mutation,childhoodapraxiaofspeech(CAS)waslistedasacharacterizeddisability(Wiley,2006).TherehasbeenlimitedmentionofCASinthe


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pediatriccochlearimplantliterature,yetaccuratediagnosisandtreatmentofmotorspeechdisordersgreatlyimpactstheoutcomeofverbalcommunicationskills.METHODSPatientswereseenatahealthcarefacilitywithareputablecochlearimplantprogramandaninternationalreputationforexpertiseinmotorspeechdisorders.Theauthorsreviewedrecordsfrom2008and2015andidentifiedacohortofchildrenwithcochlearimplantswhoalsohadbeengivenadiagnosisofCASatthefacility.Thesechildrenwereseeninitiallybetween1and6yearsofageandseveralhadbeenfollowedformanyyears.RESULTSThispresentationwillreviewanddescribethiscohortbasedonageofdiagnosisofCAS,receptiveandexpressivelanguageabilities,phonologicandmotorspeechcharacteristicsandtreatmentconsiderations.CONCLUSIONThroughaccuratediagnosisofmotorspeechdisordersinchildrenwithcochlearimplants,wemayimprovetherehabilitativeoutcomesoftheircommunicationskills.Thisco-occurrenceofCASimpactshowweprovideinterventionandprioritizegoals.REFERENCESBirman,CatherineS.;Elliott,ElizabethJ.;Gibson,WilliamP.R.(2012).PediatricCochlearImplants:AdditionalDisabilitiesPrevalence,RiskFactors,andEffectonLanguageOutcomes.Otology&Neurotology.Oct;33(8)1347-1352.WileyS1,ChooD,Meinzen-DerrJ,HilbertL,GreinwaldJ.(2006).GJB2mutationsandadditionaldisabilitiesinapediatriccochlearimplantpopulation.IntJPediatrOtorhinolaryngol.2006Mar;70(3):493-500.WileyS,JahnkeM,Meinzen-DerrJ,ChooD.(2005).Perceivedqualitativebenefitsofcochlearimplantsinchildrenwithmulti-handicaps.IntJPediatrOtorhinolaryngol.Jun;69(6):791-8. AbstractID:177PosterNumber:61Title:MorphologicalBasisforCochlearImplantationAuthors:dragoslavaD.djeric,FullprofessorofUniversityORLClinic,Med.FacultyUniv.ofbelgrade,belgrade,Serbia.Abstract:Cochlearimplantationisaneffectiveprocedureforrestoringhearingcapacitytoindividualswithsevere-to-profoundhearingimpairment.Sincethedevelopmentofcochlearimplantationinthe1960s,boththesurgicaltechniqueandtheimplantdesignhavebeenmodifiedtoreducecomplicationandallowbetterfunctionalresults.Theclassicaltechniqueforplacingcochlearimplant(CI)involvesmastoidectomyandposteriortympanotomy.However,onlyfewalternativestothisclassicapproachhavebeendescribedintheliterature.ThesuprameatalapproachwasdevelopedbyKronenbergeretal.in1999.Thismethodisasimpleandsafesurgicalprocedurethatdoesnotendangerthefacialnerveandthechordatympani.Thepurposeofthepresentpaperistoreporttheresultsofourstudyofanatomicalvariationandrelationsofthemiddleearonthelargecollectionofthetemporalbones.AttentionwaspaidtothestructuresandlandmarkswhichareimportantforCI.


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Inthemastoidregionweexaminedandpreciselydefined:thetypeofpneumatization,thepositionofthesigmoidsinus,thecourseofthemastoidsegmentofthefacialnerveandthefacialrecess.Wenotedgreatvariabilityinthecourseofthefacialnervethroughitsmastoidsegment.Thenervebifurcationdistaltothesecondgenuwasfoundintwocases.Dehiscenceinthebonycoveringofthefacialnervewereobservedadjacenttothefacialrecess.Variationsinthelocationofthechordatympaninervewerealsodescribed.Intheareaoftheatticwedescribedthemorphologicalvariationsofthemedialandlateralcompartmentandtheircommunicationwiththeothermiddleearspaces.Thecompartmentoftheatticvariesinshapeanddimensions,dependinguponthepositionoftheauditoryossicles(thebodyoftheincusandtheheadofthemalleus)inrelationtotheatticwalls,thedegreeofprominenceoflateralsemicircularcanalandthedirectionofthecourseofthetympanicsegmentofthefacialcanal.Knowledgeofthemorphologicalrelationsandvariationsisimportantforclassicalandalternativesurgicalmethodforcochlearimplantation. AbstractID:179PosterNumber:20Title:BilingualismandInfancyHearingLoss:RelationshipbetweenFirstLanguageandItalianLanguageEvolutioninaGroupofChildrenwithHearingAidsand/orCochlearImplantsAuthors:MariaConsolazioneGuarnaccia,ENT-DoctorinAudiology1,LuciaBotti,SpeechTherapist1,PatriziaFormigoni,DoctorinAudiology2,ElisabettaGenovese,ENTandDoctorinAudiology3;1ENTDept,HospitalofModena,Univ.ofModena,Modena,Italy,2ReggioEmiliaHosp.,ReggioEmilia,Italy,3DeptofDiagnosticMedicine,ClinicalandHealthPubblic,HospitalofModena,Univ.ofModena,Modena,Italy.Abstract:Introduction:Thepurposeofthisstudyistoobservethedevelopmentofthenativelanguage(L1)inbilingualdeafchildrenandtoexaminetherelationshipbetweenL1andItalianlanguage(L2),takingintoaccountdifferentexposuretimesforeachlanguage.Methods:Weevaluated13childrenwithbilateralprreverbalsensorineuralhearingloss.Allchildrenweresubmittedtoearlyhearingaids(HA)and/orunderwenttoacochlearimplant(CI)dependingonthedegreeofhearingloss(HL).Across-culturallinguisticinterview,“IL.B.S.B.”,createdfordeafchildren,wascombinedwiththeMacArthur-BatesCommunicativeDevelopmentInventory(CDI)tocomparetheacquisitionofL1andL2.Ithasbeenexploredthelinguisticexpositioninfluencesinbothlanguages.ThegapbetweentheageofthechildattheMacArthurinventoriesandtheagerelatedtothechild’slinguisticperformancewasevaluated.Theskillsachievedinthesecondlanguagewerecomparedwiththecontrolsample,consistingofthirteenmonolingualItaliandeafchildren.Results:FromacomparisonofthelinguisticcompetencereachedinL1andL2inbilingualdeafchildren,there’snostatisticallysignificativedifferences.Thequalitativeanalysis,regardingtheacquisitionofL2,hasshowedthatallchildrenexposedtoL1withintheirfamilyhaveachievedavocabularyandsentencecomprehensionperformanceinitalianthatisbetterthantheaverageperformanceofthegroupmainlyexposedtoL2withintheirfamily.ThevocabularyproductionofL2issimilarinbothgroups.TheabilitiesachievedinL1seemtosupporttheL2acquisition(thelanguageinwhichthechildattendtothespeechandlanguagehabilitationandeducation).Conclusion:TheIL.B.S.B.,hasprovenveryusefultogatherinformationontimesandexpositiontothetwolanguagesinastructuredmethod.TheanalysisoftheL2developmentwithinoursampleofdeafbilingualchildrenwithearlyinterventionshowsamoreadequatedevelopmentoftheL2whenL1(mothertongue)issustainedinthefamiliarenvironment.


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AbstractID:181PosterNumber:59Title:AnaesthesiaDuringMonoandBinauralCochlearImplantationinChildrenbefore12MonthsofAgeAuthors:SimonaMariaCozzi,PhD1,ErikaAdale,MD1,BulgheroniRosella,MD1,lucaGuzzetti,MD1,FabioMarangoni,MD1,SelmoGabriele,MD1,SalvatoreCuffari,MD1,GiulioMinoja,MD1,GregorioUgazio,MD2,ElianaCristofari,MDPhD2;1Anaesthesiaandintensivecareunit,Asst-settelaghiVarese,Varese,Italy,2ENTaudio-vestibologyunit,Asst-settelaghiVarese,Varese,Italy.Abstract:Introduction:Monoandbinauralcochlearimplantationsareacomplexsurgicalinterventionsperformedinspecializedcentersandtheproceduresareconductedundergeneralanesthesia.Manybabieshavesignificantcomorbiditiesrelatedtoprematurityandcoexistinggeneticdiseases.Despitetheyoungageandrelativecongenitalcomorbiditiesthecochlearimplantionanaesthesiaissafe.Allthepatientsarefollowedbyaudiovestibologyunitandintheearlypostoperativeperiodatgeneralintensivecareunitifnecessary.OurexperiencerevealsthatthesurgicalandanaestheticrisksaresimilartothatexpectedwitholderpediatricandadultpatientsMethods:Wehaveanalysed50patientsbefore12monthsofage,whounderwenttocochlearimplants(27binaural).Operativetime,anesthesiatime,timeinthepostoperativeanesthesiacareunit,andlengthofstaywerealsoassessed.Inourclinicalpractice,childrenarefollowedfromaudiovestibologycenterbeforebeinginsertedintheoperatingstatement.Followingasharedprocessthesurgeonandtheanesthesiateamguarantyingtheoptimizationofallpreoperativeprocedures.Allbabiesarefollowedbyanaesthestisfrompreoperativediagnosticprocedure,assedationforMRI,tothepostpostoperativeperiod.Theinfantswiththeirparentsvisit,beforethesurgicalprocedure,thesurgicalarea.Thepreoperativeevaluationfollowstheintra-hospitalpathwayandthefamilyreceivesallthepreoperativeinstructionsforfastingandmedications.Inaccordingwiththeircomorbiditiestheyreceivepreoperativesedationwithoralmidazolam0.3-0.5mg/kgandlocalanestheticcreamonthedorsalsideofthehandsandonforearms.Weencouragetheparentpresenceduringinductionofanesthesiaandallbabiescouldcarryanobjectastheir“linus’sblanket”intooperatingtheatre.Weuseaudiovisualhelpingduringplacementofvenousaccess,otherwiseforbabieswithexpecteddifficultvenousaccesswechooseasevofluraneinductionthroughmaskventilation.Anesthesiamaintenanceisthroughcontinuousinfusionofpropofolandremifentanilorthroughhalogenatedgasesandopioids.Endovenousparacetamolisgivenaspostoperativeanalgesiaand,accordingtopostoperativepainscale,weusuallyuseopioidsasdoserescue.Thepostoperativeperiodismanagedintothewardorintheintensivecareunitforthefirst12hours.Weusuallyregistertheintraoperativedata(surgicalandanethesiologicaldata)andseveraldischargesuccessdataaslengthofstay,postoperativevomitingandnauseaonset,surgicaloranaesthesiarelatedcomplications.Results:Theaverageageis10months.Theintrahospitallengthofstayis36hoursandthepatientsadmittedtotheICUare5.Nonepatientsdevelopedintraoperativeorpostoperativecomplications.Conclusion:Theageofthepatientandtheanesthesiologistpediatricexperiencearethemainrelevantchallenges.Ourexperiencerevealsthatisimportantforallthesurgicalequipe(surgeonandanaesthetist)todiscussallthepossibledifficultieshighlightingthehemostasistechnique,theintraoperativedrugspharmacokineticsandthecardiopulmonaryreservesinyoungpediatricpatients.Inconclusion,earlyimplantationisfeasibleconsideringallvariablesinvolvedinthedecisionmaking


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processandanaesthesiaforcochlearimplantsinchildrencanbesafelycarriedoutinadistrictgeneralhospitalsetting. AbstractID:183PosterNumber:11Title:EvaluationofUnilateralCochlearImplantOutcomesinPre-LingualChildrenAuthors:GuilhermeCrespo,MD,RaquelVasconcellos,MD,FernandoRodrigues,MD,FelippeFelix,MD,PhD,ShiroTomita,MD,PhD,FranciscoOsterne,MS;Otolaryngology,FederalUniv.ofRiodeJaneiro,RiodeJaneiro,Brazil.Abstract:Introduction:BrazilianPublicCochlearImplantProgramprovidesonlyoneCochlearImplant(CI)perpatient.Usingstandardquestionnaires,theaimofthisstudyistoevaluatethesuccessofunilateralCIwithlanguagedevelopmentinpre-lingualdeafchildrenandsatisfactionamongtheirfamiliesafteratleast1-yearfollowupfromimplantation.Methods:RetrospectivestudyperformedsubmittinglegalrepresentativesofCIpatientstooutcomequestionnaires-theInfant-toddlerMeaningfulAuditoryInteractionScaleforpre-lingual4-year-oldchildrenandyounger;aswellastheMeaningfulAuditoryInteractionScaleforolderthan4yearsofagepre-linguals.Otherinformationgatheredseparatelywaswithregardstonegativelifechangesbroughtaftercochlearimplantation;andinrespecttothewishofgettingCIfortheotherearifitweretobeoffered.Results:Consideringtheparticipatingpatientsinthisstudy,100%ofthelegalrepresentativesreferredtherewasn’tanynegativelifechangesaftercochlearimplantsurgery;81,8%saidtheywouldliketoimplantthecontralateralear,9,1%saidtheywouldnot,and9,1%couldnotanswerthisquestionatthistime.Allpatientswithpre-lingualdeafnessattendedspeechtherapysessionsforhearingtraining.Accordingtothequestionnairesappliedtoevaluateoutcomes,theaveragescoreencounteredwas30,5outof40points,whileonly18,2%ofthesepatientsscoredlessthanhalfofthepossiblepoints.Conclusion:Afteranalyzingourresults,bothobjectiveandsubjectivecollecteddatacanbeconsideredoutstanding.Mostpatientsshowedimpressivebenefitsregardingnotonlyfunctionalaspectsofhearing,butalsosatisfactorylanguagedevelopmentafter1-yearfollowupandlongerperiods. AbstractID:184PosterNumber:201Title:ConsiderationofAgeatImplantationonCochlearImplantProgrammingAuthors:MeredithA.Rooth,AuD1,EnglishR.King,AuD2,EllenDeres,AuD2,AndreaBucker,AuD2,SarahMcCarthy,AuD2,MargaretDillon,AuD1;1Otolaryngology/Head&NeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,2Audiology,UNCHealthcare,ChapelHill,NC.Abstract:Introduction:Cochlearimplantcodingstrategiesdifferinwhatspeechinformationiscodedandhowitispresentedtothelistener.Thespecificcodingstrategyselectedmayinfluenceacochlearimplantrecipient’sspeechperception.Ofthemultiplecodingstrategiesavailable,thereisnotonecodingstrategythatconsistentlydemonstratesimprovedperformance.Performancebetweencodingstrategiesmaybeinfluencedbypatientvariables,includingageatimplantation.Thepresentreportexploredthepotentialrelationshipbetweenageatimplantationandcodingstrategyonearlyspeechperceptionoutcomes.


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Methods:Speechperceptionwasassessedduringthefirstsixmonthsofdeviceusebetweentwocohortswholistenedexclusivelytooneofthreecodingstrategies.Thetwocohortsdifferedbyageatimplantation.ThespeechperceptiontestbatteryincludedCNCwordsinquietandAzBiosentencesinquietandnoise(10dBSNR).Performancewascomparedbetweengroupsandbetweencodingstrategies.Results:Allsubjectsexperiencedanimprovementinspeechperceptionwithinthefirst6monthsofcochlearimplantuseascomparedtopreoperativeperformancewithconventionalamplification.Differencesbetweenagegroupsandcodingstrategieswerenoted.Conclusion:Contemporarycodingstrategiesmayenhancepostoperativespeechperceptionabilities.However,ageatimplantationmaywarrantconsiderationwhenprogrammingcochlearimplantrecipientsatinitialactivation.Abetterunderstandingoftheinteractionbetweenageatimplantationandspeechperceptionwithindividualcodingstrategiesisneededtooptimizeindividualprogramsandimproveperformanceacrosstheagespectrum. AbstractID:186PosterNumber:43Title:LanguageOutcomesinChildrenFollowingCochlearImplantRevisionSurgeryAuthors:KseniaA.Aaron,M.D.1,LaurieS.Eisenberg,Ph.D.2,LaurelM.Fisher,Ph.D.2,KarenC.Johnson,Ph.D.2,ChristineM.Mitchell,Sc.M.3,ElinaKari,M.D.1;1USCTinaandRickCarusoDepartmentOtolaryngology-HeadandNeckSurgery,KeckSch.ofMed.ofUSC,LosAngeles,CA,2USCCarusoFamilyCenterforChildhoodCommunication,KeckSch.ofMed.ofUSC,LosAngeles,CA,3DepartmentofEpidemiology,JohnsHopkinsBloombergSch.ofPubl.Health,Baltimore,MD.Abstract:Introduction:Cochlearimplant(CI)devicefailure,althoughararecomplication,candisruptcommunicationdevelopmentinpediatricrecipientsduetoprogressiveorsuddeninterruptiontotheaccessofsound.Althoughrevisionoutcomeshavebeenreported,moststudiesonlylookatshort-termrevisionoutcomesandemphasizedetectionthresholdsandspeechperceptionscores.Toourknowledge,nonehavetrackedpediatricspokenlanguagelongitudinallybothpre-andpost-CIrevisionsurgery.OurprimaryaimistocharacterizeCIrevisionsurgeryinalarge,nationallyrepresentative,prospectivecohortstudy,andtoexaminetheeffectsofrevisionCIonspokenlanguageoutcomes.Methods:DatafromparticipantsenrolledatsixtertiaryacademicCIcenters,wereanalyzed.Thechildren(n=188)receivedtheirinitialCIbetween2002and2004,and102wenttoreceivedaCIinthecontralateralear.Here,weexaminedataonrevisionsurgeriesandlanguagestandardscores(SS)fromtheVerbalComprehensionScaleoftheReynellDevelopmentalLanguageScalesandtheCoreCompositescoreontheComprehensiveAssessmentofSpokenLanguage.Results:Ofthetotalearsimplanted(n=290),27revisionCIsurgeriesoccurred(9.3%)between2002andmid-2015:20earsrequiredonerevision,2earsneededtworevisions,and1earnecessitatedthreerevisions.Ofthe23participantswithatleastonerevision,6participantswerere-implantedpriortoanypost-CIassessmentsandtherefore,arenotfurtherdescribed.Allparticipantsscoredbelownormal(SS<85)atthepre-CI(baseline)assessment.Post-CI,pre-revisionlanguagescoresfromthevisitimmediatelypriortothefirstrevisionsurgery(mean=0.7yearsearlier)wereclassifiedaseitherbelownormal(n=12)orwithinthenormalrange(SS85-115;n=5).Theaveragetimefromthebaselinesurgerytothefirstrevisionwas5.1years(range:1.0-11.9).Participantshavebeenfollowedforpost-revisionlanguageoutcomesforanaverageof2.9years(range:0.3-7.1)todate(follow-upisongoing).In9participants’post-revisionlanguagescoresremainedbelownormal,5remainedinthenormalrange,


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and3improvedfrombelownormaltowithinthenormalrange.Noclearpatternsinetiologyofdeafness,imagingresults,orsurgicalcomplicationswereobservedamongparticipantswithrevisions.Conclusions:Theoverallrevisionpercentageof9.3%forthismulticenterstudyisinlinewithothersingle-sitestudiesinchildren(range2.9-12.9%).LongitudinaldataonspokenlanguageskillshavenotpreviouslybeenreportedforchildrenundergoingrevisionsurgeryfollowingCIdevicefailure.Despiteindividualvariability,theseresultsofferinsightsintopre-andpost-revisionlanguageoutcomes.Notably,languagescoresremainedstableorimprovedpost-CIrevisionsurgery.Ultimately,reimplantationshouldbecarriedoutwithminimaldelaytohelpmaintainandimprovethetrajectoryoflanguageoutcomes. AbstractID:196PosterNumber:206Title:PreoperativeAudiologicalDataasaPredictorofCochlearImplantHearingThresholdsafterSixMonthsofDeviceActivationinChildrenYoungerthanFiveYearsAuthors:JuliaS.C.Chiossi,BSc,FabianaDanieli,MSc,MiguelA.Hyppolito,PhD;DptoOftalmologia,OtorrinolaringologiaeCirurgiadeCabeçaePescoço,Univ.edeSãoPaulo,RibeirãoPreto,Brazil.Abstract:Introduction:Predictingcochlearimplantoutcomesinyoungchildrenisstillachallengeforclinicians.Thisuncertaintymayinfluencetheindicationsforsurgeryandcandidacycriteria.Therefore,findingpreoperativeindicatorsofgoodcochlearimplantprognosisisfundamentalfortakingevidence-baseddecisions.Theaimofthisstudywastodetermineifthepreoperativeaudiologicalinformationcanpredictaudiologicalthresholdswiththecochlearimplant,inashort-termevaluationinchildren.Methods:47childrenwithaprofoundprelingualhearingloss,agedbetweenoneandfiveyearsold,werestudied.Preoperativeaudiologicaltestingincludedaided,andnon-aidedpure-toneaudiometrymeanthreshold(aPTA&naPTA);auditorybrainstemresponsethreshold-clickstimuli(ABR),andauditorysteadystateresponsemeanthreshold(ASSR).AllchildrenhadabsentotoacousticemissionsandnormalcochlearMRIresults.Postoperativehearingthresholdsweremeasuredwiththecochlearimplantinfieldaudiometryafterameanof7.2(SD=2.1)monthsofsurgery,i.e.,aboutsixmonthsaftercochlearimplantactivation.Biologicalandsocialdatawerealsoassessedtodismissconfoundingvariablesandincludeessentialcofactors,namely,gender;ageathearinglossandCI;etiology;familyincomeandeducationallevel;andspeechtherapyattendance.Ascreeninganalysisofthebiologicalandsocialvariableswasconductedformodelfitting.Forstatisticcorrelationsaconfidenceintervalof95%andthesignificancelevelof0.05wereadopted.Results:"ageatimplant"wastheonlybiologicalfactorcorrelatedtocochlearimplanthearingthresholds(p-value=0.02),beingincludedinthemodelasidetoaudiologicaldata,providingitwithmorereliability.Thecompletemodelincludingallfouraudiologicalevaluationsplustheageatimplantshowedthereisasignificantcorrelationbetweenpreoperativetestingandcochlearimplanthearingthresholds(p-value=0.01)withacorrelationof28.6%.Theindividualsignificanceanalysisofeachvariableobtainedthefollowingp-values:naPTA=0.04;aPTA=0.69;ABR=0.85;ASSR=0.18;ageatimplant=0.01.Amodelcomprisingonlythetwosignificantvariables-naPTA&ageatimplant-wasabletopredict24.1%ofthecochlearimplanthearingthresholds(p-value=0.00;oddsratio=6.96).Conclusion:Preoperativeaudiologicaldata,mainlyfromthresholdsonnon-aidedpure-toneaudiometry,wasasignificantpredictorofcochlearimplantthresholdsinthefirstsixmonthsafterimplantactivation.Ageatimplantwasamajorcofactortothismodel.


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AbstractID:197PosterNumber:195Title:SpeechComprehensionAbilitiesofAdultsReceivingBilateralCochlearImplantsDuringChildhood:HowdotheyPerforminDifficultHearingSituationsEspeciallyinBackgroundNoise?Authors:KristenRak,Priv.-Doz.Drmed.,SebastianSchraven,Priv.-Doz.Drmed.,MariaKoeping,Dr.med.,RudolfHagen,Prof.Dr.Dr.h.c.,WafaaShehata-Dieler,Prof.Dr.med.;DepartmentofOto-Rhino-Laryngology,Plastic,AestheticandReconstructiveHeadandNeckSurgeryand,Univ.ofWuerzburg,Wuerzburg,Germany.Abstract:Introduction:In1996thefirstbilateralcochlearimplantation(CI)hasbeenperformedforbilateralhearingrehabilitation.Thisbroughtaboutasignificantlybetterspeechcomprehension,especiallyindifficulthearingsituations.Since1998,childrenhavealsobeenimplantedbilaterally,eithersequentiallyorsimultaneously.Thechildrenhaveshownarapid,verysatisfyinghearingandlanguagedevelopment.Meanwhile,someoftheseearlyimplantedchildrenalreadyareadults.Thequestioncameup,howthelongtermspeechcomprehensionabilitiesofthispopulationare?Emphasisofthisevaluationwastheenhancementofspeechcomprehensionabilitiesbythebilateraluseandthescoresinbackgroundnoise,sincebilateraluseoftheCIshouldbringmostbenefitinthissituation.Methods:Speechaudiometricresultsofearlybilaterallyimplantedpatientselderthan18yearsnowwereevaluated.Forthispurpose,aretrospectivedataanalysisoftheavailableaudiologicaldatasetswascarriedout.Results:46patientsofbilateralCIusersfulfilledtheinclusioncriteria.Themeanageofimplantationwas8.6yearsandthecurrentagewas21.7years.WiththesingleCIs66.1%ofthepresentedFreiburgermonosyllabicwordswerecorrectlyunderstoodat65dB,whereasat80dB71%.WiththebilateralCIthevaluesenhancedto69.0%and77.1%,respectively.TheaveragescoreontheHochmair-Schulz-Mosersentencetestinquietwas84.1%andat10dBSNR70.3%withbilateralCI.Conclusion:Thedatashowthatbilaterallyimplantedchildrenagehaveaverysatisfactoryspeechcomprehensionuptotheadulthood.Especiallyindifficulthearingsituationslikenoise,theyoungadultswithbilateralCIshadexcellentspeechcomprehensionabilities. AbstractID:199PosterNumber:30Title:DevelopmentofaParentingStressModuleforCaregiversofSchool-AgeChildrenwithCochlearImplantsAuthors:AlexandraL.Quittner,PhD1,MichaelF.Hoffman,MS2,IvetteCejas,PhD3;1BehavioralHlth.SystemsRes.,MiamiBeach,FL,2Psychology,Univ.ofMiami,CoralGables,FL,3MillerSchoolofMedicine,Univ.ofMiami,Miami,FL.Abstract:Introduction:Severalstudieshaveshownthatparentsraisingchildrenwithseveretoprofoundhearinglossesreporthigherlevelsofstressintheirparentingrolethanparentsofhearingchildren(Quittneretal.,2010).Acondition-specificfamilystressscalewasdevelopedintheearly1990s,priortotheavailabilityofcochlearimplants(CIs)(FamilyStressScale,FSS;Quittneretal.,1990),whichindicatedthatcommunication,discipline,safetyandeducationalplacementwereamongthemoststressfulparentingtasks.Higherparentingstresswasalsosignificantlyrelatedtolanguagedelaysandbehaviorproblems.DuringthedevelopmentofthefirstCI-specific,health-relatedqualityoflifemeasures,focusgroupparticipants(e.g.,teachers,speechpathologists,surgeons)andindividualparentinterviewsindicatedthatparentsexperiencefrequentandchallengingstressorsuniquetotheirchild’shearingloss


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anduseofaCI.Thus,ourobjectivewastodevelopamodulethatreliablymeasuresthistypeofcontextualparentingstress.Methods:Focusgroupsconsistingofhealthcareproviders(e.g.,audiologists,otolaryngologists)attwocochlearimplantcentersandprofessionalsatoneuniversity-basedschoolwereaskedaboutstressorsrelatedtoparentingachildwithaCI.TwentyparentsraisingachildwithaCI,ages6to12years(Mchildage=9.2years,SD=1.87),completedasemi-structuredinterviewlasting45-50minutes,whichwasaudiotapedandtranscribedforcontentanalysisusingNVivo.Nineitemsweregeneratedfromthisfirstqualitativephase,withfollow-upcognitivetesting.Duringthisphase,parentsratedthenineitemsona4-pointLikertratingscale(extentofstressorconcern),withscoresstandardizedona0-100scale;lowerscoresindicatedhigherlevelsofparentingstress.Results:Parentsinthecognitivetestinggroupweremostlymothers(90%),with50%havingcompletedacollegedegree,85%caringforanotherchildinthehome.Werecruitedparticipantswitharangeofracesandethnicities(65%White,non-Hispanic;15%African-American,15%Hispanic,and5%Asian).Importantly,10%offamiliesreportedthatSpanishwastheprimarylanguagespokenathome.StandardizedscoresontheParentingStressModulerangedfrom20.83(highstress)to85.19(lowstress),withanaveragescoreof58.33.Parents’highestratedstessorsincluded:1)CI/sbreaking;2)CI/sgettinglost;3)childhurtduringsports.Discussion:Qualitativedatafromhealthcareprofessionalsworkingwithschool-agechildrenwithCIs,andparentswhowereraisingthem,reportedanumberofspecificstressorsaffectingtheparentingrole.Nineitemsweregeneratedandratedbycaregiversin20familiesattwocochlearimplantcenters,yieldingawiderangeofparentingstressscores.Themesincludeddecisionsabouteducationalplacement,CIsbreakingorgettinglost,andthereactionsofotherstothechild’sCI/s.Nextstepsincludepsychometricevaluationofitsreliabilityandvalidity.Awell-validatedparentingstressmeasure,whichtakeslessthan5-minutestocomplete,couldbebothakeyoutcomemeasuretoassessfamilyadaptationtoschool-agechildren’suseofCIsandaclinicallyusefulmeasuretoguideandevaluateparent-childinterventionsinthispopulation. AbstractID:201PosterNumber:111Title:ChallengingSituationsinBonebridgeImplantationAuthors:RobertTrotic,MD,PhD1,MihaelRies,MD,PhD1,JakovAjduk,MD,PhD1,IvaKelava,MD1,AndroKosec,MD1,DaliborMatkovic,bacc.physioth.2;1Dpt.ofENT&HeadandNeckSurgerySestremilosrdniceUniv.Hosp.Zagreb,Zagreb,Croatia,2PrivatePraxis,Zagreb,Croatia.Abstract:Introduction:TheBonebridgeistranscutaneousboneconductionhearingimplantsystem,whichprovidesavaluableandstableaudiologicalbenefittopatientssufferingfromconductiveormixedhearinglossandsinglesideddeafness.Methods:Bonebridgemaybeimplantedthroughthreedifferentapproaches:thetransmastoid,theretrosigmoid,orthemiddlefossaapproach.nd:white'>avaluableandstableaudiologicalbenefittopatientssufferingfromconductiveormixedhearinglossandsinglesideddeafness.Results:Challengingsituationscanbeskinreaction,skingrowthovertheabutment,dura,sigmoidsinusorsomeotheranatomicalstructuresinjuries,andwoundinfection.Conclusion:TheBonebridgeoffersalowercomplicationratetopercutaneoussystemsandhigherandmorereliablehearinggaincomparedtoothertranscutaneousorpercutaneoussystems.


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AbstractID:203PosterNumber:45Title:TheRoleofPost-operativeAntibioticsFollowingCochlearImplantationAuthors:GalitAlmosnino,MD1,DanielZeitler,MD2,SethSchwartz,MD,MPH2;1NeuroscienceResearchInstitute,VirginiaMasonMed.Ctr.,Seattle,WA,2DepartmentofOtolaryngology,VirginiaMasonMed.Ctr.,Seattle,WA.Abstract:Introduction:Post-operativeantibioticsfollowingcochlearimplantationarewidelyused.Therearenoexistingprescribingguidelinesforsurgeonsandthereislimitedandinconclusivedataintheexistingliteratureonthebenefit.Theuseofantibioticswhenthereisnoprovenpositiveeffectincreasescostofcare,cancontributetoantibioticresistanceandincreasestheriskofmedicationsideeffects.Inthisretrospectivecase-controlstudy,weevaluatedtheoutcomesofcochlearimplantpatientswhoreceivedpost-operativeantibioticsversuspatientswhodidnot.Methods:Thiswasaretrospectivecase-controlstudyinatertiaryreferralteachinghospital.Allpatientsundergoingcochlearimplantationbybothsurgeonsatourinstitutionbetween2013-2016wereidentifiedbyCPTcodes.Weidentified151patients.Fifteenpatientswerelosttofollowupandexcludedfromthestudy.Patientagerangedfrom9months-91years.Aminimalaccessincision,tightperiostealpocketapproach,andasingleintraoperativedoseofIVantibioticswasusedinallpatients.Startingin2015,onesurgeonstoppedprescribingpost-operativeantibiotics.Wecomparedinfectionratesinacontrolgroupthatreceivedantibioticsinthe18monthspriortothischangebythatsurgeon(n=95)tothecohortofpatientsthatdidnotreceivepost-operativeantibiotics(n=36).Inasecondanalysis,20patientsthatreceivedcochlearimplantswithpost-operativeantibioticsbythesecondsurgeonwerecomparedtothe36patientswhodidnotreceivepost-operativeantibioticsduringthesametimeframe.Results:Noneofthe36casesandnoneofthe95historiccontrolsnor20concurrentcontrolsexperiencedpost-operativeinfection.Conclusion:Inthissmallsample,post-operativeantibioticsfollowingcochlearimplantationdidnotimpactinfectionratesintheperi-operativeperiod.Post-operativeantibioticsmayoffernobenefitwhileleadingtoresistance,allergy,cost,andothersideeffects.Thispilotstudyshouldencouragesurgeonstore-evaluatestandardpracticearoundantibioticuseafterCIsurgery. AbstractID:207PosterNumber:219Title:ParentalPsychosocialExperiencesinPediatricHearingHealthcare:AQualitativeAnalysisAuthors:DianaBigler,BS1,MeaganPilar,MPH2,AllisonMerritt,BS2,JulieJacobs,MPH2,MatthewBush,MD3,ChristinaStudts,PhD2;1Univ.ofKentuckyColl.ofMed.,Lexington,KY,2DepartmentofHealth,Behavior,&Society,Univ.ofKentuckyColl.ofPubl.Health,Lexington,KY,3DepartmentofOtolaryngology-HeadandNeckSurgery,Univ.ofKentucky,Lexington,KY.Abstract:Introduction:Forparentsofchildrenwithhearingloss,fragmentationofservicesischallengingtonavigate.Withinthehearinghealthcaresystem,parentsmustcoordinatemultipleencounterswithclinicians,therapists,andotherteammembers.Parentsmaylackaccesstonecessarymedicalinformationandsocialsupporttonavigatethiscomplexprocess,leadingtoanxietyandsocialisolation.Theobjectiveofthisresearchwastoinvestigatethepsychosocialexperiencesofparentsofchildrenwithhearinglossduringthediagnosticandtreatmentprocessusingaqualitativeapproach.


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Methods:One-hoursemi-structuredkeyinformantinterviews(N=20)withparentsofchildrenwithcochlearimplants,hearingaids,orbothwereaudio-recordedandtranscribed.Fiveresearchteammembersreviewedtranscriptsanddevelopedaninitialcodebooktoidentifyrecurringpsychosocialthemes(i.e.anxiety,isolation).Tworesearchteammemberscompletedsamplecoding,withinterraterreliabilityexceeding80%forallcodes.Eachtranscriptwasthencodedbyaprimarycoderandreviewedforagreementbyasecondcoder.Discrepancieswereresolvedbycoderdiscussion.Representativequotationsforcodeswerecompiledandassessedbythefullresearchteamtoidentifyconnectionsbetweenpsychosocialandclinicalexperiencesinhearinghealthcare.Results:Themajority(85%)ofparentsandchildrenwerenon-HispanicWhite.Annualhouseholdincomerangedfrom<$20kto>$90k,andparenteducationrangedfromhighschooldiplomaorGED(15%)tograduateeducation(over30%).Mostparents(90%)werebiologicalmothersofthechildren.Ageofchildrenwasequallydistributed(2-5)andjustoverhalf(60%)weremale.Halfofchildrenhadhearingaidsandhalfhadcochlearimplants;most(65%)hadbilateralauditoryrehabilitativedevices.Parentexperiencesdifferedbetweentwodistinctgroups:(a)proactive,well-resourcedparents,and(b)overwhelmed,under-resourcedparents.Theproactiveparentswerestrongadvocatesanddescribedamplefamilysupportandresources.Incontrast,theoverwhelmedparentsdescribedfeelingsofisolation,eitherinreferencetosocialsupportorlackofinformation.Inbothgroups,parentsattributedsuccessingatheringinformationtofinancialresourcesortotheirownhealthliteracy,ratherthantoguidancefromhearinghealthcareproviders.Parentsfrequentlydescribedfeelingoverwhelmedormisunderstandingthesignificanceofthediagnosisortreatmentandfrustrationwithperceivedlackofguidanceandempathyfromhealthcareproviders.Conclusion:Someparentsofchildrenwithhearinglossreportnegativepsychosocialexperiencesinnavigatingthehearinghealthcaresystem.Theeffectoftheseexperiencesonauditoryrehabilitationisunknown.Integratedpsychosocialinterventionstoexpandinformationandsupport,suchasclinicallyfacilitatedsupportgroups,couldreduceisolationandfrustrationinthispatientpopulation. AbstractID:210PosterNumber:104Title:PediatricPatientswithCochlearImplants:AQualitativeStudyontheObstaclestoFull-timeUtilizationAuthors:PaulaA.Tellez,MD1,FrederickK.Kozak,B.Sc.,MD1,RuthChia,BAMScRAvd1,JuliePauwels,MSc1,GraceS.Yi,Mdcandiate2;1OTOLARYNGOLOGY,BCCHILDREN´SHOSPITAL,VANCOUVER,Canada,2UNIVERISTYOFBRITISHCOLUMBIA,VANCOUVER,Canada.Abstract:Introduction:WhilemanycochlearimplantpatientsusetheirCIfull-time,somedonot.Theaimofthisstudywastodeterminebymeansofparentalinterview,thereasonswhyfull-timeusedidnottakeplaceandwhy.Methods:AretrospectivechartreviewofpediatricpatientswhoreceivedacochlearimplantatourinstitutionbetweenJanuary1,1989andMay31,2014andwhohavebeenusingtheCIforaminimumoftwoyearsrevealedthat35/150patientswerepotentialpart-timeornon-users.Atelephone/in-personsurveywasconductedwiththeparentsorcaregiversofthoseidentifiedaslessthanfull-timeornon-userstoassessthereasonswhy.Results:Thirty(85.6%responserate)patientscompletedtheinterviewprocess,and5/30werefoundtobefull-timeusers.Oftheremaining25partialornon-users,15patientshadaunilateralCI,ofwhich3werenon-usersand12werepartialusers.Ten/25hadabilateralCI:3bilateralsimultaneousCI


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recipientswerepart-timeusersofbothCIs,6bilateralsequentialCIrecipientswerefull-timeusersoftheirfirstCIandpartialornon-usersofthesecondCI,and1patientwasanon-user.Themostcommonreasonscitedbyparentsforlessthanfull-timeuseincluded:fatiguefromtheeffortoflistening(9/30,30%),additionalmedicalneeds(9/30,30%)includingautism(4/30,13%),lackofappropriateschoolclassroomsupport(10/30,33%)andaperceivedlackofbenefit(11/30,37%).Forty-fourpercentofparentsreportednegativereactionssuchasstaring,commentsorharassmentfromothers;howeveronly3%reportedthatthisaffectedtheirchild’sCIuse.Conclusion:ReasonsforlimitedCIuseinpediatricpatientsarediverseandoftenmultifactorial,rangingfromphysicallimitationstopsychosocialfactorsandlimitedcommunity/schoolsupport.CounselingfamiliesontheobstaclestofulltimeCIuseandtherealisticexpectationsforCIbenefitincomplexneedspatientsshouldbeconsidered.Additionally,alackofappropriateclassroomsupporthighlightstheneedformorecommunityadvocacy. AbstractID:212PosterNumber:81Title:CochlearImplantationinaChildDiagnosedwithFascioscapulohumeralMuscularDysphagiaAuthors:YoungHoKim,MD,PhDOTORHINOLARYNGOLOGY,SEOULNATIONALUNIVERSITYBORAMAEMEDICALCENTER,SEOUL,Korea,Republicof.Abstract:Introduction:thefacioscapulohumeralmusculardysplasiahavesymptomsandsignsofmuscleweakness,suchasfacialmuscleweakness,shoulderweakness,abnormalheartrhythm,weakeningofthebiceps,triceps,deltoids,andlowerarmmuscles,lossofstrengthinabdominalmuscle,andfootdrop.Futhermore,hearinglosswasreportedinsomepatientswiththisdisease.Inthisstudy,wereportedtheclinicalcharacteristicsandcochlearimplantation(CI)outcomeofthepatientwhohadprofoundhearinglossandfacialnervepalsy,andwasdiagnosedwiththisdisease.Methods:weretrospectivelyreviewtheclinicalinformationaboutthepatientwhohadvisitourclinicwiththesymptomofsensorineuralhearinglossandfacialnervepalsyatbothside.Results:Three-yearoldboyvisitedwithbilateralsensorineuralhearinglossandbilateralfacialnervepalsy.Hisnew-bornhearingscreeningtestshowedbilateralfailureandauditorybrainstemresponsetest4monthsafterbirthrevealed45dBonrightand55dBonleft.Hestartedbilateralhearingaids16monthsafterbirthandbilateralfacialnervepalsy(FNP)wasfound23monthsafterbirth.Onphysicalexamination,thepatientwithFNPofHouse-BrackmanngradeIVhadsymptomsofwingingscapula,lumbarlordosis,andabsentpectoralisminorsuggestingPolandsyndrome.Chromosomalstudy,temporalboneCT,andinternalauditorycanalMRIshowedallnormalfindings.PuretoneaudiogramdemonstratedbilateralsensorineuralhearinglosswithresidualhearingatlowfrequenciesandABR55dB/85dBonrightand95dB/95dBonleftat1and3kHz.Therewerelatencydelayandamplitudedecreaseofendpointofbilateralfacialnerveonelectromyographyoffacialmuscle.Languagedevelopmentalstudyperformedatageof4showedCAPscore4andsentencescore(audiovisual)30%,andlanguageagewasdelayed6months.Hisspeechdiscriminationwaspoordespiteuseofbilateralhearingaidssothatleftcochlearimplantation(CI)wasdoneatageof6.Electrodewasinsertedfullyusingroundwindowapproach.PostoperativeNRTwasallnormalat22channelsandtransorbitalviewshowedawell-positionedelectrodeincochlea.Postoperatively,hearingthresholdsatlowfrequenciesontheleftearwerepreservedwell.Preoperative,postoperative3and6monthsCAPscore/sentencescorewere4/40%,6/83%,and6/100%.HeisusingleftCIandrighthearingaidwellwithoutconversationproblem.


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Conclusion:ThepatientwhowasdiagnosedwithfascioscapulohumeralmusculardysplasiashowedgoodCIoutcome.Onthebasisoftheseresults,Ciatthecountersideisalsobeingplanned. AbstractID:216PosterNumber:210Title:TheOutcomeofDomesticCochlearImplantsinPrelingualDeafnessChildrenAuthors:WeiLu,MD,PhDTheFirstAffiliatedHosp.ofZhengzhouUniv.,Zhengzhou,China.Abstract:Introduction:ToinvestigatethedevelopmentofauditoryandspeechskillsandthesecurityandstabilityamongtheprelingualdeafchildrenwithNurotronVenuscochlearimplants.Methods:78cochlearimplantsubjectswererecruitedfromthefirstofaffiliatedhospitalofZhengzhouuniversity.Subjectsweredividedinto5groupsaccordingtotheageatthetimeofimplantation.:groupA(between13and24months),groupB(between25and36months),groupC(between37and48months),groupD(between49and72months),groupE(between73and96months).Theauditoryandspeechskillswasjudgedby(IT)MAIS/MUSSquestionnaires.Post-operativecochlearradiographdeterminethepositionofcochlear.Followingupthecomplicationandusageofcochlear.Results:TheauditoryandspeechabilityofchildrenwithCIsimprovedconstantly.Theauditoryandspeechofdifferentgroupswasstatisticallysignificant.Allthesurgeryof78casesNurotron-Venuscochlearimplantsweresuccessful.Post-operativecochlearradiographshowedelectrodeinnormalposition.2caseswithprocessorfailure.TheremainingCIswereimplantedcompletely.Theabilityofauditoryisrelatedtospeech.Conclusion:With1yeartheabilityofauditoryandspeechimprovedgradually.Thescoreofauditoryandspeechaboutthesmallagegroupsislowerthanolderchildrenintheearlydays.Therewasnoinfluenceonauditoryin12months.Smallchildren’sscoreofspeechislowerthanolderchildrenin12months.Thebetterabilitytointegrateauditoryinformation,thebettertheabilitytospeech.TheNurotronCIsworkssafetyandeffectively. AbstractID:219PosterNumber:100Title:SurgicalComplicationsandMorbidityinCochlearImplantation.Authors:IhabK.Sefein,Sr.,MD,AssisstantprofessorofOtolaryngologyENTDepartment,TheNatl.EgyptianHearingandSpeechInst.,Cairo,Egypt.Abstract:Introduction:Cochlearimplantation(CI)hasbeenestablishedworldwideasthesurgicaltreatmentforindividualswithbilateralseveretoprofoundhearingloss.Thisisasafeandstandardprocedureinthehandsofexperiencedimplantsurgeons.Complicationsduetosurgeryareminimalandareoftenencounteredincaseswithcongenitalanomaliesofthetemporalboneandinnerear.Methods:Allpatientsreceivingcochlearimplantsatourinstitutionbetween2014and2015Ouraimwastoreportthefrequencyofsurgicalcomplicationsfollowing112consecutiveCIsin102childrenand10adultsintheNationalHearingandSpeechInstituteCairo-Egypt.TheinternationalconsensusonthereportingofcochlearimplantcomplicationsproposedbyHansenetal.[5]wasusedandevaluated.


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Results:Inall,112implantationswereperformedin102Pediatric&10adultpatients.Overall,complicationsoccurredin21patients(18.75%),includingmajorcomplicationsin12(10.71%)andminorcomplicationsin9(8.03%)cases.Complicationsweredelayedin9(8.03%)ofthesecases.Nodeathwasattributedtodeviceimplantation.Majorcomplicationsoccurredin12casesincluded:misplacedelectrodesin2cases,Acerebrospinalfluidleak(Gusher)in4cases,Labyrinthitisossificansin1patient,magnetdisplacementin1case,(CSOM)Centralperforationin1case,seromaandhematoma(Severecutaneousinfections)in1case,Woundinfectionin1caseandPersistentpain/discomfort(Migration)incase.Conclusion:ComplicationsofCIinchildrenarecommonthanadultwithtraumaasamajorfactor.Innerearmalformationsshouldpromptspecificpreventivemanagement.Cochlearimplantationinyoungchildrendidnotappeartobeariskfactorinthisstudy. AbstractID:221PosterNumber:5Title:OptimizingtheBenefitofCochlearImplantProcessorsforSoundLocalizationAuthors:DanielBeaudoin,M.O.A1,Marie-SoleilHoude,M.Sc.S.(A)2,JulieDufour,M.O.A.1,FrancoisChampoux,Ph.D3;1CIUSSCtr.Suddel'iledeMontréal,Montreal,Canada,2CISSSdesLaurentides,St-Jérôme,Canada,3Écoleorthophonieetaudiologie,UniversitédeMontréal,Montreal,Canada.Abstract:Introduction:Severalstudieshavesuccessfullylinkedcochlearimplant(CI)processorparametersconfigurationwithincreasedspeechperception.Morespecifically,ithasbeensuggestedthatmediumtohighstimulationratesallowforbetterextractionoftemporalacousticsinformationthanlowstimulationrates.Thisprocessoftemporalextractionisacrucialstepinspeechperception.However,theimpactofachangeinCIprocessorparametersconfigurationforotherprocessesunderlyingauditorysceneanalysisremainsunexplored.ThemainobjectiveofthisstudyistopresenttheimpactofachangeinCIstimulationratesonauditorylocalizationinthehorizontalplaneforbilaterallyimplantedpost-linguallydeafenedindividuals.Methods:Acertifiedaudiologistprogrammedfourelectricalstimulationsratesof250,900,1800and2400ppsinaninitialsessionforeachparticipant.MappingthedeviceatacomfortablelevelusingT-andC-levelscontrolledsoundloudnesslevel.Stimulationmodewasmonopolar(MP)+1forallfourconditionswithamaximaof8andapulsewidthof12-25µs.Thenumberofactiveelectrodeswaskeptconstantacrossconditions.Thebehaviouraleffectofthemodificationwasassessedusingasoundlocalizationtask.Results:ResultssuggestthatanincreaseofCIstimulationratecaneffectivelyimprovesoundlocalization.Conclusion:ThisstudyprovidesaninterestingfirstindicationastothebenefitsofmodifyingtheparametersofCIsprocessorstoimprovesoundlocalization. AbstractID:223PosterNumber:26Title:CIProvisionforChildrenofDeafParentsAuthors:AnnetteLeonhardt,ProfessorDoctorLehrstuhlfürGehörlosen-,Ludwig-Maximilians-Univ.München,80802München,Germany.Abstract:CIProvisionforChildrenofDeafParents–AResearchProgramme


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PosterAnnetteLeonhardtIntroduction.Towardstheendofthe1980sthefirstcochlearimplantationsinchildrenwereperformedinHannover(Germany).Atthetime,thepossibilityofdeafparentsoptingforCIfortheirchildrenwasvirtuallyinconceivable,reactionsrangingfromrestrainttovehementrejection.Inthemid-nineties,however,thefirstcochlearimplantationswerecarriedoutondeafchildrenofdeafparents(Begall1995).In2000theresearchprogrammeentitled„CIProvisionforChildrenofDeafParents“waslaunchedandcurrentlycomprises7substudies.Thepilotstudy(2001-2004)wasfollowedbythedevelopmentofspecialinformationmaterialonthesubjectofCIinchildren(substudy2),specificallydesignedfordeafparents(2006-2009).Furthersubstudiesfocuson:•vocabularydevelopmentinbothspeechandsignlanguageinthesechildren(wherebysignlanguageremainsthefamilylanguageandspeechasa`bridge´totheworldoftheHearing.(substudy3),•therespectivefamilysituation(substudy4)andinterviewswithyoungadults-who,asdeafchildrenofdeafparents,receivedaCIinchildhood-todeterminetheircurrentfeelingsaboutCIprovision.(substudy5).MethodsThevarioussubstudiesincludedvaryingresearchmethodsasappropriate.Interviews(substudies1,2,3und5),AWST-R(activevocabularytestfor3-5-year-oldchildren)orWWT(vocabularyandwordfindingfor6–10-year-olds),PERLESKO(signlanguagevocabulary)(substudy4)andthefamilysystemtest(FAST)(substudy4).ResultsCochlearimplantedchildrenofhearingimpairedparentsshowsimilardevelopmenttothoseofhearingparentsif(andonlyif)earlyandadequatecontactwiththeHearingworld-e.g.hearingcarers,orparticipationinacrèche,nurseryschoolorplaygroup–isguaranteed.Thecourseofdevelopmentisshowntobepositiveinalmosteveryaspect.SpeechacquisitiondependsentirelyoncontactwiththeHearing.Signlanguagewillcontinuetobethefamilylanguage.Thechildrenareabletoswitchfromonelanguagetoanother,communicatingwithappropriateregister.ConclusionThenumberofhearingimpairedparentsoptingforcochlearimplantationfortheirchildrenisontheincrease.WhereasthefirstCIprovisionswereinitiatedbythechildrenthemselves(inthiscaseoldernurseryschoolchildrenorprimaryschoolchildren)orinsomecasesencouragedbygrandparents,itisnowtheparentsthemselveswhotaketheinitiativeasearlyaspossible.AcomparisonofCIchildrenofhearingparentsanddeafparentswillinvariablyyieldsomeanomaliesbutmanyparallelscanbeobserved. AbstractID:224PosterNumber:220Title:CochlearServicePointAuthors:ElianaCristofari,MDPhD1,EnricoViolin,Aud2;1ENTaudio-vestibologyunit,Asst-settelaghiVarese,Varese,Italy,2Cochlearsrl,Varese,Italy.


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Abstract:Introduction:FromthebirthofthecenterofVareseHospitalAudiovestibology,thesteadyincreaseinthenumberofcochlearimplantsrecipients,broughtthecentertohandlemostcasesofpatientswithcochlearimplantinItaly,highlightinghightimingofassistanceincaseofmalfunctionsthedevice.Inparticular,thecochlearimplant(CI)recipientwasforcedtocomeoutthecenterandgotoaprivatefacility,thenbackattheservicefortestingthereplacedcomponents.TheassociationAguav(parentsandusers’sassociationaudiovestibologyVareseonlus)hasstronglyadvocatedtheestablishmentofaninternalservicetothestructurehospitalthatwouldobviatetheuser’sinconvenienceandinparticularfacilitatethepaperwork.Methods:ThemethodhasusedtheanalysisofsatisfactionandthetimesofassistancebeforeandafterthecreationofaservicepointwithintheAudiovestibologycenter.Theprojectnamed"ServicePointCochlear"cametolifeinMay2014andhasresetthetimingofdeliveryofassistancetothepatientwithasubstantialimprovementintheindexofusersatisfactionandthecenteroperators.Inaddition,theServicePointfacilitatestheuserinthemanagementofadministrativepracticesbyactingasanintermediarybetweentheuserandtheNationalHealthSystem.ThroughcollaborationbetweenHospitalandprivateentity,theassistancealsoisprovidedontheaccessoriesoutofwarrantywithimmediatereplacementpartdoesnotworkthroughtheloansprovidedtoyoubyyourAudiovestibologycenter.Results:Thenumberandthequalityofservicetothepatientpointedoutasignificantimprovementofsatisfactionandqualityofassistancetothecochlearimplant’srecipients.Theimprovementaremoresignificantinthefirstyearfromtheopeningofthisservice.Conclusion:Inconclusionitisclearthatthe"ServicePointCochlear"todayrepresentstheidealtoolfortheimmediatemanagementofthepatient'sproblemsthatneedassistancewiththecochlearimplant,andistheonlyserviceofitskindonanationallevel,withinapublichealthfacility,madepossiblethankstothesynergybetweenpublicandprivate. AbstractID:226PosterNumber:182Title:MusicTrainingImprovesPitchPerceptioninPrelinguallyDeafenedChildrenWithCochlearImplantsAuthors:LieberP.Li,MD,PhD1,JoshuaChen,MD2,AnnChuang,MD3,CatherineMcMahon,PhD4,Jen-ChuenHsieh,MD,PhD5,Tao-HsinTung,PhD6;1DepartmentofOtolaryngology,Cheng-HsinGen.Hosp.,Taipei,Taiwan,2DepartmentofOtolaryngology,FarEasternMem.Hosp.,NewTaipei,Taiwan,3MackayMem.Hosp.,Taipei,Taiwan,4MacquarieUniv.,Sydney,Australia,5TaipeiVeteransGen.Hosp.,Taipei,Taiwan,6Cheng-HsinGen.Hosp.,Taipei,Taiwan.Abstract:Introduction:Thecomparativelypoormusicappreciationinpatientswithcochlearimplantsmightbeascribedtoaninadequateexposuretomusic;however,theeffectoftrainingonmusicperceptioninprelinguallydeafenedchildrenwithcochlearimplantsremainsunknown.Thisstudyaimedtoinvestigatewhetherpreviousmusicaleducationimprovespitchperceptionabilityinthesechildren.Methods:Twenty-sevenchildrenwithcongenital/prelingualdeafnessofprofounddegreewerestudied.Teststimuliconsistedof2sequentialpianotones,rangingfromC(256Hz)toB(495Hz).Childrenwereaskedtoidentifythepitchrelationshipbetweenthe2tones(same,higher,orlower).Effectsofmusicaltrainingduration,pitch-intervalsize,currentage,ageofimplantation,gender,andtypeofcochlearimplantonaccuracyofpitchperceptionwereevaluated.


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Results:Thedurationofmusicaltrainingpositivelycorrelatedwiththecorrectrateofpitchperception.Pitchperceptionperformancewasbetterinchildrenwhohadacochlearimplantandwereolderthan6yearsthaninthosewhowereaged6years(ie,preschool).Effectofpitch-intervalsizewasinsignificantonpitchperception,andtherewasnocorrelationbetweenpitchperceptionandtheageofimplantation,gender,ortypeofcochlearimplant.Conclusion:Musicaltrainingseemstoimprovepitchperceptionabilityinprelinguallydeafenedchildrenwithacochlearimplant.Auditoryplasticitymightplayanimportantroleinsuchenhancement.Thissuggeststhatincorporationofastructuredtrainingprogramonmusicperceptionearlyinlifeandaspartofthepostoperativerehabilitationprogramforprelinguallydeafenedchildrenwithcochlearimplantswouldbebeneficial.Alongitudinalstudyisneededtoshowwhetherimprovementofmusicperformanceinthesechildrenismeasurablebyuseofauditoryevokedpotentials. AbstractID:231PosterNumber:66Title:EstimatingtheCouplingEfficiencyandIntegrityofVSBMiddleEarImplantSystemsUsingABR/ASSRMethodsAuthors:UteGeiger,M.Sc.1,AndreasRadeloff,Professor2,WaafaShehata-Dieler,Professor1,RudolfHagen,Professor1,MarioCebulla,Professor1;1CHC,Univ.hospitalWürzburg,Würzburg,Germany,2Univ.hospitalOldenburg,Oldenburg,Germany.Abstract:Introduction:TheVibrant-SoundbridgeTM(VSB)isanactivemiddleearimplantthatissurgicallycoupledtodifferentstructuresinthemiddleear,dependingonthetypeofhearinglossandtheindividualphysiologyofthemiddleear.HearingimprovementishighlydependentonthecouplingefficiencybetweentheFloatingMassTransducer(FMT)andthemiddleearstructure.Estimatingthecouplingefficiencyintraoperativelyisparticularlyinpatientswithaboneconductivehearinglossof30dBHLandhigherhelpfultoachieveadequatehearingresultsandavoidrevisionsurgeries.Furthermore,inchildrenitischallengingtotestreliablytheintegrityoftheimplant,hearingdegradation,andhearingoutcomesafterfittingwithsubjectivetests.Currentlythereisnosufficientmethodtodeterminethecouplingefficiencyandtheintegrityintraoperatively.Forthisapplicationweintraoperativelymeasuredauditorybrainstemresponses(ABRs),whilestimulatingthepatientviatheimplant.Methods:Awirelessstreamer(SivantosMiniTekTM)wasusedtotransmitstimulifromtheABRsystemviaaudioprocessor(SambaTM)totheFMToftheimplant.TheABRswereevokedbychirp-sounds,usingmodifiedbroadbandCE-Chirpsaswellasoctavebandchirpsstartingfromlevelsaboveboneconductionthresholdtolevelsbelowthreshold.Forthisstudy,weevaluatedABRsinchildrenandinadultVSBpatientsonasinglepatientbasis.Results:TheABR-thresholdswererelatedtoboneconductionthresholdsandtothevibrogramtoverifythisnewmethod.Overall,ABRmeasurementsviaVSBareabletodeterminethecouplingefficiencybetweentheFMTandthemiddleearstructure.Furthermore,theintegrityoftheimplantcanbetestedobjectively.Conclusion:Thismethodcanbeusedtodeterminethecouplingefficiency,theintegrityoftheImplant,toobjectifythefittingoftheVSB,anddetermininghearingdegradation,whichcanbeveryhelpfulinimmatureorhandicappedpatients. AbstractID:232


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PosterNumber:176Title:AShortFormoftheSpeech,SpatialandQualitiesofHearingScaleforUsewithChildren:DevelopmentStageAuthors:JenniferM.Allsopp,MSc1,CatherineF.Killan,MSc2,PaulD.Baxter,PhD3,EdwardC.Killan,PhD3;1FacultyofMathematicsandPhysicalSciences,Univ.ofLeeds,Leeds,UnitedKingdom,2YorkshireAuditoryImplantService,BradfordTeachingHosp.NHSFndn.Trust,Bradford,UnitedKingdom,3FacultyofMedicineandHealth,TheUniv.ofLeeds,Leeds,UnitedKingdom.Abstract:Introduction:Anumberofself-reportquestionnaireshavebeendevelopedtomeasurecochlearimplant(CI)users'hearingabilityinreal-worldsettings.Forchildren,amodifiedversionoftheSpeech,SpatialandQualitiesofHearingScale(SSQ)isusedtoassessachild’shearingabilityviareportsfromparents(i.e.theSSQ-P).TheSSQ-Pconsistsof23itemswhichassessvariousaspectsofspeechperception,soundlocalizationandidentificationandhasbeenusedwithinarangeofclinicalandresearchsettings.However,clinicalexperiencesuggeststhatthelengthandcomplexityoftheSSQ-Pmakesitoverlytime-consumingtocomplete,resultingininaccurateorincompleteassessmentofthechild’shearingability.Theaimofthisstudy,therefore,wastodevelopashortformoftheSSQ-Pusingstatisticalanalysesofpreviouslycollectedclinicaldata.Methods:CompletedSSQ-Pquestionnaireswereanalysedfor66children(32female,34male)withbilateralcochlearimplantsgivenineithersimultaneous(N=31)orsequential(N=35)procedures.Allchildrenwereatleastfiveyearsold(medianage8years9months;range5years3monthsto16years4months).Theirparent(s)/guardian(s)hadfullycompletedtheSSQatleastoneyearpost-secondcochlearimplant(mediantestinterval=4years,range1yearto5years).WheretheSSQhadbeencompletedonmorethanoneoccasionthemostrecentresultswereanalysed.Explanatoryfactoranalysis(EFA)wasusedtoidentifylatenttraitswithinthedataandconfirmatoryfactoranalysis(CFA)wasusedtoconfirmwhichtraiteachofthe23itemsmeasured.Eachitemwasthenanalysedusingitemresponsetheory(IRT).Viastatisticalmodelling,thisassesseswhichitemsprovidegoodlevelsofdiscriminationwithineachlatenttrait.Results:EFAidentifiedthreelatenttraits(speech,spatialhearingandqualitiesofhearing)withinthedata.CFAconfirmedlatenttraitsweremeasuredbytheircorrespondingitems,withtheexceptionofonespeech-relateditemwhichwasmorecloselyalignedtospatialhearing.IRTanalysisexcluded13items,sothattheresultantshortformversionoftheSSQ-Pcomprisedof10items,withspeech,spatialhearingandqualitiesofhearingassessedby4,3and3itemsrespectively.Conclusion:AshortformoftheSSQ-P,theSSQ-P10,hasbeendevelopedforuseinclinicalsettingswithparentsofchildrenwhousecochlearimplants.Validationofthisquestionnaire,priortorecommendingitswidespreadclinicaluse,isrequired.AbstractID:233PosterNumber:52Title:EnlargedCochlearAqueductandSurgicalRiskofCerebrospinalFluidLeak:HowMuchisCommon?Authors:GiovanniBianchin,MD,LorenzoTribi,MD,ValeriaPolizzi,MD,PatriziaFormigoni,MD;ENTdepartment,ASMN-IRCCSHosp.ofReggioEmilia(Italy),ReggioEmilia,Italy.Abstract:ENLARGEDCOCHLEARAQUEDUCTANDSURGICALRISKOFCEREBROSPINALFLUIDLEAK:HOWMUCHISCOMMON?Introduction:


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Thelastmodernradiologicaltecniqueshaveimprovedthestudyofthethinnerinnerearstructures,suchascochlearandvestibularaqueduct,thathaveoftenbeensuggestedasacauseofsensorineuralhearinglossandintraoperativecerebrospinalfluid(CSF)leak.Cochlearaqueduct(CA)isasmallbonycanalinthetemporalbonethatconnectsthesubarachnoidspaceoftheposteriorfossatothebasalturnofthecochlea.Aswelldefectsinthebonypartitionofthefundusoftheinternalauditorycanal,malformationsofthecochlearandvestibularaqueducthavealsobeensuggestedasacauseofperilymphaticgusherfollowingstapessurgeryandcochleostomyduringcochlearimplant.IntraoperativeCSFleakisaserioussurgicalcomplicationwithpossibilityofresidualCSFfistulaandahypotheticincreasedriskfordevelopingmeningitispostoperatively.Methods:Demographic,radiologicalandsurgicalresultswereevaluatedinthecasehistoriesoverthelast15yearsatENTDepartment,ASMN-IRCCSHospitalofReggioEmilia(Italy).SpecialattentionhasbeenmadeonthecochlearandvestibularaqueductmalformationandtheircorrelationwithCSFleakduringsurgery.Results:Ourevaluation,conserning278casesofcochlearimplant,showedthatenlargedCAhasanincidenceof2.16%withapercentageofintraoperativegusherobservedof83,4%.Conclusion:SpecialattectionshouldbegiventopreoperativeimagingtopredictthepotentialintraoperativeriskofCSFleak.InourcaseseriesECAmaybethebestriskpredictorfactorofCSFleakatcochleastomyduringICsurgery. AbstractID:234PosterNumber:180Title:SequentialBilateralCochlearImplantationinChildren-MinimalAuditorySkillsDevelopmentExpectedAccordingtoHearingStimulationandDelayBetweentheTwoCochlearImplantsAuthors:MélanieLaferrière,M.O.A.1,DanielPhilippon,M.D.,D.M.D.,F.R.C.S.(C)2,FrançoisBergeron,Ph.D.3,CaroleLosier,M.O.A.2;1IRDPQ,CIUSSSdelaCapitale-Natl.e-IRDPQ,Québec,Canada,2CHUdeQuébec-UniversitéLaval,Québec,Canada,3UniversitéLaval,Québec,Canada.Abstract:Introduction:Since1984,theQuébecCochlearImplantProgramhasperformedmorethan800pediatriccochlearimplantations.Tovalidatethatthedevelopmentofchildren’sauditoryskillsisoptimizedassoonaspossibleandbeabletoactquicklyiftheprogressiondiffersfromwhatisgenerallyexpected,theteamhasdevelopedin2007anobservationalgridspecifyingtheminimallyexpectedauditorydevelopmentmilestonesat1month,3months,1year,2yearsand3yearsfollowingaunilateralimplantation.In2015,asimilartoolwasdevelopedforpaediatricbilateralsequentialcochlearimplantationcases.Thisgridwasdevelopedfromanexpertconsensusbasedonclinicalexperienceandavailablescientificliterature.Itincludes7indicatorsthatspecifythelevelofhearingabilitiesexpectedaccordingtotheexperiencewiththedevicesandthedelaybetweenthetwoimplantations(<3years,3-5years,5-7yearsand7-13years).Theaimofthisprojectistovalidatetheindicatorsandthetimelineproposedbytheexperts.Methods:Aretrospectivereviewwasundertakenonchildren’sfileswhounderwentsequentialbilateralcochlearimplantationbetween2012and2016attheQuébecCochlearImplantProgram.Auditoryperformancesdatafromspeechperceptiontestsandquestionnaireswereretrievedat2weeks,3months,1year,2yearsand3yearspost-implantation.Additionalinformationondurationofdeafnessinbothears,ageatimplantation,implantationdelayandotherdeficitswerealsoretrieved.


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Results:78fileswerereviewed.Theavailabledatamakeitpossibletoverifyfourindicatorsfromthegrid:•Auditoryskillsinsilencewiththe2ndCIissimilartothosewiththe1stCI•Auditoryskillsinlightnoise(eg,signal-to-noiseratioof+10dB)withthe2ndCIiscomparabletothosewiththe1stCI•Thereisabinauraladvantageforspeechrecognitioninnoise•Thereisabinauraladvantageforlateralization(left-right).Preliminaryanalysisshowsthatthemajorityofsubjectsdevelopsauditoryskillsinsilenceandinnoisewiththe2ndCIcomparabletothoseobservedwiththe1stCI.Fewsubjectsdemonstrateasignificantbinauraladvantageforspeechrecognitioninnoiseandlateralizationofsounds.Longer-termdataareneededtovalidatethesetwocriteria.Thedetailedresultswillbepresentedanddiscussed.Conclusion:Bilateralcochlearimplantationisbecomingthestandardclinicalpracticeindeafchildrenandthis,atanincreasinglyyoungerage.Thisprojectaimtovalidatetheclinicaldecisionsbasedonthegridand,thus,supportthefollowingclinicalinterventions. AbstractID:235PosterNumber:165Title:DeviceWear-TimeinPediatricCochlearImplantPatientsAuthors:ErikaB.Gagnon,DoctorofAudiology,HollyF.B.Teagle,DoctorofAudiology,LisaR.Park,DoctorofAudiology,JenniferWoodard,DoctorofAudiology,KevinD.Brown,MD,PhD,CarltonZdanski,MD;Otolaryngology/HeadandNeckSurgery,TheUniv.ofNorthCarolinaatChapelHill,Durham,NC.Abstract:Introduction:Bestpracticeforpediatricpatientswithhearinglossemphasizesearlydiagnosisandinterventionwithhearingtechnology.Accesstosoundviahearingtechnologyiscrucialforspokenlanguagedevelopmentforchildrenwhoaredeaf.Yet,technology-wear-timeisavariableoftenoverlookedinpatientoutcomes.Pressingquestionsincludehowoftenpatientsutilizetheirtechnology,andhowdeviceweartimeimpactslanguagedevelopment.Datalogging,ortheabilitytotrackhearingtechnologywear-time,hasbeenavailableinhearingaidtechnology,buthasonlyrecentlybecomeavailablewithcochlearimplantswiththecurrentgenerationspeechprocessors.Priorstudiesassessinglongitudinalhearingaidwear-timeinchildrenfoundthatwear-timeincreasedwithage,exceptforasmallpercentageofpatientswhomaintainedlimiteddeviceusedespitethechild’sage.Theobjectiveofthisstudyistoinvestigatecochlearimplantdevicewear-timebyage,andcomparewear-timebetweenearsforbilateralusers.Methods:Aretrospectivechartreviewexaminedover100cochlearimplantrecipientswithexternalspeechprocessorscapableofdatalogging.Thesepatientsrangedinagefrom0-21.Dataloggingmeasureswereobtainedacrosssingleormultipleroutinevisits.Results:Resultsrevealawiderangeofwear-timeacrossages,withaveragedailycochlearimplantuseincreasingwithage.Forbilateralcochlearimplantrecipients,arangeofwear-timewasseenacrossears.Conclusion:Similartohearingaidpatients,childrenutilizingcochlearimplantsshowincreasedaveragedailyuseastheyage,withaportionthatmaintainlimiteddeviceuse.Nowthatcochlearimplantaudiologistshaveaccesstothepatients’averagedailywear-timeandananalysisofthedailyauditoryenvironment,thisnewdatahasbecomeacriticalcounselingtoolregardinglengthofdailyuse,faultyequipment,magnetstrengthandamountofspeechinput. AbstractID:238PosterNumber:183Title:ScreeningandAnalysisofCommonDeafnessGenesinPatientswithSevereHearingLoss


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Authors:shaofengliu,doctorDepartmentofOtolaryngology-HeadandNeckSurgery,YijiShanHosp.,TheFirstAffiliatedHosp.ofWannanMed.Coll.,Wuhu,China.Abstract:ScreeningandAnalysisofCommonDeafnessGenesinPatientswithSevereHearingLossIntroduction:Todiscussmutationtypesandrateofcommondeafnessgenesinpatientswithextremeseveresensorineuralhearinglossbygenetictest.Toinvestigatethecorrelationbetweenthephenotypeofgenemutationandtheeffectofcochlearimplantation.Methods:Select105patientswithextremelyseveresensorineuralhearingloss,usepatient’speripheralbloodandsusceptibledeafnessgenediagnostickittotesttheGJB2,SLC26A4and1555g,C1494Tlocusmutations.UseMAIS,CAPandSIRtoevaluatethespeechrecoveryeffectfor96patientswhohadsubjectedbothdeafnessgenedetectionandcochlearimplantation6monthsand1yearaftertheimplantation.Result:Geneticmutationshadbeenidentifiedin25ofthe105extremeseveredeafnesspatients,withmutationrateof23.81%(25/105),GJB2mutationwasdetectedin14ofthe105patients,withmutationrateof13.33%(14/105),ofwhich2casesalsohadSLC26A4mutation.11caseshadSLC26A4mutation,withmutationrateof10.48%(11/105),1casehad12srRNA1555Gmutation,withmutationrateof0.95%(1/105)and1casehad12srRNAC1494Tmutation,withmutationrateof0.95%(1/105).CAPevaluationresultsshowedthat6monthsafterimplantation,thelevelofthecontrolgroup,GJB2GroupandSLC26A4groupwas3.24±0.547,3.70±0.823and2.43±0.535respectively.12monthsaftertheimplantation,thelevelofthecontrolgroup,GJB2groupandSLC26A4groupwas4.55±0.807,5.30±0.675,3.86±0.900respectively.SIRassessmentresultindicated:6monthsaftertheoperation,thelevelofthecontrolgroup,GJB2groupandSLC26A4groupwas1.34±0.476,2.00±0.816and1.29±0.488respectively.12monthsaftertheoperation,thelevelofthecontrolgroup,GJB2groupandSLC26A4groupwas2.25±0.579,3.00±0.667and2.29±0.488respectively.MAISassessmentresultindicatedthat:6monthsaftertheimplantation,thescoreofthecontrolgroup,GJB2groupandSLC26A4groupwas28.25±3.710,29.80±1.932and24.00±3.266respectively.12monthsaftertheimplantation,thescoreofthecontrolgroup,GJB2groupandSLC26A4groupwas31.23±3.708,34.00±2.309and26.00±3.162respectively.12monthsaftertheimplantation,CAPcomparativedifferencebetweenGJB2groupandcontrolgrouphadstatisticalsignificance(P<0.05);GJB2groupcomparedtoSLC26A4,P<0.05;thecomparativedifferencebetweenSLC26A4groupandcontrolgrouphadnostatisticalsignificance(P>0.05).SIRcomparativedifferencebetweenGJB2groupandcontrolgrouphadstatisticalsignificance(P<0.05);thecomparativedifferencebetweenGJB2groupSLC26A4grouphadstatisticalsignificance(P<0.05);thecomparativedifferencebetweenSLC26A4groupandcontrolgrouphadnostatisticalsignificance(P>0.05).MAIScomparativedifferencebetweenGJB2groupandcontrolgrouphadstatisticalsignificance(P<0.05);thecomparativedifferencebetweenGJB2groupandSLC26A4grouphadstatisticalsignificance(P<0.05);thecomparativedifferencebetweenSLC26A4groupandcontrolgrouphadstatisticalsignificance(P<0.05).Conclusion:GJB2,SLC26A4and12srRNAarethemostcommongenemutationsfordeafnesspatients.TheeffectofspeechrecoveryforGJB2genemutationrelateddeafnesspatientswasbetterthanthoseofSLC26A4geneandnon-genemutationrelatedpatientsaftercochlearimplantation. AbstractID:240PosterNumber:63Title:LateralSemicircularCanalOcclusion,SaccusDecompressionAndCochlearImplantation:ANewApproachForRefractoryMenière’sDiseaseAndFunctionalDeafness


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Authors:GunnarDoobe,Resident,IngoTodt,PDDr.med.,PhilippMittmann,Dr.med.,ArneborgErnst,Prof.Dr.med.;earnoseandthroat,headandnecksurgery,UnfallkrankenhausBerlin,Berlin,Germany.Abstract:Introduction:FordecompensatedvestibularsymptomsincasesofMenière’sdiseaseandsingle-sidedfunctionaldeafnessthecombinationofvestibularsurgeryandcochlearimplantationcanbereasonableapproach.Theobjectiveofthisstudywastheinvestigationofthesuccessofalateralsemicircularcanalocclusionwithsaccusdecompressionandcochlearimplantation.Methods:SevenpatientswithrecurrentattacksofvertigoandseveresensorineuralhearinglosscausedbyrefractoryMenière’sdiseaseweretreatedbythemostlyone-stagelateralsemicircularcanalocclusion,saccusdecompressionandcochlearimplantation.Inthreepatientsbothsideswereaffected.ThesuccessofthismethodwasevaluatedbytheDizziness-Handicap-Inventory(DHI)performedpreoperatively,postoperativelyandaftersixweeks.Results:PriortosurgerytheDHIofallpatientsindicateddistinctphysical,emotionalandfunctionaldeficits.Aftersurgerytheimpairmentcouldbereducedinallcasesevenincaseofbilateralaffection.Regulartogoodaudiologicaloutcomecouldbeachievedbycochlearimplantation.Partialpreservationofresidualhearingwaspossible.Conclusion:Thecombinationoflateralsemicircularcanalocclusion,saccusdecompressionandcochlearimplantationcanbeaneffectiveoptionforpatientswithMenière’sdiseaseandseverehearinglossifvertigosymptomscannotbetreatedconservatively.Becauseoftheratheratraumaticlateralsemicircularcanalocclusionthismethodispossibleevenincasesofbilateralaffection.Comparedtothelabyrinthectomyortriplesemicircularcanalocclusionitisthemostatraumaticapproachwithsimilareffectiveness. AbstractID:243PosterNumber:92Title:ElectrodeDesignandInsertionalDepth-dependentIntracochlearPressureChanges:AModelExperimentAuthors:PhilippMittmann,MD,ArneErnst,MD,IngoTodt,MD;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:IntroductionPreservationofresidualhearingisoneofthemajorgoalsinmoderncochlearimplantsurgery.Intracochlearfluidpressurechangesinfluenceresidualhearingandshouldbekeptlowbefore,duringandaftercochlearimplantinsertion.Theelectrodearrayitselfhasanonnegligibleimpactonintracochlearfluidpressurechanges.Theaimofthisstudywasinvestigatewhetherperimodiolarandlateralcochlearimplantelectrodearrayswithdifferentcharacteristicsshowvariableintracochlearfluidpressurechanges.MethodsTheexperimentswereperformedinanartificialcochlearmodel.Intheapicalpartapressuresensorwasinsertedandthesystemwasfilledwithwater.Witheveryelelctrodearrayfiveinsertionswereperformed.Theinsertionwithaninsertionspeedof0.5mm/swasdividedintothreepartsandstatisticallyevaluatedintermsofpeakfrequencyandpeakamplitudes.ResultsThepeakfrequencyoverthethirdswasincreasinginbothelectrodes.Intermsofpeakamplitudesaslightincreasewasseeninthelateralwallelectrodebutnotinthemidscalarelectrode.Significantdifferenceswerefoundinthefirstthirdofthebetweenbothelectrodearray.


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ConclusionMidmodiolarandlateralwallelectrodesshowdifferentintracochlearfluidpressurechangesduetointracochlearplacement,electrodecharacteristicsandinsertion. AbstractID:244PosterNumber:93Title:Single-sidedCochlearImplantation:ObservationsinBadPerformerAuthors:PhilippMittmann,MD,ArneErnst,MD,SandraScholz,PhD,Rolf-DieterBattmer,PhD,IngoTodt,MD;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:IntroductionPatientswithsinglesideddeafnesscannowadaysgainfromacochlearimplant.Themajorityofthesepatientsiswelladaptedandbenefitsfromtheimplant.Theaimofthisstudywastoevaluatereasonsforbadperforminginagroupofpatientswithsinglesideddeafness,whichreceivedacochlearimplant.MethodsInaretrospectivecaseseries65patientswereenrolled.Sevenbadperformerswereenclosed.Freiburgermonosyllabics,localisationtestingandradiologicalimageswereevaluated.ResultsLocalisationtestingshowedmissingoftheabilityoflaterisationinthreepatientswhereasFreiburgermonosyllabicswordscoresimprovedinthreepatients.Onepatienthadnospeechperceptionafteroneyearofrehabilitation.MRIfindingsrevealedcerebralaffectioninfivepatients.ConclusionVariousreasonscaninfluencetheoutcomeinunilateralcochlearimplantationinpatientswithsinglesideddeafness.Thesereasonsaremainlypreoperative,operativeorpostoperative.Neverthelessthemajorityofpatientsbenefitsfromtheimplant. AbstractID:245PosterNumber:126Title:SemanticsandtheBrain:TheN400asNeuralMarkerofLanguageDevelopmentinYoungCochlearImplantedChildrenAuthors:NikiK.Vavatzanidis,MSc1,AnjaHahne,Dr.2,DirkMürbe,Prof.2;11)MaxPlanckInst.forHumanCognitiveandBrainSci.2)TechnischeUniv.Dresden,Dresden,Germany,2TechnischeUniv.Dresden,Dresden,Germany.Abstract:Introduction:Languageacquisitionisonekeymotivatorforpediatriccochlearimplantation,yetwestillknowlittleaboutthedevelopinglanguagenetworkofyoungcochlearimplantedchildren.Theobjectiveofthefollowingstudyistoassesswhateffectadelayedauditoryaccesstolanguagehasontheoveralllanguagedevelopmentofyoungchildrenandwhethertheacquisitionprocessfollowsthechronologicalortheauditoryage.Amilestoneoflanguageacquisitionisthelearningofsemanticrelationshipsbetweenwordsandobjects,i.e.thebuildingofavocabulary.Ifaftersuccessfullearningsuchasemanticrelationshipisviolated(bye.g.misnaminganobject),thecognitiveprocessingofthismismatchbecomesvisibleintheelectroencephalogram(EEG)asanegativedeflection,theso-calledN400component.TheN400thusenablesustoobjectivelyassessthereceptivevocabularyofachild.


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Withthisstudyweintendtoestablishwhethercochlear-implantedchildrendisplayaN400similartonormalhearingchildren,andifsowhatdevelopmentaltrajectoryitpresentsduringthesecondyearofimplantation.Methods:WerecordedtheEEGof32bilaterallyimplantedchildren(19congenitallydeaf)at12,18and24months(+/-2months)afterfirstactivationofthefirstimplant.Ageatfirstactivationwas9-50months(average:21months,median:17months).Duringtherecordingthechildrenpassivelywatchedpicturesof44basiclevelwords.Thepictureswereaccompaniedbyanacousticallypresentedwordwhichwaseithercongruousorincongruous(e.g.apple-dog)tothepicture.Eachpicturewaspresentedonceascongruousandonceasincongruouspicture-wordpair.Inaddition,24monthsafterimplantactivationthechildrenperformedalanguagetest(SETK-2;normedfornormalhearingchildrenof24-29months),whichwasusedtoretrospectivelygroupthechildrenintolow,norm,andhighperformers.Results:AnN400isobservable12monthsafterimplantactivationevenincongenitallydeafchildren.Bythetimeof24monthspostactivationtheN400hasmaturedtoresembletheN400ofnormalhearingchildren.Whengroupingtheevent-relatedpotentials(ERPs)accordingtolanguageperformance,though,itappearsthatpoorperformersdonotdisplayasemanticmismatchinformofanN400ineitheragegroup.Conclusion:Cochlear-implantedchildrendevelopanN400asearlyas12monthsafterimplantactivationandshowaprogressingmaturationoverthesecondyearofhearing.Theythusreflecttheresultsofnormalhearingchildrenoftherespectivechronologicalage.Thissuggeststhattheinitialemergenceofareceptivevocabularyprogressesatasimilarpacestartingwithfirstcontacttospokenlanguage.Childrenwhoarenotwithinthenormalrangeoflanguagedevelopmentafter24monthsofimplantuseareanexceptioninthattheyfailtoshowaneuralsemanticmismatchsigninformofanN400.Thusthefirstsignsofadiverginglanguagedevelopmentseemtobevisiblealreadyinthesemanticprocessingattheauditoryageof12months. AbstractID:246PosterNumber:161Title:EffectivenessoftheBimodalFittingFormulainAdvancedBionicsBimodalCochlearImplantRecipientsAuthors:M.NoelleDunbar,DoctorofAudiology1,SarahW.Kennett,DoctorofAudiology2,CassandraL.Bosworth,DoctorofAudiology1,SmitaAgrawal,DoctorofPhilosophy3;1Otolaryngology-HeadandNeckSurgery,ColumbiaUniv.Med.Ctr.,NewYork,NY,2Audiology,ArkansasChildren'sHosp.,LittleRock,AR,3AdvancedBionics,Valencia,CA.Abstract:EffectivenessoftheBimodalFittingFormulainAdvancedBionicsBimodalCochlearImplantRecipientsIntroductionCochlearimplants(CIs)areregardedashighlysuccessfulprostheticdevices;however,manyCIusersperformpoorlyinnoiseandciteitasaskilltheywouldliketoimprove.Evidencesuggeststhatuseofahearingaid(HA)inthecontralateralearcanimprovespeechunderstanding,particularlyinthepresenceofbackgroundnoise.Whilebimodaluseiscommoninclinicalpractice,optimizingtheprogrammingbetweenboththeCIandHAisafairlynewtechnique.ThecurrentstudyintendstocomparespeechperformanceinnoiseandusersatisfactionwithanovelhearingaidfittingformuladesignedspecificallytoworkwiththeCIandHA,ascomparedtoatraditionalhearingaidfittingformula.


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MethodsApproximately15adultbimodaluserswillberecruitedforthisstudy.Participants’performanceonaspeech-in-noiselisteningtaskwillbemeasuredinanumberofconditions.Inordertoobtainabaselinescore,thesubjectwillparticipateinaCI-onlycondition,bothinquietandinnoise.ThepatientwillthenbefittedwithaHAwhichusesatraditionalfittingformula,withspeechperceptiontestingtofollowinthebimodalcondition.ParticipantswillthenbefittedwithaHAusingthenovelhearingaidfittingformula.Speechperceptionmeasureswillberepeatedintheexperimentalbimodalcondition.AsubjectiveratingscalewillbecompletedbytheparticipantduringthistestingsessionregardingpreferenceofHAformula.ParticipantswillbeinstructedtousetheHA(programmedwiththenovelfittingformula)athomeforanacclimationperiodof2-4weeks.Followingthisperiod,theindividualwillreturnforadditionalspeechperceptiontestinginordertodeterminethepresence,oramount,ofanadaptationeffect.Theparticipantwillalsocompleteaquestionnaire.Audiologists’opinionsofthedeviceandnovelfittingformulawillalsobecapturedinthestudy.ResultsDatacollectionwillbegininearlyMarch2017.Theresearchershypothesizethatparticipantswillperformbetterusingthenovelfittingformula,duetothecoordinatedprocessingandtimingofdevices.Asecondhypothesisisthatparticipantswillprefertheresearchfittingformulatotheirconventionalfittingformula.Finally,wehypothesizethataudiologistswillhaveahighopinionofthenovelfittingformuladuetoafasterfittingprocessandimprovedacceptabilityandoutcomes.ConclusionBecausenodatahasbeencollectedatthistime,wecannotstateconclusions.Basedonpreviousevidencefromsimilarstudies,weexpectourresearchhypotheseswillbeaccepted.WeanticipateconclusionsbytheconferenceinJuly2017. AbstractID:247PosterNumber:139Title:MRIArtifactsandCochlearImplantPositioningat1.5TinVivo-AMiniCaseSeriesAuthors:PhilippMittmann,MD,ArneErnst,MD,GritRademacher,MD,IngoTodt,MD;UnfallkrankenhausBerlin,Berlin,Germany.Abstract:Introduction:ThenumberofcochlearimplantrecipientsaswellasthenumberofMRIsiscontinuouslyincreasingannually.TheindicationcriteriaforcochlearimplantationhavebeenchangedovertheyearsandthegrowingnumberofimplantationsinpatientsafteracousticneuromaresectionsunderlinetheimportanceofapostoperativeMRimagingtoassesstheinternalauditorycanal(IAC)andthelabyrinth.TheMRIartifactinducedbythecochlearimplantmagnetisaknownproblemshouldbefurtherobservedbythisinvestigation.TheaimofthisstudywastoevaluatethevisabilityoftheinternalauditorycanalandthelabyrinthinrelationtodifferentCImagnetpositionsandMRIsequencesat1.5T.Methods:Wecomparedtheartifactsofcochlearimplantmagnetsatdifferentheadpositionsinthreepatientsat1.5T.Theobservedpositionsvariedwithanasion-externalearcanalangleof90°,120°and160°andavariabledistanceof5cm,7cmand9cminrelationtotheexternalearcanalanddifferentMRIsequences.Results:


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Thecompleteassessmentoftheinternalauditorycanalandlabyrinthwasverygoodpossiblewithamagnetpositionedat90°and9cmand120°and9cm.With160°and9cmtheassessmentoftheinternalauditorycanalandlabyrinthwasstillsatisfying.Ahigh-resolution3DT2wDrivesequencedecreasedthevisibilityofthestructuressignificantlywhereasahigh-resolutionT2wclearsequenceallowedsufficientvisualisationofthestructures.Conclusion:ThepositionoftheimplantandtheMRIsequenceused,determinetheassessmentoftheIACandthelabyrinthat1.5TMRI.Apositionoftheimplantmagnetatanasion-externalauditorycanalangleof90°or120°withadistanceof9cmcanalisthereforerecommended. AbstractID:251PosterNumber:119Title:TriphasicPulsesReduceFacialNerveStimulationinCIUsers:Intra-andPostoperativeElectromyographicDataAuthors:YoussefAdel,Dipl.-Ing.1,AndreasBahmer,Prof.Dr.mult.2,UweBaumann,Prof.Dr.-Ing.1;1AudiologicalAcoustics,Univ.Hosp.Frankfurt,FrankfurtamMain,Germany,2TheoreticalClinicalandExperimentalNeurophysiology,Univ.Hosp.Würzburg,Würzburg,Germany.Abstract:Introduction:Facialnervestimulation(FNS)issometimesobservedincochlearimplant(CI)usersasanundesirablesideeffectofintracochlearbiphasicelectricalstimulation,especiallyinsubjectswhosufferfromotoscelerosisorotheretiologieswhichrequireaboveaveragestimulationlevels.TwocommonclinicalremediestoalleviateFNSaretoextendstimulusphasedurationoftherespectiveelectrodeorcompletelydeactivatetheelectrode.However,insomecasestheseoptionsdonotprovidesufficientFNSreductionorarenotfeasible.TriphasicelectricalstimulationhasbeenpreviouslyshowntoreduceFNS,butnoobjectivemeasureswereconductedtoquantifythisbenefit.Thisstudypresentselectromyographic(EMG)datacollectedintra-andpostoperativelyinCIusers.Methods:PostoperativeEMGrecordingswereconductedinawakeCIusers(n=4).Adhesivesurfaceelectrodeswereattachedattheareascorrespondingtomusclesinnervatedbythefacialnerve(musculiorbicularisoriandoculi).Stimuliwere1-mspulsetrainspresentedat100ppswithpulsedurationof100µs.Theyhadeithersymmetriccathodic-leadingbiphasicortriphasicpulseshape.Ineachcondition,stimulationamplitudewasincreaseduntilthesubjectreporteduncomfortableFNS,thenEMGpotentialswerecollectedat4equidistantpointswithinthatrange.IntraoperativeEMGrecordingswereconductedinsubjectsstillundergeneralanesthesiaafterreceivingaCI(n=5).Subdermalelectrodeswereattachedtotheaforementionedmuscles,whicharecommonlypartofintraoperativefacialnervemonitoringduringcochlearimplantationsurgery.Stimuliwere1-mspulsetrainspresentedat100ppswithpulsedurationof150µs.Theyhadsymmetricbiphasicortriphasicpulseshapewithdifferentpolarities.EMGpotentialswerecollectedat10equidistantpointsbetweenresponsethresholdandsaturationlevel.Results:PostoperativeEMGdatawerecollectedin3outof4awakeCIusersuptouncomfortableFNS,whiletheremainingexperimenthadtobeaborted.Resultsdemonstratedhighvariability,butindividualinput-output(IO)functionsforbiphasicandtriphasicpulsesweredifferent.Comparedwithstandardbiphasicstimulation,triphasicpulsesrequiredhigherstimulationlevelstoelicitequivalentFNSasreflectedbyEMGamplitudes,i.e.theIOfunctionofbiphasicpulseswassteeperthanthatoftriphasicpulses.IntraoperativeEMGdataconfirmedthesefindings.Furthermore,apolarity-dependenteffectwasfoundwherethedifferencesbetweenbiphasicandtriphasicIOfunctionswerediminishedforanodic-leadingcomparedwithcathodic-leadingstimulation.


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Conclusion:TriphasicpulsescanreduceFNSduetoagenerallysmallergradientofEMGinput-outputfunctioncomparedwithbiphasicpulsestimulation.Thiscouldbeexplainedbydifferencesinspatiotemporalspreadoftheelectricalfieldproducedbythedifferentstimuli. AbstractID:252PosterNumber:177Title:FactorsInfluencingSound-SourceLocalizationinChildrenwithBilateralCochlearImplantsAuthors:CatherineKillan,MSc1,AndrewScally,MSc2,CatherineL.Totten,MSc1,ChristopherH.Raine,Ch.M.1;1YorkshireAuditoryImplantService,BradfordTeachingHosp.Fndn.Trust,Bradford,UnitedKingdom,2SchoolofAlliedHealthProfessionsandSport,Univ.ofBradford,Bradford,UnitedKingdom.Abstract:Introduction:Theabilitytohearwheresoundscomefromisanimportantskillforchildreninsocial,recreationalandeducationalsettingsaswellasfortheirpersonalsafety.Clinicalassessmentsfindthatlocalizationaccuracyforchildrenwithbilateralcochlearimplantsvariesfromnear-normaltoaninabilitytolocalizeabovechancelevel.Thereasonsforthisvariationarenotyetfullyunderstood.Thisstudythereforeaimedtostatisticallymodeltheeffectsofinter-implantintervalandonsetofprofounddeafnessonsoundlocalizationinchildrenwithbilateralcochlearimplants.Methods:Theauthorsconductedaretrospective,observationalcohortstudyusingroutinelycollectedclinicaldata.Participantswere142bilaterallyimplantedchildrenaged4yearsorolderthatcompletedatleastoneofthreetests12monthsormorepost-secondimplant.Stimuliwerepre-recordedvoicesrandomlyrovedfrom65to75dB(A)in1dBsteps.Left/rightlateralizationwasassessedviatwoloudspeakersat±60°azimuth.Percent-correctscoreswerecalculatedandthesimultaneousandsequentialgroupswerecomparedviaFisher’sExactTest.Sound-sourcelocalizationaccuracywasassessedusingtwoforced-choiceprocedures;a3-choicetestwithloudspeakersat-60°,0°and+60°azimuthanda5-choicetestwithloudspeakersat-60°,-30°,0°,+30°and+60°azimuth.Root-mean-square(RMS)errorswerecalculated.Childrenwerecategorizedbyinter-implantinterval:Simultaneous(N=75),0to23months(N=12);24to47months(N=18);48to71months(N=16)and≥72months(N=21).Theywereclassifiedas“CongenitallyDeaf”(thresholdsof≥90dB(HL)at2and4kHzinatleastoneearfrombirth)or“Acquired/Progressive”(thresholdsinitially≤90dB(HL)at2or4kHzbilaterally,laterfallingbelowthislevel).Datawereanalyzedviamultiplelinearregressionmodelling,controllingfortimesincesecondimplant,age,manufacturerandconcentration.Results:Lateralizationdatashowedceilingeffectsandnoeffectofsimultaneousorsequentialimplantationwasseen.Sound-sourcelocalizationmodelsforboththe3-choiceand5-choicetestsfoundnosignificantdifferencebetweenthesimultaneousgroupandchildrenwith0to2yearsinter-implantinterval(p=0.323;p=0.819respectively).Inter-implantintervalof>2yearsledtogreaterRMSerror,from6.3degrees(5-choicetest;inter-implantinterval48to71months;p=0.08)to25.1degrees(3-choicetest;inter-implantinterval>72months;p<0.001).Acquired/progressivehearinglossledtobetteraccuracythancongenitaldeafnessby10.4degrees(3-choicetest;p=0.001)and5.7degrees(5-choicetest;p=0.013)RMSerror.Manufacturerwassignificantinbothmodels(p<0.001).Conclusion:Unilateralandbilateralauditorydeprivationshouldbeminimizedforchildrenwithprofoundhearinglosstomaximizetheirfutureabilitytolocalizesoundsviacochlearimplants. AbstractID:254


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PosterNumber:214Title:PlaceDependentStimulationRatesImprovePitchPerceptioninCochlearImplanteesAuthors:TobiasWeissgerber,Dr.,TobiasRader,Dr.,YoussefAdel,Dipl.-Ing.,UweBaumann,Prof.;AudiologicalAcoustics,Univ.Hosp.Frankfurt,FrankfurtamMain,Germany.Abstract:Introduction:Innormalhearing,thepitchofanacoustictonecantheoreticallybeencodedbyeithertheplaceofstimulationinthecochleaorthecorrespondingrateofvibration.Thusspectralattributesandtemporalfinestructureofanacousticsignalarenaturallycorrelated.Cochlearimplants(CIs)currentlydisregardthismechanism;electricalstimulationisprovidedatfixedelectrodepositionswithdefaultplaceindependentstimulationrateassignments.Thisdoesnotaccountforindividualcochlearencodingdependingonelectrodearrayplacement,variationsininsertiondepth,andtheproximitytonervefibers.Encodingpitchinsuchmannerdeliverslimitedtonalinformation.WehypothesizethatthislimitationinelectricstimulationisatleastpartiallyduetothemismatchbetweenfrequencyandplaceencodinginCIs.Methods:11subjectswithlate-onsetsingle-sideddeafnessandalmostnormalhearingintheunaffectedearparticipatedinthestudy.Wedeterminedindividualelectrodelocationsbyanalysisofcochlearradiographicimagesobtainedaftersurgeryandcalculatedplacedependentstimulationratesaccordingtomodelsofthenormaltonotopicfunction.Inapitchmatchingmethod,subjectswerepresentedwithanelectricstimulusintheimplantedearandanacousticstimulusintheoppositeearinalternatingorder.Theywereaskedtomatchtheperceivedpitchoftheacousticstimulustothatoftheelectricstimulusbyadjustingthefrequencyoftheacousticstimulus.Pitchmatchingwasconducted6timesforeachofthe6mostapicalelectrodes.Results:5of11subjectsachievednearlyaone-to-onefunctionbetweenelectricalstimulationrateandacousticpitchperception,whilegenerallymatchedpitchfrequenciesasafunctionofcalculatedelectricalstimulationratewerewell-fittedbylinearregression(R²intherange0.70-0.97,R²log=0.88forcollapseddata).Matchedacousticfrequenciesasafunctionofestimatedelectrodeinsertionanglerangedfrom80Hzat605°to1683Hzat190°.Collapsedmediandatawereintherangeofonemusicaloctavewithrespecttothepitchmodelfunction.Conclusion:ResultsofpitchmatchingexperimentsdemonstratethusfarunparalleledrestorationoftonotopicpitchperceptioninCIuserswithsingle-sideddeafness.Futurestimulationstrategiesshouldtakepatients’individualelectricfrequency-to-placemapintoaccounttoprovideenhancedbenefitintermsoftheappraisalofmusic,theperceptionoftonallanguages,orspeechperceptioninnoise. AbstractID:257PosterNumber:12Title:CorrelationofCochlearImplantationOutcomesinChildrenWithPre-ExistingCerebralAbnormalitiesAuthors:ShwetaS.Deshpande,MastersinAudiologyandSpeechLanguagePathology,NeelamVaid,MS(ENT)DNB;BIGEARS,K.E.M.Hosp.,Pune,India.Abstract:Introduction:Imagingexaminationplaysanimportantroleinthepre-implantevaluationofpediatricsensorineuralhearingloss(Joshi,2012).Abnormalitiesdetectedbypre-operativebrainMRIscansoncochlearimplantcandidatesarecommon(30%),(Jonas,2012)however,itsinfluenceontheeffectofCIhasnotbeenclarified.Thepurposeofourstudyistoevaluatetheoutcomesinchildrenaftercochlearimplantationwithpre-existingneurologicalabnormalitiesdiagnosedonMRIexamination.Methods:


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17children(agerange-22mnthsto9yrs6mnths)withprofoundsensorineuralhearinglossdiagnosedwithpre-existingCNSabnormalitiesontheMRIexaminationswereselected.TheCNSabnormalitiesconsistedofnon-specificperiventricularsignalabnormalities,bilateralnon-specificsubcorticalwhitematterabnormalitiesandtemporallobearachnoidcyst.Temporallobeinvolvementwasseenin8outofthe17children.Theimplantageofthechildrenvariedfrom3to24months.Theywerefollowedupfortheoutcomespreand3,6,9,12,18and24monthspostimplantationusingstandardisedassessmentscalesi.e.MAIS/IT-MAIS,LiP,CAP,MonosyllabicWordRecognitiontestandSIR.Results:Only3outof17childrendiscontinuedfollow-upafter18monthspostimplantation.50%ofthechildrenachievedafullscoreonMAISand70%achievedafullscoreonLiPbyaround12monthspostimplantation.Only7outof13childrenachievedaCAPscoreof6i.e.canunderstandsomespokenwordswithoutperformativesby1yearspostimplantationhoweverdidnotprogressfurther.10outof17childrenachievedlessthan50%scoreonwordrecognitiontestby12monthspostimplantation.TheSIRscorewas2(i.e.intelligiblespeechisdevelopingforsinglewords)onlyfor4childrenafter1yearpostimplantation.Conclusion:BrainabnormalitieswerecommononthebrainMRimagingofthepatientswithsensorineuralhearinglosswithwhitematterchanges,beingthemostcommonfinding.Theseabnormalitiesdidnotseemtoinfluencetheshort-termhearingimprovementaftercochlearimplantation,howevertheydoaffecttheauditoryidentificationandcomprehensionoflanguage.Furtherstudywithmorepatientsandlongerfollow-uptimeisneededtoconfirmourresults. AbstractID:261PosterNumber:134Title:FixedandAdaptiveBeamformingImprovesSpeechPerceptioninNoiseinCochlearImplantRecipientsAuthors:ClemensHoneder,MD,RudolfsLiepins,MSc.,ChristophArnoldner,MD,MichaelaBlineder,MSc.,StefanFlak,BSc.,SonjaReiß,MSc.,AlexandraKaider,Msc.,DominikRiss,MD;Med.Univ.ofVienna,Vienna,Austria.Abstract:Introduction:Eventhoughmanycochlearimplantusersachieveremarkablelevelsofspeechperceptioninquiet,speechrecognitioninnoiseremainsamajorchallengeforthesepatients.Directionalmicrophones,whichareanestablishedapproachtoimprovespeechintelligibilityinnoiseinhearingaidusers,becameavailableforMED-ELcochlearimplantrecipientswiththenewSONNETaudioprocessor.Theaimofthisstudywasthereforetodetermineifthefixedandadaptivebeamformingtechnologyimprovesspeechintelligibilityinnoise.Methods:18adultcochlearimplantpatientswereincludedinthestudy.Speechreceptionthresholds(SRT)weremeasuredwithanadaptivespeechtest(OldenburgerSentenceTest)incontinuouslypresent,speechshapednoise.Targetsentenceswerepresentedinfrontofthelistener,noisesourceswereplacedat-135°and135°,respectively.OutcomemeasureswerethedifferencesinSRTwithmicrophonesettings:omnidirectional,fixedbeamformer,andadaptivebeamformer.


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Results:AnalysisrevealedthattheuseofdirectionalmicrophonesimprovedSRTsasfollows:fixedbeamformervs.omnidirectional:-4.27dB(p<0.0001);adaptivebeamformervs.omnidirectional:-6.12dB(p<0.0001);andadaptivebeamformervs.fixedbeamformer:-1.84dB(p=0.001).Conclusion:ThefixedandevenmoretheadaptivebeamformeroftheMED-ELSONNETaudioprocessorsignificantlyimprovedspeechreceptionthresholdsinnoise.Cochlearimplantuserswillthereforebenefitindifficultlisteningsituations. AbstractID:265PosterNumber:82Title:PredictingtheDegreeofDifficultyinCochlearImplantSurgery-TheUseofanObjectivelyStructuredImagingBasedGradingSystemAuthors:AmeetKishore,FRCS1,AshwaniKumar,MNAMS1,NeevitaNarayan,BSc,MBA2;1ENT,HeadNeckSurgery,IndraprasthaApolloHosp.,NewDelhi,India,2SpHearSpeechandHearingClinic,NewDelhi,India.Abstract:Introduction:Hearingpreservationandloweringtheageforcochlearimplant(CI)surgeryhasresultedinincreasedemphasisonimprovingsurgicaltechnique.Variationsintheanatomyofthetemporalboneandincochlearorientationcanoftencauseanintraoperativechallengetothesurgeon.TheaimofthisstudywastoassessiftheuseofanobjectivelystructuredgradingsystembasedonHighResolutionComputerTomography(HRCT)ofthetemporalbone,correlatedwithintraoperativefindingsandhelpedthesurgeonpredictthedegreeofdifficultyincochlearimplant(CI)surgeryinourpractice.Methods:TheseniorauthoristheprimaryCochlearImplantsurgeonattheinstitutionwithacohortofover900cochlearimplantrecipientsinthelasttenyears.BothHRCTandMRIareroutinelyusedinthepreoperativeevaluationofallpatientsundergoingCIsurgery.A10pointimagingbasedgradingsystemdescribedbyVaidetal[IJOHNS2015;67(2),150-158]wasusedconsecutivelyin100earstoscorethefindings(whichwasdocumentedbythesecondauthor)andpredictpotentialdifficulties.Thefindingsweresubdividedintothreerelevantcategories:mastoidectomy,accesstofacialrecessandaccesstoroundwindow.Thisscorewascomparedtotheintraoperativefindings,difficultyencounteredduringsurgeryandthedurationofCIsurgery(whichwasdocumentedbythefirstauthor).Thesescoreswereanalysedforeachofthethreecategoriesofthesurgicalapproach.Results:Thefindingsonimagingandtheresultantscoreseemedtocorrelatewithintraoperativefindings.Thehypopneumatisedmastoidcontributedmaximallytowarddifficultyinmastoidectomy.Thefindingofnarrowandscleroticfacialrecesscorrelatedmaximallywiththedifficultyintheposteriortympanotomy.TheunfavourableExternalAuditoryCanal-BasalTurnCochlearlinecorrelatedmaximallywithpoorroundwindowaccess.Thesurgeonwasthusabletopredictthepotentialdifficultiesencountered.Longersurgicaltimeswereseeninpatientswithahigherscoreonimaging.Thedetailsofthescoringsystemandfindingswillbediscussed.Conclusion:TheuseofastructuredimagingbasedgradingsystemcanhelpaCIsurgeonanticipatethechallengesthatmightbeencounteredduringsurgeryandthuspredictintraoperativeissuesandsurgicaltime,andisparticularlyusefulforthenoviceCIsurgeons. AbstractID:266


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PosterNumber:117Title:ImprovingValueforCochlearImplantPatients:TheRoleoftheAudiologyAssistantAuthors:MatthewSchmitt,B.S.,SaraHollander,M.A.,DouglasSladen,Ph.D.;Otolaryngology,MayoClinic,Rochester,MN.Abstract:Introduction:Audiologistsareunderincreasingdemandtoprovidecochlearimplantservices.TimeisoftenspreadthinbyadministrativetasksthatcouldbetakenoverbyanAudiologyAssistant.InthecurrentqualityimprovementprojectspecifictaskswerehandedoverAudiologyAssistantsinordertoprovidetimefortheAudiologistto“workatthetopoftheirlicense”.Methods:Thisqualityimprovementprojecttookplaceinalargecochlearimplantprogramwithsiximplantaudiologistsandtwoaudiologyassistants.Thecurrentstatepracticeactivitieswereoutlinedduringaninitialretreat.Duringsubsequentretreatsthestaffidentifiedareasinwhichaudiologyassistantscouldbeused.ThenumberofpotentialcontacthourswascalculatedalongsidewiththetimewithanAudiologistversusAudiologyAssistant.Patientsatisfactionwasmeasured.Results:DatashowedthatthetimeAudiologistAssistantswereabletoperformservicestdecreasedoverallcontacthours,anddidnotsacrificepatientsatisfaction.Conclusions:ThisqualityimprovementprojectdemonstratedthatAudiologyAssistantsareabletoimprovepatientcareofalargecochlearimplantpractice.Thechangeinpracticeallowspatientstomovethroughtheprogramwithgreaterease. AbstractID:267PosterNumber:169Title:LanguageOutcomesforChildrenwithHearingLossDuetoCMVAuthors:DebbieHatch,Au.D.1,AnneDare,Au.D.1,RebekahCrisp,Au.D.1,HannahHodsonMcLean,Au.D.1,ElizabethAbeyounis,M.S.2,StephanieMoodyAntonio,M.D.1;1Otolaryngology,EVMS,Norfolk,VA,2SpeechTherapy,CHKD,NewportNews,VA.Abstract:Introduction:Itiswellestablishedthatchildrenwithhearinglossvaryintermsoflanguageoutcomes;however,fewstudieshaveformallyassessedlanguageoutcomesinchildrenwithhearinglossduetoCytomegalovirus(CMV).CMVisoneoftheleadingcausesofcongenitalhearingloss.Thereareanestimated20,000-30,000babiesbornwithCMVintheUSeveryyear.AccordingtotheNationalCMVFoundation(2016),90%ofthesebabiesareasymptomatic;however,approximately10%-15%willdevelophearinglosswithinmonthsoroverseveralyearsoflife.Methods:Methods:Thisisaretrospectivereviewofthelanguageoutcomesof9childreninourclinicthathavehearinglossduetoCMVandusehearingaidsand/orhavecochlearimplants.Inaddition,wewillhighlightonepatientwhowasdiagnosedatoneyearofagewithsevere-to-profoundsensorineuralhearinglossandreceivedbilateralcochlearimplantsat21months.Afterapproximately1.5yearsofconsistentCIuse,shehasgoodreceptivelanguageskillsandtheabilitytoreadbuthasminimalexpressivelanguageskillsandreliesonanaugmentativecommunicationsystemaswellassignlanguageforherexpressiveneeds.Results:Results:Theninechildreninthisretrospectivestudyhaveavariedamountofsuccessintermsofage-appropriatereceptiveandspokenlanguage.Conclusion:Conclusion:Therangeofsuccessforage-appropriatespokenlanguageforchildrenwithhearinglossduetoCMVisvariable.Thismaybeduetothepresenceand/orseverityofotherdisabilitiesthatmayaccompanythehearinglossanddamagetospecificareaofthebraincausedbythevirus.


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AbstractID:268PosterNumber:4Title:ExploringtheStoriesHearingParentsTelltheirDeafChildrenabouttheirDecisionto(ornotto)OptforCochlearImplantationDuringInfancyAuthors:KristinaM.Scharp,Ph.D.1,BrittanA.Barker,Ph.D.2;1Languages,Philosophy,andCommunicationStudies,UtahStateUniv.,Logan,UT,2CommunicativeDisorders&DeafEducation,UtahStateUniv.,Logan,UT.Abstract:Narrativesofidentity(re)construction:UnderstandingtheexperiencesofparentswhohavechildrenwithcochlearimplantsAbstractIntroduction:Whenfamiliesexperiencemajordisruptions—suchasadiagnosisofhearinglossand/ormakingthedecisionforachildtoundergocochlearimplantation—familymembersmustoftenrenegotiatewhotheythinktheyare(theiridentity)tocopewiththeirnewsituation.Researchsuggeststhatonewaytheycopeandreconstructtheiridentityisthroughsharingtheirpersonalstory.Indeed,narratingsimultaneouslyreflectsandconstructsaperson’sreality.Thus,itmightcomeasnosurprisethatresearchhaslinkednarrationwithpsychologicalwell-beingoutcomes.Thepresentstudyextendswhatweknowaboutpersonalnarrativesandidentitytoilluminatetheexperienceofparentswithchildrenwhousecochlearimplants(CIs).Methods:Researcherscollectedparents’online,public-domainblogsthatincludedstoriesabouttheirexperienceswiththeirchildrenwhouseCIs.Researchersengagedinnarrativethematicanalysis,thecorrespondingmethodtoourinterpretivenarrativeapproach,toexplorestorytypesacrossparents.Fourverificationprocedureswereconducted.Results:Multipleidentityreconstructionsemergedinthestorycorpusthatillustratedarangeofresponsestotheirfamily’sexperiences.Someparentsstruggledwiththeiridentity,sharingstoriesofvictimizationwhereasotherparentsnarratedstoriesthatreflecttheirredemptiveabilitytolearnsomethingfromtheirexperience.Theemergentidentitytypesalludetotheparents’abilitytoberesilientandtheiroverallwell-being.Conclusion:Throughtheintroductionofthematicnarrativeanalysiswewereabletohighlighttheimportanceofunderstandinghowfamiliesmakesenseofandtalkabouttheirexperiencesinrelationtotheirchildren’shearingloss.Asresearchsuggests,individualswhoareabletosharetheirstoryinawaythatsolicitssupportivecommunicationareactivistonbehalfoftheirownwellbeing.ThisisknowledgethatwilllikelyhaveimportantfutureimplicationsforprovidingcomprehensiveclinicalservicesandauralrehabilitationforbothchildrenwithCIsandtheirfamilies. AbstractID:272PosterNumber:65Title:DelayedFacialPalsyFollowingUncomplicatedTympanomastoidSurgeryAuthors:BretislavGal,M.D.,Ph.D.,EvaTothova,M.D.,MiroslavVesely,M.D.;DepartmentofOtorhinolaryngologyandHeadandNeckSurgery,St.Anne'sUniv.Hosp.andFacultyofMed.MasarykUniv.,Brno,CzechRepublic.


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Abstract:Introduction:Thepurposeofthisstudywastoestablishthefrequencyofoccurrenceofdelayedfacialnervepalsyfollowingtympano-mastoidsurgery.Methods:Aretrospectivereviewofallpatientswhohadundergonetympano-mastoidsurgeryinourdepartmentovertheprevious10yearswascarriedout.Atotalof620patientswereincludedinthestudy.Forthereviewofthechart,wecheckedintraoperativefindings,clinicalfeaturesofdevelopmentandrecoveryoffacialnervepalsy.SevenpatientswereidentifiedashavingDFNPpalsyoverthisperiodoftime.Results:Thefrequencyofdelayedonsetfacialnervepalsyfollowingtympano-mastoidsurgeryinourserieswas1.1percent.Noneshowedknownpredisposingfactorssuchasbonyfacialcanaldehiscenceorbulgingfacialnerveherniation.Chordatympaniwascutin1case.Theonsetofthefacialpalsyoccurredbetween3and14dayspostoperatively(average8,3days).Completerecoveryoffacialfunctionwasobservedbetween4and10weeksaftersurgery(average6,4weeks).Conclusion:Delayedfacialnervepalsyisaveryrarecomplicationoftympano-mastoidsurgery.Itcanoccuruptotwoweeksafterthesurgery.Postulatedmechanismsofdelayedfacialpalsyincludeneuraloedema,vasospasmandmainlyreactivationofdormantviralinfections(varicellazoster,herpessimplex).Thecombineduseofprednisoneandacyclovirwasaneffectiveformoftreatmentforallpatients. AbstractID:273PosterNumber:179Title:HearingOutcomesAfterCochlearImplantationbyEtiologyofHearingLoss-ASingleCentreExperienceAuthors:GeorgeKurien,MD,DavidLow,MBBS,DavidShipp,MA,TrungN.Le,MDPhD,VincentLin,MD,JosephChen,MD;Otolaryngology-HeadandNeckSurgery,SunnybrookHealthSciencesCentre,Univ.ofToronto,Toronto,Canada.Abstract:Title:HearingOutcomesafterCochlearImplantationbyEtiologyofHearingLoss–ASingleCentreExperienceIntroductionThehearingoutcomesfollowingcochlearimplant(CI)surgeryareinfluencedbyvariousfactorsincludingtheunderlyingetiologyofthehearingloss.WepresentthehearingoutcomesseenatasingleinstitutioninCIpatientswithanidentifiablecauseofsensorineuralhearingloss.MethodsAretrospectivereviewofprospectivelycollecteddatafromtheCIclinicdatabasewasperformedonallCIsurgeriesbetween1984and2016.Patientdemographicdata,etiologyofhearingloss,preoperativehearingthresholds,andpreoperativeand1yearpostoperativespeechdiscriminationscoreswereobtained.Results420patientswhounderwentCIsurgerywithknownetiologiesofhearinglosswereidentified.Ofthese,52%weremaleandmeanageattimeofsurgerywas54.5years.MeanpreoperativePTAfortheoperatedearwas107dB,andpreoperativespeechdiscriminationscoreswere10%(CID,n=64)and32%(HINT,n=370).Themostcommonidentifiableetiologywasotosclerosis(n=105),followedbyMeniere’sdisease(n=56),andmeningitis(n=51).MeanHINTscoresat1yearfordifferentetiologiesrangedbetween34%and96%.EtiologieswiththemostfavourableHINTscoreswereCogan’ssyndrome,


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Meniere’sdisease,andototoxicity.LeastfavourablescoreswereseeninUsher’ssyndrome,GJB2mutation,andmeningitis.ConclusionOurdatashowawiderangeofhearingoutcomesinaCIpopulationoverthreedecades.ItisimportanttoconsidertheunderlyingetiologywhencounsellingpatientsabouthearingoutcomesfollowingCIsurgery. AbstractID:278PosterNumber:138Title:UpgradingElectric-AcousticStimulationExternalTechnology:SpeechPerceptionOutcomesAuthors:SarahMcCarthy,DoctorofAudiology,MeredithAnderson,DoctorofAudiology,EnglishKing,DoctorofAudiology,EllenDeres,DoctorofAudiology,AndreaBucker,DoctorofAudiology,HaroldPillsbury,DoctorofMedicine,MargaretDillon,DoctorofAudiology;UNCHosp.Hearing&VoiceCtr.,ChapelHill,NC.Abstract:Introduction:Electric-AcousticStimulation(EAS)monaurallycombinescochlearimplantandhearingaidtechnologiesforCIrecipientswithpreservedlow-to-midfrequencyhearing.TheEASclinicaltrialenrolledpatientswithmild-to-moderatehearinglossinthelow-to-midfrequencyrange,whowerefitpostoperativewithanaudioprocessorthatcombinedelectricandacousticmodalities.SubjectsdemonstratedasignificantimprovementinspeechperceptionabilitieswithEASascomparedtoconventionalhearingaidsorwitheitherstimulationmodealone.Recently,EASsubjectswereupgradedtoanewergenerationaudioprocessorthatoffersadditionalprogrammingcapabilities.TheobjectiveofthisstudywastoexaminespeechperceptionofEASrecipientswhenprogrammedwiththenewaudioprocessor.Methods:Twenty(20)experiencedEASrecipientswithgreaterthan2yearsoflisteningexperiencewereenrolled.Subjectswerefitwiththenewaudioprocessorusingbehavioralmappingmethods.Theacousticcomponentwasprogrammedbasedontheunaidedaudiogramusingreal-earand/ortestboxmeasures.Thetestbatteryincludedassessmentofresidualhearingandaidedspeechperception.SpeechperceptionmeasuresincludedrecordedCNCwordsinquietandAzBiosentencesinquietandinbabble(+10dBSNR).Subjectswereevaluatedonthedayofthefittingand1monthpost-fitting.Results:Subjectsexperiencedstablespeechperceptionabilitiesinquietandatrendforimprovedspeechperceptionabilitiesinnoisewiththenewaudioprocessorwithadditionalprogrammingoptions.Conclusions:EASrecipientsmayexperienceadditionalimprovementsinspeechperceptionwiththenewgenerationaudioprocessor.Individualizedmappingprocedureswillbediscussed.Understandingofoptimalmappingmethodsandassociatedspeechperceptionoutcomesisneededashearingpreservationproceduresexpandtothepediatricpopulation.PediatricEASrecipientsmayexperiencesimilargainsinperformance. AbstractID:279PosterNumber:181Title:DoestheBenefitofIntraoperativeTestingofCochlearImplantsOutweighAssociatedCosts?Authors:AshleighLewkowitz,Au.D.,RebekahTozer,Au.D.,AmandaGriffin,Au.D.,Ph.D.,JenniferHarris,Au.D.,SusanGibbons,Au.D.,ElizabethEricksonO'Neill,Au.D.,GregLicameli,M.D.;BostonChildren'sHosp.,Waltham,MA.


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Abstract:Introduction:Neuralresponsetelemetryispresentlyperformedduringeachcochlearimplantsurgerycompletedatourcenterinordertoconfirmdevicefunctionandelectrodeplacement.Ifresultsareabnormal,thesurgeonwillthenrequestintraoperativeradiographicimagingonacase-by-casebasistoverifyplacement.Corroborationofintraoperativecochlearimplantdevicefunctionandelectrodeplacementishighlyvaluable;however,existingliteratureonthistopicsuggeststhatintraoperativex-ray,notneuralresponsetelemetry,ismostoftenthedecidingfactorinuseoftheback-upinternaldevice.Additionally,presentliteratureindicatesthatintraoperativeneuralresponsetelemetryshowslittlecorrelationwithpostoperativeperformance.Assuch,theimpactofintraoperativetestingonsurgicalandclinicalmanagementofcochlearimplantpatientsatourcenterwasinvestigated.Methods:Aretrospectivechartreviewwasconductedtoexaminetheresultsofintraoperativetestingduringcochlearimplant(CI)surgeries(n=68)atapediatrictertiarycarecenterovera12-monthperiod(4/2015to4/2016).Frequencyofnon-normalresultsonintraoperativeimpedancetelemetry(e.g.openorshortcircuits)andneuralresponsetelemetry(e.g.absentresponse)wascalculatedandthentrackedforresolutionupto6monthspost-surgery.Inanefforttoidentifyfactorsassociatedwithabnormalintraoperativetelemetryresults,thedatawerethenexaminedbyCImanufacturer,ageatsurgery,lateralityofCI,presenceofabnormalanatomy,andsurgicalapproach.Ifandhowintraoperativetestingresultsimpactedsurgicalandaudiologicalmanagementwasinvestigatedbyreviewofrecordsandclinicianinterviewforeachsurgery.ThesurgicalandaudiologicalvalueofintraoperativetestingofCIswasfurtherevaluatedthroughacost-benefitanalysis.Results:In34%(23/68)oftheCIsurgeriesreviewed,non-normalintraoperativeresultswerefound.Resolutionofissuesoccurredfollowingsurgeryinmorethanhalfofthese23cases.Foramajorityofthecaseswithknownlackofresolution,noresolutionwasanticipated(e.g.hypoplasticnerve).Asignificantdifferenceinthefrequencyofabnormalresultswasfoundbetweenmanufacturers.Nosignificantdifferenceintheoccurrenceofabnormalvs.normalintraoperativeresultswasfoundbetweenageatsurgery,lateralityofCI,presenceofabnormalanatomy,norsurgicalapproach.Surgicalandaudiologicalmanagementwasinfluencedbyintraoperativetestingresultsforonlyasmallnumberofcases.ReimbursementforintraoperativetestingislowinrelationtotheadditionalcostsofextendingORtimetoaccommodatetestingandtheamountofaudiologist’stimededicatedtotheprocedure.Conclusion:Thecostsassociatedwithintraoperativetestingaresignificant,especiallyconsideringhowinfrequentlyresultsoftestingwerefoundtochangesurgicalorclinicalmanagement;becauseofthis,alternativeproceduresfortheroutineverificationofdeviceplacementandfunctionshouldbeconsideredandarecurrentlybeingtestedatourCIcenter. AbstractID:280PosterNumber:132Title:Long-termExperiencewithElectric-AcousticStimulationAuthors:EnglishR.King,AuD1,MargaretT.Dillon,AuD2,MeredithA.Rooth,AuD2,EllenDeres,AuD1,AndreaBucker,AuD1,HaroldC.Pillsbury,MD2;1UNCHealthCare,DepartmentofAudiology,UniveristyofNorthCarolinaatChapelHill,ChapelHill,NC,2Otolaryngology/Head&NeckSurgery,UniveristyofNorthCarolinaatChapelHill,ChapelHill,NC.Abstract:Introduction:CochlearImplantsystemswhichcombineelectric-acousticstimulation(EAS)inthesameeararenowFDAapproved,commerciallyavailableandincreasingintheUS.TheUSclinicaltrialinvestigatedthesafetyandeffectivenessofEASinsubjectswithsteeplyslopingmid-to-highfrequencyhearingloss.SpeechperceptionisreportedlyimprovedwithinthefirstyearoflisteningwithEASascomparedtopre-operativeresultswithconventionalamplification.Theobjectiveofthepresent


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reportistoreviewlong-termstabilityofpost-operativeresidualhearingandaidedspeechperceptionresultsofEASrecipients.Methods:UnaidedresidualhearingandaidedspeechperceptionwithEASwerereviewedwithlong-termuse(>5years).Allsubjectsunderwentcochlearimplantationwithashallowelectrodearrayinsertion,maintainedresidualhearingintheimplantedearandweresubsequentlyfitwithcombinedstimulation.TheaidedspeechperceptiontestbatteryincludedCNCwordsinquietandCUNYsentencesinsteadynoise(0SNR).Arepeated-measuresANOVAwasusedtoanalyzethestabilityinresidualhearingovertimeandaidedspeechperceptionwithmultipleyearsoflisteningexperience.Results:Residualhearinginthecontralateralearremainedstableoverthestudyperiod.Subjectsdemonstratedvariabilityinhearingpreservationintheimplantedearovertime.AllsubjectsexperiencedsignificantlyimprovedspeechperceptionwithEASascomparedtopre-operativeperformance.Speechperceptioninquietandnoisewasmaintainedorimprovedwithlong-termlisteningexperience,evenwhenachangeinresidualhearingwaspresent.Conclusion:EASprovidesimprovementinspeechperceptionascomparedtopre-operativeperformance,despitevariationsinresidualhearingpreservation.Optimalmappingtechniquesinthispatientpopulationwillbediscussed.Withchangeorvariationsinresidualhearing,mappingandprogrammingconsiderationsneedtobemade.EASmaybeaviabletreatmentoptionforsubjectswithsubstantialresidualhearingandlimitedspeechperceptionwithconventionalamplification.Agreaterunderstandingoflong-termhearingstabilityandaidedspeechperceptionisneededasEASexpandstothepediatricpopulation. AbstractID:281PosterNumber:75Title:OurExperienceinPediatricCochlearImplantationAuthors:djilaliaiadkhaled,MaitredeconferenceA,djilaliaiadkhaled,MaitredeconferenceA,MegharbiOuziane,Dr;médecine,chusidibelabbes,sidibelabbes,Algeria.Abstract:Introduction:Thecochlearimplant(IC)isusedtoallowthechildrenreachedofaneurosensorydeafnesstoacquireahearingperception,acomprehensionofthewordandlanguageacquisition.Themajorityofthesechildrenhavefactorsassociatedwiththeirprofounddeafnesswhichconditionthefunctionalresults.Methods:weundertookanexploratorydescriptiveandanalyticalstudyoveraperiodof7ansbetweenayear2008and2015inconnectionwith43childrenimplantedinourdepartmentandfollow-ups,between2013and2015isanaverageof14implantsperyearResults:Wenotedadiscretemasculinepredominance,thesexratioisof1,04boyforagirl.MiddleAgeisof3years9month,astandarddeviationof19months,withanextremeof19monthminimalandmaximumageof7years41%hadsimilarcasesinthefamily.21%oftheimplantedchildrenhadtwodeafcasesinthefamily,14%hadthreecases,twoimplantedchildrenhadfourprofounddeafnessinthefamily,andonehadsevendeafcasesinthefamily.Wenotedthepresenceoftwocasesdeafinthesiblingsin18%oftheestablishedchildren,andthreedeafpersonsormoreinthefamilyin6,98%oftheimplantedchildren.Wenotedtheconceptoffeverinthepersonalantecedentsat23,26%,twocasesofmeningitiswereannounced,andpersistenceofarterialchannelamongtwopatients,04childrenhadhyperpyreticconvulsions.18,60%ofthesechildrenhadanotitisassociatedwithdeafnessatthetimewiththediagnosis,takendrugsduringthepregnancywasnotedat27%ofthecases.Theradiologyfindsapathologicalcochleain16%ofthepatients,cochleadeformityin14%,cochlearossificationin2%,a


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dilationofthevestibularacqueductin7%ofthechildren,procidenceofthefacialnerveinonepatient,andprocidenceofthesidesinein12%ofthechildren.Thecongenitalcausesofdeafnesswasnotedin95,35%,53,49%aregeneticsyndromic,and32,56aregeneticnoune-syndromic,othersharethetypeacquiredin4,6%whicharepost-meningeal.Thechoiceoftheoperatedear:wasmadeaccordingtoseveralparameters:dexterity,residualhearing,andthedisordersvestibular.WeplacedaMedelimplanttodatein51%,Cochlearimplantin49%,theinsertionoftheimplantbytheroundwindowat83%andbytheopeningofthecochleostomyin16,28%,thegeyzerwasseenin9,30%.wecarriedoutanaudiometricevaluationinfreefieldandorthophonicofourpatients,theconsanguinityisadeterminingfactorinhearingperceptiontheproductionofthelanguage,therelationissignificantthePisequalto0,05,thesecondfactoristheageofimplantation,weobtainedbetterresultsamongpatientsoperatedatearlyage,a0-2years,and2-4yearsincomparisonwiththechildrenoperatedwithagemorethan4years.Conclusion:Thestudyoftheassociatedfactorswithdeepdeafnessinthechildallowstounderstandthehearingevolutionofthedeafpatients,andtoreinforceanorthophonicreeducationinamorerigorouswayinordertoimprovetheseresults. AbstractID:283PosterNumber:32Title:HealthRelatedQualityofLifeinChildrenwithCochlearImplantsEquippedatanEarlyAgeDuringtheFirstTwoYearsAuthors:AlexanderG.Saenz,MedicalDoctotrHOSPITALUNIVERSITARIO,MENDOZA,Argentina.Abstract:Introduction:Inthelastyearstherehasbeenaninterestintheevaluationofresultsinchildrenimplantedbeyondtheauditoryresults.Childrenandtheirparentsgothroughadelicateprocessbeforeandaftertheplacementofthecochlearimplant,fromthediagnosisbutprincipallyintheauditoryhabilitation.Theearlyyearstendtohaveunexpectedordesiredresults,toaccompanythefamily(parentsandimplantedchild)inthehearingimpairedprocessesrequiresasolidandinterconnectedrehabilitationequipmentandatoolthatallowstosupervisenon-auditoryaspectsofimpactinlifeOfthechildimplantedatanearlyage.ForthisreasonIhavedevelopedaninstrumenttudetermineandvalidateaparent-reportedoutcomesinstrumentfocusingonthesocialandemotionalskillsdevelopmentgiventhebenefitsofusingthecochlearimplantinchildrenequippedatanearlyageduringthefirstyearsofuse.Methods:DevelopmentandvalidationoftheHRQLC-CIoccurredinfourphases:1)focusgroupswith7parentsofchildrenand12teachers,audiologistandcaregiversofchildrenequippedwithCItodevelopadraftinstrument,2)itemgeneration,3)pilotstudytoassesscontentvalidityin10patientsand4)psychometricvalidation.Results:Focusgroupsidentifiedsymptomsandtheassociatedbother,thedimensionsdevelopmentandthepatientsandhealthequipmentrehabilitationobservationsincochlearimplantatedchildrenasthecentralconceptsintheirexperience.Qualitativeanalysisindicatedthatsaturationwasachievedfortheseconceptsandyieldedaninitial75-itemdraftinstrument.Anexpertgroupunderstoodthequestionnaireandfoundtheitemstoberelevantindicatingcontentvalidity.Patientinput,itemdescriptivestatisticsandfactoranalysisidentified40itemsthatcouldbedeleted.Thefinal35-itemHRQLC-ICconstituting5dimensions:functional,social,psychological,physicandfavorableandunfavorablefactors.TheinitialpsychometricanalysisresultssuggestthattheHRQLC-ICmetthecriteriaforitemdiscriminantvalidity.


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Conclusion:TheHRQLC-ICseemstobeareliableandvalidquestionnairerelevanttoassesparents,therapistandmedicalENTinthehabilitationprosesofcochlearimplantedchildren.Theuseofthisquestionnairewillprovideassessmentofqualityoflife,impactoftreatmentonpatientoutcomesinclinicaltrials,andmayaidintreatmenteffectivenessevaluation. AbstractID:287PosterNumber:1Title:ValidationoftheRCHSDChildren'sImplantProfile(ChIP)Score:ImprovingOutomesofPediatricCochlearImplantCandidatesAuthors:HeatherRose,SLP-CCC,AVT1,DanielaCarvalho,MD2,RosabelO.Agbayani,MPH3;1DevelopmentalServices-SpeechandHearing,RadyChildren'sHosp.SanDiego,SanDiego,CA,2Otolaryngology,RadyChildren'sHosp.SanDiego-UCSanDiego,SanDiego,CA,3RadyChildren'sHosp.SanDiego,SanDiego,CA.Abstract:ABSTRACTBackground:Cochlearimplantation(CI)hasbecomethestandardofcaretoprovideaccesstosoundforpatientswithseveretoprofoundhearinglosswhodonotbenefitsignificantlyfromhearingaids.DeterminingcandidacyforaCIinthepediatricpopulationisacomplexandsubjectiveprocess.Creationofstandardandobjectiveprognosticinformationwouldbeuseful,notonlytosupportdecisionsaboutCIinaparticularchild,butalsotohelpcounselthefamilyabouttheexpectationsofpossibleoutcomesandtoplanforpost-CIservices.TheCochlearImplantTeamusesamodifiedChildren’sImplantProfile(ChIP)todetermineCIcandidacy.Theteamincludesaudiologists,speechandlanguagepathologists,anauditory-verbaltherapist,physician(pediatricotolaryngologist),developmentalpsychologist,socialworker(asnecessary)andeducationalliaison.Objectives:TheobjectiveofthestudywillevaluatetheeffectivenessoftheChIPscorebydeterminingacorrelationwiththecommunicationoutcomesaftercochlearimplantation,evaluatingtheeffectivenessoftheChIPscoreusedtoimprovefamilyexpectationswiththesurgery,andtodeterminethebesteducationalsettingforthechild.Methods:30PediatricPatientswereevaluatedusingtheChIPtoolandhadbeenimplantedfor3yearsormorewereaskedtoparticipateinthestudy.Consentswereobtained,andparentswereaskedtoprovideschool/teacherinformation.Theteacher/educatorwasaskedtocompleteaquestionnaire,basedontheAuSpLan(toassessmodeofcommunicationandskilllevel)andtheSIFTERtest(toevaluatetheacademicplacementofchildrenwithhearingloss).Statisticalanalysiswasperformed.Results:30Teacherresponseswereanalyzedusingdecisiontreemodelstoexaminetherelationshipbetweenresponsevariablesandpossiblepredictors.ForIndependentVariable“UnderstandsSpokenVocabulary”thereweresignificantresultsforthoseindividualswhowererated“BelowAgeLevel”andcombinedresultsof“AtAge”or“AboveAgeLevel.”IndividualswhowereratedbelowaverageforunderstandingspokenlanguagewerereportedtouseTotalCommunicationsincecochlearimplantation.Forthoseindividuals“AtAge”or“AboveAgeLevel”30%wasreportedtohaveAgeAppropriatereadingcomprehensionskillswhenreadingtoselfwithspokenlanguage.Conclusions:


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PreliminaryresultsshowthattheChIPTooliseffectivefordeterminingcandidacy.TheresultssupportChIPAsubjectsaremorelikelytounderstandspokenvocabularyatageoraboveagelevel.DataforCHIPCscoresindicatesubjectsarelikelytouseManualCommunication(ASL)incomparisontoChIPBorChIPAsubjects.ThestudyisexpectedtocontinuetoJune2017.Atthattime,wehopetodeterminemoredefinitiveresultstosupportourhypotheses. AbstractID:288PosterNumber:121Title:GeneTherapyRestoresHearingFunctioninaMouseModelofGeneticHearingLossAuthors:Kyu-YupLee,PhD,MD1,Min-AKim,MS2,NariRyu,MS2,Un-KyungKim,PhD2;1KyungpookNatl.Univ.Hosp.,Daegu,Korea,Republicof,2KyungpookNatl.Univ.,Daegu,Korea,Republicof.Abstract:Introduction:MethioninesulfoxidereductaseB3(MsrB3),whichstereospecificallyrepairsmethionine-R-sulfoxide,isanimportantMsrproteinthatisassociatedwithauditoryfunctioninmammals.MsrB3deficiencyleadstoprofoundcongenitalhearinglossduetothedegenerationofstereociliarybundlesandtheapoptoticdeathofcochlearhaircells.Methods:Inthisstudy,weinvestigatedafundamentaltreatmentstrategyinanMsrB3deficiencymousemodelandconfirmedthebiologicalsignificanceofMsrB3intheinnerearusingMsrB3knockout(MsrB3(-/-))mice.Results:Wedeliveredarecombinantadeno-associatedvirusencodingtheMsrB3genedirectlyintotheotocystatembryonicday12.5usingatransuterineapproach.WeobservedhearingrecoveryinthetreatedearsofMsrB3(-/-)miceatpostnatalday28,andweconfirmedMsrB3mRNAandproteinexpressionincochlearextracts.Additionally,wedemonstratedthatthemorphologyofthestereociliarybundlesintherescuedearsofMsrB3(-/-)micewassimilartothoseinMsrB3(+/+)mice.Conclusion:Toourknowledge,thisisthefirststudytodemonstratefunctionalandmorphologicalrescueofthehaircellsoftheinnerearintheMsrB3deficiencymousemodelofcongenitalgeneticsensorineuralhearinglossusinganinutero,virus-mediatedgenetherapyapproach.OurresultsprovideinsightintotheroleofMsrB3inhearingfunctionandbringusonestepclosertohearingrestorationasafundamentaltherapy. AbstractID:293PosterNumber:174Title:HearinginNoiseBenefitUsingtheCochlear™MiniMicrophone2+withNucleus®SoundProcessorsAuthors:MarianJones,MasterofAudiologyDesign&Development,CochlearLtd,MacquarieUniversity,Australia.Abstract:HearinginnoisebenefitusingtheCochlear™MiniMicrophone2+withNucleus®SoundProcessorsM.Jones1,1CochlearSydney,AustraliaIntroductionTheNucleus®soundprocessorallowswirelessaudio-connection,relievingrecipientsoftheuseofcablesduringcertaincommunications.Traditionally,cochlearimplantrecipients’accesstoassistivetechnologyhasinvolvedconnectinganAudiocableorusinganintermediarydevicesuchasanFMreceivertothe


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soundprocessor.AlthoughassistivetechnologycanprovideincreasedSNRbenefittothepatient,theyhavedrawbacksoutsideoftheirfinancialcost.WithFMsystems,anear-levelorbodywornreceiverisnecessaryforroutingthesignaltothepatient’shearinginstruments.Forchildrenespecially,thiscancreateproblemsduetoincreasedsizeofthehearingaidwiththeear-levelreceiver,aswellastheinconvenienceofhavingaseconddevicetowear.TheCochlear™WirelessMiniMicrophone2+isacliponmicrophonethattransmitssounddirectlytotheNucleus®soundprocessor.Designedforoneononecommunicationindifficultlisteningsituation,andmayalsobeconnecteddirectlytoMP3players.ItisalsocompatiblewithGNResoundhearingaids.ThestudyevaluatesthehearingperformancebenefitobtainedusingtheCochlear™MiniMicrophone2+wirelessaccessoryandthePhonakRogerFM™receiverwithNucleus®soundprocessorusers.MethodologyTwenty-fourexperiencedNucleus®recipientswererecruited.Thepreferredhearingmodevariedacrossparticipantswitheightbilateralusers,eightunilateralusers,andeightbimodalusers.Speechperformancetestinginadaptiveclassroomnoisewasconducted,comparingthesoundprocessor(s)andGNResoundhearingaid(bimodalsubjects)withandwithouttheMiniMicrophone2+orthePhonakRoger™FMreceiver.ResultsThespeechperformanceresultsinadaptiveclassroomnoiseshowthattheCochlear™MiniMicrophone2+providessignificantbenefitovertheBaseline(Nucleus®processor(s)/hearingaidalonecondition),aswellascomparablebenefitsprovidedbyPhonakRoger™FM.Fulldetailswillbepresented.ConclusionTheCochlear™MiniMicrophone2+isaconvenient,easytousewirelessaccessorythatprovidestheNucleus®soundprocessoruserwithincreasedhearingperformanceindifficultlisteningsituations.HearinginNoiseBenefitusingtheCochlear™MiniMicrophone2+AccessoryPage1/1 AbstractID:296PosterNumber:213Title:FactorsImpactingLong-termFollow-upandCochlearImplantUseinChildrenAuthors:CynthiaWarner,AuD1,AleciaJayne,AuD1,PrashantS.Malhotra,MD2,OliverF.Adunka,MD,FACS2,UrsulaM.Findlen,PhD1;1ClinicalTherapies-AudiologyDepartment,NationwideChildren'sHosp.,Columbus,OH,2Otolaryngology,NationwideChildren'sHosp.,Columbus,OH.Abstract:Introduction:Theextenttowhichchildrenweartheircochlearimplantcanbetakenasanindirectmeasureofperceivedbenefitfromusingthedeviceforcommunication.However,severalfactorshavebeenidentifiedasimpactinglong-termuseofcochlearimplants,includingageatimplantation,communicationmode/approach,leveloftechnology,andcompliancewithattendingcochlearimplantmappingappointments.Etiologyofhearinglossaswellasthepresenceofcomorbiddiagnoseshavealsobeencitedaspotentialfactorsimpactinglong-termuseand/orbenefit.Currently,thereisinsufficientdatatospecificallydefinehowetiology,comorbiddiagnoses,andaudibilityrealizedwiththecochlearimplantplayapartinlong-termuseandhowtheymayinteractwithotherfactorssuchascommunicationmode/approach,ageatimplantation,andcompliancewithrecommendedappointments.Methods:Retrospectivechartreviewofchildrenimplantedbetween2006and2012wasusedtoexplorethefollowingfactorsamongpediatriccochlearimplantusersandnon-users:etiologyofhearingloss,


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presenceandcomplexityofcomorbiddiagnoses,ageatimplantation,chosencommunicationapproach,compliancewithrecommendedfollow-up,anddistancetotheimplantcenter.Allchildrenhad5yearsormoreoffollowuppost-implantation.ComorbiddiagnosesweredefinedusingamodifiedPediatricMedicalComplexityAlgorithmtodefineseverityofcomorbiddiagnosesandmitigatingsocialissuesthatcanimpactfollow-throughwithrecommendedfollow-upappointments.Amultifactoranalysiswasusedtoevaluatetheextenttowhichfactorsaccountedforvariabilityinameasureofaudibilityaswellaswhetherachildeventuallybecameanon-user.Results:Consistentwithpreviousresults,ageofimplantationsignificantlyimpactedbenefitrealizedbychildrenwithcochlearimplants.Etiologyofhearingloss,especiallycochlearnervedeficiency,wasassociatedwithpoorerlong-termuse.Increasingcomplexityofcomorbiddisease,mitigatingsocialfactors,anddistancefromtheimplantcenterimpactedachild’sabilitytoattendaudiologymappingappointments.Multifactoranalysissuggeststhatthesefactorsinteractinacomplexwaytocontributetowhetherachildconsistentlyusestheircochlearimplantsystemoreventuallydiscontinuesuse.Conclusion:Thisstudysupportedpreviousdataandaddedseveraldimensionstostudyinghowpatientvariablescanimpactbenefitfromcochlearimplantationandeventuallong-termuse.Understandingthesefactorsandhowtheyinteractcanprovidebothimplantingotologistsandaudiologistsusefulinformationwhencounselingfamilieswhoareconsideringcochlearimplantationfortheirchildren. AbstractID:297PosterNumber:221Title:CurrentMeasurementsofMusicAppreciationinCochlearImplantUsersAuthors:AlvindeTorres,MD1,MeredithLilly,BS2,JamesSpratt,BS2,MichaelHoa,MD1;1Otolaryngology-HeadandNeckSurgery,GeorgetownUniv.Hosp.,Washington,DC,2GeorgetownUniv.Sch.ofMed.,Washington,DC.Abstract:Introduction:Musicplaysanimportantroleinintellectual,emotionalandsocialdevelopment.Cochlearimplant(CI)usersexperiencedeficitsinmusicperceptioncomparedtonormalhearinglisteners(NHL)duetothedifferencebetweenthestimulusprovidedbytheCIfromthestimulusgeneratedbyanormallyfunctioningauditorysystem.Thisdifferenceinmusicperceptionandappreciationisaresultofcurrentcochlearimplanttechnology,whichwasinitiallydevelopedforspeechcomprehensionandhasyettobeoptimizedforthemorecomplextaskofmusicprocessing.AsCItechnologyadvances,theabilitytotargetmusicperceptionasaprimaryoutcomeisbecomingmoreattainable.Consequently,specificmethodsandtestsforevaluatingmusicappreciationinCIusersareneeded.Musiccanbebrokendownintorhythm,pitch,andtimbre.WhileCIusersperformatthelevelofNHLsinrhythmperception,theyperformbelowNHLsinperceptionofbothpitchandtimbre.Difficultywithpitchperceptionismultifaceted,butmainlystemsfromtheinabilityofthecochlearimplanttofilternarrowfrequencyrangesandtodeliverfinelytunedelectricalcurrenttopreciselocationsonthecochlearbasilarmembrane.Perceptionoftimbre,whichiscomprisedofbothtemporalfinestructure(TFS)andtemporalenvelope(TE),ischallengingduetoCIusers’inabilitytoextractinformationfromtheTFSofanauditorystimulus,meaningtheyrelyalmostentirelyontheextractedTE.Abstractcomponentsofmusic,suchasemotion,mood,andmusicsatisfactioncanalsobemeasured.OuraimistoreviewtheliteratureandpresentthecurrentmethodsinwhichmusicappreciationandperceptionarebeingevaluatedinCIusersaswellasthestepsbeingtakentoimprovethem.Methods:AliteraturesearchwasperformedtargetingpediatricCIuserswithexamplekeywordsbeing“cochlearimplants”and“music”or“musicappreciation”usingOvid,Pubmed,andMedlinedatabases.ThesearchwasexpandedtoincludeadultCIusersduetothepaucityofpediatricstudies.Thesearch


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waslimitedbystudytypetoincludecomparativestudies,clinicalstudies,casereports,andrandomizedcontroltrials.ThesearchwasfurtherlimitedtoEnglisharticlespublishedwithinthelasttenyears.ExclusioncriteriawereconcomitantuseofhearingaidsduringthestudyandsignificantresidualhearingintheCIusergroup.Results:Theliteraturesearchgenerated46articles.Acasereportandcomparativestudywereexcludedbasedonrelevancetothisreview.Studieswereanalyzedbasedontheindependentvariableandgroupedaccordingly.Dependentvariablesincludedaudiogramandspeechrecognitiontests,audioandvisualstimuluspairing,musicandsatisfactionquestionnairesandsurveys,electroencephalography.Conclusion:ThecurrentmethodsdescribedinthisreviewhavecontributedtotheunderstandingandimprovementofmusicperceptioninCIusers.Promisingapproachesinimprovingmusicperceptiontodateincludeprocessorandprogrammingoptimizationandmusictraining. AbstractID:300PosterNumber:131Title:SubjectiveFeedbackandSatisfactionwiththeCochlearKanso™OfftheEarSoundProcessorReportedbyAdultCochlearImplantUsersAuthors:MarianJones,MasterofAudiologyDesign&Development,CochlearLtd,MacquarieUniversity,Australia.Abstract:SubjectivefeedbackandsatisfactionwiththeCochlearKanso™OfftheEarsoundprocessorreportedbyadultcochlearimplantusersM.Jones1,1CochlearSydney,AustraliaIntroductionAdvancesincochlearimplanttechnologyandmicroprocessingoverseveraldecadeshasresultedintheminiaturizationoftheexternallywornCIsoundprocessorfromabulkybody-worndevicetosmaller,currentgenerationBTEprocessorshousedovertheearandattachedviaacabletoaseparateheadworntransmittingcoil.TheKansoSoundProcessorisanewprocessordesignthatincorporatesthecoilandmagnetintotheprocessorbodyallowingthesingleunit,cable-freeprocessortobeworncompletelyoff-the-earandofferingpotentiallygreatercomfortanddiscretioncomparedwithconventionalBTEdevices.WhiletheformfactoroftheKansoprocessorhasbeenoptimizedforanOTEplacement,theprocessoroffersthesamefunctionalityasthecurrentgenerationNucleus6BTEprocessortechnologyincludingdualmicrophones,environmentalclassifierprogramSCAN,SmartSoundiQandwirelessconnectivity.TheobjectiveofthisstudywastoevaluatetheacceptanceoftheKansoSoundProcessorwithemphasisonsubjectivehearingperformance,retention&comfort,reliabilityandeaseofuse.MethodTwentyresearchparticipantsaged18yearsofageorolderandexperiencedwithaNucleusCP810orCP900seriesBTEsoundprocessorcompletedthestudy.Thepreferredhearingmodevariedacrossparticipantswithsevenbilateralusers,fourunilateralusers,andeightbimodal/SSDusers.Subjectivefeedbackandsatisfactionaswellasacceptanceanduseofaccessories,wasassessedviacompletionoftake-homediariesandadministrationofin-clinicsurveys.Participantswereaskedtorateresponsesusinga5pointLikertscaleandresultswereanalysedusingaone-sampledsignedranktesttoidentifydifferencesbetweenKansovsBTEprocessorratings.Results


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SurveyresultscomparinguserresponsesforKansovstheirownBTEprocessorwillbepresented.Comparisonsof‘OverallHearingPerformance’(p<0.05),‘ListeningtoMusic’(p<0.05),‘Comfort’(p<0.001),‘LookandFeel’(p<0.001),‘LearntoUse(p<0.05)and‘EaseofUse’(p<0.01)wereallfoundtobesignificantlymorefavourableforKansocomparedwiththeBTEprocessor.ThemajorityofparticipantsalsoreportedanincreaseinconfidencewhilewearingtheKansoprocessor.Therewasnosignificantdifferencesfoundforothersurveyquestions.Conclusion:Studyfindingssupportthathumanistfactorssuchascomfort,usability,confidenceandaestheticsmayratemorehighlywithanOTEasopposedtoaBTEsoundprocessor.TheKansosoundprocessormaythereforeprovideanattractivealternativetoconventionalBTEprocessorsespeciallyforthoseCIuserswhohighlyvaluediscretionandsimplicity.SubjectivefeedbackandsatisfactionwiththeCochlearKanso™OfftheEarsoundprocessorreportedbyadultcochlearimplantusersPage1/1 AbstractID:302PosterNumber:167Title:PediatricCochlearImplantDataloggingInUnder2YearOldsAuthors:NaomiJ.Gibson,MasterofAudiology,JoanneM.Lake,MSpEd,MeganChinnery,BSLT;SouthernCochlearImplantProgramme,Christchurch,NewZealand.Abstract:Introduction:Theavailabilityofdatalogginggivesanobjectiverecordofcochlearimplantprocessoruseintheunder2yearoldcohort.Methods:Collectedthedataloggingresultsfrom20cochlearimplantusersintheunder2yearoldpopulation.Separatedtheseresultsbygender,ageatimplantationandhearingaidusepriortoimplantion,Results:Processoruseincreasesaschronologicalagenears2yearsofage.Thefemalepopulationsprocessorusebecamemoreconsistentatanearlierstageintheimplantationprocessor.Conclusion:Improvedrelationshipbetweenprofessionalsandfamiliesascounsellingisnowbasedonobjectiveevidence.Abletoprovideadifferentrangeofstrategiesinordertoestablishconsistentprocessoruse.Betterinformedparentsforsettingachievableprocessorusegoals.Relationshipbetweenprofessionalsandparentsarestrengthenasprocessorusegoalsareobjective,openandmeasurable. AbstractID:303PosterNumber:184Title:AnalysisonEffectofHearingandSpeechRehabilitationafterCochlearImplantationAuthors:shaofengliu,doctorDepartmentofOtolaryngology-HeadandNeckSurgery,YijiShanHosp.,TheFirstAffiliatedHosp.ofWannanMed.Coll.,Wuhu,China.Abstract:AnalysisonEffectofHearingandSpeechRehabilitationafterCochlearImplantationIntroduction:Toassessandanalyzethehearingandspeechrehabilitationeffectofpatientswithcochlearimplants.ExploretherehabilitationeffectofNurotroncochlearimplantsinolderdeafchildren.Methods:Makehearingandspeechrehabilitationassessmentandoneyearfollow-upvisitto98patientswithsevereandextremeseverebilateralsensorineuralhearinglosswhoreceivedunilateralimplantationofNurotroncochlea.Theyoungestcasewas1yearandtheoldestwasaged16,withaverageageof8.86±3.66years.Allpatientswithcochlearimplantsselectedweredividedintothree


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groups,GroupAincluded10caseswithageofunder3yearsold;groupBincluded26caseswithageofover3yearsbutunder7yearsold;groupCincluded62caseswithageofbetween7to16.AllgroupsweresubjectedtohearingandspeechassessmentbyMAIS,CAPandSIR,beforethesurgeryandat3months,6monthsand12monthsaftersurgeryandbootingrespectively.Results:Thehearingandspeechrehabilitationeffectofallpatientswithcochlearimplantsgraduallyimprovedwithextensionofrehabilitationtime.Scoresofopenspeechassessment(%)ofallthegroupswereasbelow:groupA(9.70±2.41),groupB(13.89±3.27)andgroupC(13.69±3.90)beforesurgery;groupA(24.30±2.36),groupB(27.38±5.33)andgroupC(19.42±2.85)at3monthsaftersurgeryandbooting;groupA(32.81±2.74),groupB(36.81±6.69)andgroupC(24.89±3.21)at6monthsafterthesurgeryandbooting;groupA(49.50±5.68),groupB(47.31±9.48)andgroupC(36.83±3.48)at12monthsaftersurgeryandbooting.ThescoresofChineseAuditoryPerceptionAssessment(%)ofallgroupswereasbelow:groupA(17.20±5.57),groupB(20.77±5.16)andgroupC(24.78±8.06)beforesurgery;groupA(39.90±7.39),groupB(48.65±5.36)andgroupC(44.34±6.37)at3monthsaftersurgeryandbooting;groupA(55.40±10.46),groupB(59.65±8.77)andgroupC(56.16±7.21)at6monthsafterbooting;groupA(68.70±10.07),groupB(72.54±9.79)andgroupC(67.27±7.57)at12monthsafterbooting.MAISscoresofallgroupswereasbelow:groupA(8.90±2.51),groupB(13.42±3.35)andgroupC(13.94±4.40)beforethesurgery;groupA(23.60±3.10),groupB(26.31±3.11)andgroupC(20.55±3.66)at3monthsafterthesurgeryandbooting;groupA(27.70±3.34),groupB(28.81±3.69)andgroupC(24.68±3.23)at6monthsafterthebooting;groupA(31.90±5.02),groupB(31.19±3.81)andgroupC(28.44±3.33)at12monthsafterbooting.12monthsafterbooting,CAPcomparativedifferencebetweenthegroups(t=12.79,p=0.002)wasdistinctandwasofstatisticalsignificance(P<0.05).12monthsafterthesurgeryandbooting,SIRcomparativedifferencebetweenthegroups(t=12.61,p=0.002)wasdistinctiveandwasofstatisticalsignificance(P<0.05).Conclusion:Nurotroncochlearimplantationcanimprovethehearingandspeechabilityofbilateralextremelyseveresensorineuraldeafnesspatients,andthelongertherehabilitationtimeafterimplantation,thebettertheeffect.Theyoungertheageforimplantation,thebetterthepostoperativerehabilitationeffect.However,olderdeafchildrencanstillimproveinspeechperceptionandcognitiveabilitiesthroughcochlearinplantation.Itisaworthytentativeapproachoncochlearimplantationsinolderdeafchildren. AbstractID:305PosterNumber:170Title:PediatricCaseReportofPerformancewithThreeDifferentRemoteMicrophoneSystems:ReceiversVersusStreamersAuthors:BethA.Holstad,Au.D.Audiology,TheMoogCtr.forDeafEd.,St.Louis,MO.Abstract:Introduction:Parentsfrequentlyreportthattheirchildhasdifficultyhearinginnoise,despiteuseofnewspeechcodingstrategiesaimedatconqueringthisproblem.Subjectiveandobjectivebenefitofnoiseprogramscontinuestolagbehindthatrealizedwithremotemicrophonesystems.SchoolsstrugglewiththecostsassociatedwithprovidingIEPmandateddigitalremotemicrophonesystems,andgravitatetowardcost-savingsingle-receiveroptionscoupledtoneckloopsystems,streamers;or,microphonestreamersalone.Historically,signaldeliverythroughnondirectconnectsystemshasresultedinpoorerperformance.Currentsystemsthatstreamremotemicrophonesignalswithorwithoutasinglereceivermaylikewiseresultinpoorerperformancecomparedtodirectconnect,bilaterallyfitteddigitalreceivers.Conversely,wirelessstreamingofremotemicrophonesignals,withor


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withoutareceiver,maybemorecosmeticallydesirabletochildren,andreduceprocessorbatterydrainandpowerlimitations.Methods:Completedfittingandfunctionalevaluationofthreesystems:1)adigital,dynamicremotemicrophone/2-receiversystem,2)adigital,dynamicremotemicrophone/1-receiver/streamersystem,and3)astreameraloneusing60dBArecordedpresentationoftheW-22wordlists(binaurally)andAZBiosentencelists(monaurally)presentedat0°azimuthinquiet,innoise,andinnoisewithHATsystem.Recordedmultitalkerbabblewaspresentedat-180°azimuthforbinauraltesting,andatthetestearformonauraltestinginnoiseconditions,ataSNRneededtoreduceperformanceinquiteby~50%.Optimalreceivergainorstreamervolumewasidentifiedasthatwhichallowedperformanceinnoisetoequalorapproximatethatinquiet.Results:Inquiet,listeningwithbothimplantsonly,RSrepeatedwordswith84%accuracy.Inthemonaurallyaidedcondition,AZBiosentenceswererepeatedwith95%and92%accuracyattherightandleftearrespectively.Innoise(0SNR),RS’saccuracydeclinedto40%forwords,and57%(right),38%(left)forsentences.Withtheadditionofadigital,dynamicremotemicrophone/2-receiversystem,RSrepeatedwordswith92%accuracyandsentenceswith89%(right)and93%(left)accuracy.Withadigital,dynamicremotemicrophone/1-receiver/streamersystemwordswererepeatedwith92%accuracy,andwithastreameralone,wordswererepeatedwith88%accuracy.Conclusion:Forthischild,essentiallyequalperformancewaspossibleusinga0SNRin60dBAofnoisewiththesethreesystems.Thisunexpectedfindingsuggestsfuturehypothesis-basedevaluationofthesesystemsiswarrantedinlargergroupsofchildren,andathigherlevelsofnoise. AbstractID:306PosterNumber:58Title:WhoCanBenefitfromEAS?Authors:young-myoungchun,MD,You-ReeShin,MD;SoreeEarClinic,seoul,Korea,Republicof.Abstract:Introduction:EAShaveproducedlargeimprovementsinthespeechreceptionabilitiesofthesepatients.PrerequisitesforsuccessfulEASarethefollowings;(1)FullyunderstandhowacousticsoundisimportantinCIuse.(2)Validatesurgeon’sconfidenceonhisownHPsurgery.(3)TrytolookforpossiblecandidatestogetbenefitfromEAS.(4)SetuphowtoeffectivelyapplyacousticsoundtoCIuser!Fittingstrategy.AlthoughEAShavebeenestablishedashighlyeffectiveprocedures,questionsremainaboutcandidateselection:whocanbenefitfromoptimalcombinationsofelectricandacousticstimuli.Methods:33subjects(39ears)whohaveavariablerangeofresidualhearingpre-CIoperationwereenrolledinthisstudy,whichweredividedintotwogroupsbypost-CIresidualhearinglevels;onewascharacterizedbyfunctionalresidualhearinginthelowfrequencybandswithnearlytotaldeafnessinthehighfrequencyrange(PD-group:N=34,Age;mean27.7yr(range3~60Yr)).InitiallyPD-groupweredividedintothefollowingsubgroups:Electricalpartialstimulation(EPS),EPS-extended,ElectricAcousticStimulation(EAS),EAS-extended1&2,non-EAS.TheothergroupwascharacterizedbyseveretoprofoundHLinthemostoffrequencybandswithouttotaldeafness(Non-PDgroup:N=5,Age;mean23yr(range4~49Yr).AllpatientswererecommendedthecombinedusewithnaturalhearingoramplifiedsoundwithHA.Theacousticbenefitsaccordingtoavailableresidualhearinglevelorfrequencyrangewereevaluatedbymeasurementofacousticandelectric-acousticperformanceinspeech,music,noiseinbestEASmappingcondition.AllpatientswereaskedthereasonstouseacoustichearingwithCI.


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Properacousticrangeandmappingoptimizationweredifferentaccordingtopostop.residualhearingfrequencyrangeandspeechprocessor.Results:MostofsubjectspreferredtousenaturalacousticsoundoramplifiedsoundwithCI.Iftheresidualhearinglevelbelow250Hzwashigherthan30dB,patientspreferredtothefittingconditionofpartialstimulationbyCI,ontheotherhand,patientswithresidualhearinglowerthan30dBat250Hzneededamplification.InEASgroups,ifforsomebenefitstopatients,theremustberemainedresidualhearingof85dBhigherbelow250Hz.IfnottherewerenotanybenefitswithEASmode.Innon-PDgroup,thepatientswhohadsomeresidualhearingat<1KHzshowedsomebenefitswithHA.Takingtogether,wecansummarizetheavailableaudiologiccriteriaforacousticConclusion:Allthesepatientseventhoughwithdifferentlevelsofresidualhearingpreferredtouseacoustichearing,howeverthedegreeofbenefitdifferedbetweenthegroups.Sothedifferentiationbetweenthegroupsisveryimportant,becausethegroupsarenotequalandtheirgoalsintreatmentaredifferent.ConcludingwecansaythateventhoughHPwasnotsuccessful,someresidualacoustichearingmightbehelpfulforthebetterperformance,soweshouldgiveachancetouseacousticsoundtoallCIuserswithresidualhearing.However,whendiscussingthepossibilityofexpandingthecriteriaforEASCIcandidacy,severaluniquegroupsneedtobereviewed,eachhavingtheirownspecialconsiderations. AbstractID:312PosterNumber:55Title:ACaseofCochlearImplantationinNeurofibromatosisTypeIIAuthors:Sung-WonChoi,MD,Se-JoonOh,MD,PhD,Eui-KyungGoh,MD,PhD,Soo-KeunKong,MD,PhD;OtorhinolaryngologyHeadandNeckSurgery,PusanNatl.lUniv.Hosp.,BUSAN,Korea,Republicof.Abstract:Introduction:Patientswithneurofibromatosistype2(NF2)developbilateralvestibularschwannomasthatcancausebinauralprogressivehearinglossinmostindividuals.AuditoryrehabilitationforprofoundbilateralsensorineuralhearinglossinpatientswithNF2posesagreattherapeuticchallenge.Methods:HerewereportacaseofundergoingCIafterhavingbeentreatedwithgamma-knifeinNF2andshowingimprovedopen-setspeechperception.Thepatienthadprogressivehearinglossover5yearsandtherewereobservedbilateralacoustictumorabout2yearsago.Hismotherhadalsobilateraldeafness.SowediagnosedNF2andgammakniferadiosurgerywasdone.Thereafter,thesizeofmassesweredecreasedandkeptstable.Buthehadstillprogressivehearingdisturbance,sowantedtohavebetterhearingperformance.Puretoneaudiometryshowedapproximately88dBHLinrightear,100dBHLinleftear.SpeechdiscriminationwereRt32%,Lt4%.TherewereresponseinRtearat90dBclicksound,andnoresponseinLtearonauditorybrainstemresponse.Temporalbonecomputedtomography(CT)showedbilateralenlargedinternalacousticmeatusandMagneticresonanceimage(MRI)showedbilateralacoustictumors,whichitssizewereright7×3mm,left16×9mmResults:Wedecidedtodocochlearimplantation,preoperativepromontorystimulationtestshowedbilateralsimilarresponsethresholdandgapdetection.Wehaddiscussedwiththepatienttodecidetheimplantsite.Atfirst,werecommendedtheRtsidewhichshowedmoresuperiordiscriminationscores.ButthepatientwantedtousebinauralhearingthatRt.EarwasusedbyhearingaidandLt.earwasusedbycochlearimplant.SowedecidedtodoCIinLtear.Therewerenospecificeventintheoperationroom,Neuralresponsetelemetry(NRT)showedtheresponsedintheallchannel.At10monthsafter


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surgerywhenthemappingwerestable,speechdiscriminationbyusingHINTshowed96%,CAPscorewere7,puretoneaudiometryinsoundfieldshowed32dBAthresholdConclusion:AuditoryrehabilitationisessentialtopreservethequalityoflifeofNF2patients.Wherethereissomeresidualhearing,thiscanbeachievedthroughoptimizationofhearingaids.However,inprofoundlydeafpatientsorpatientswheretreatmentislikelytocauseprofounddeafness,cochlearimplantation(CI)andauditorybrainstemimplantation(ABI)providethebestoptionsforrehabilitation.Thedecision-makingprocessiscomplexandrequiresconsiderationofeachsidewithrespecttotumorsize,rateoftumorgrowth,hearinglevel,presenceorabsenceofcochlearnerveandfunction,facialfunction,andpatientchoice.Anumberofoptionsexistwhenplanninghearingrehabilitation.CImaybeofbenefitifapatientrequiresVSexcisionwherecochlearnervepreservationisthoughtpossible,independentofthelevelofpreoperativehearingineitherear. AbstractID:313PosterNumber:56Title:CochlearImplantataionafterBilateralOticCapsuleViolatingTemporalBoneFracturesAuthors:Sung-WonChoi,MD,Se-JoonOh,MD,PhD,Soo-KeunKong,MD,PhD,Eui-KyungGoh,MD,PhD;OtorhinolaryngologyHeadandNeckSurgery,PusanNatl.lUniv.Hosp.,BUSAN,Korea,Republicof.Abstract:Introduction:Temporalbonefracturesoftencausealossofaudiovestibularfunction.Patientswithbilateralprofoundsensorineuralhearinglossduetotemporalbonefracturesbutwhostillhaveanintactauditorynervemaybecomecandidatesforcochlearimplantation.However,duetopost-traumaticfibrosisorossificationofthecochlea,surgerycouldbechallengingandcomplicated.Therefore,itisessentialtocarefullyevaluateimagingstudiesthatincludecomputedtomography(CT)andmagneticresonanceimaging(MRI).Methods:Thepatientwasreferredtotheotologydepartmentwithbilateraldeafness.Twomonthsbeforepresentation,thepatienthadseveretraumaafteratrafficaccidentandwasadmittedtotheneurosurgicaldepartmentwithsubduralandsubarachnoidhemorrhagesforconservativetreatment.Afterthepatientrecoveredfromhisacuteinjury,henoticedbilateralhearingloss.Anotoscopicexaminationwasnormal,andaudiologicexaminationrevealedbilateralprofoundsensorineuralhearingloss.Ahigh-resolutiontemporalboneCTrevealedbilateraloticcapsule-violatingtemporalbonefractures.Cochlearimplantationwasconsideredforauralrehabilitation.However,thepatientdecidedtowaitfornaturalrevivalofhearing.Aftertwomonthsthepatientadmittedhisdeafnessandexpressedadesireforcochlearimplantation.Arepeatedaudiologicevaluationrevealedfindingssimilartothoseoftheprevioustest.Results:Onthehigh-resolutiontemporalboneCT,obliterationandlabyrinthitisossificanswerenotdetected,asinthepreviousscan.However,obliterationofthepathwayfromtherightvestibuletotherightbasalturnwasidentifiedonthetemporalMRI;thisfindingwasnotdetectedonapreviousMRIobtainedtwomonthsearlier.Theleftearwasselectedasthesideforimplantationfourmonthsafterthetrauma.AMed-ElConcertoFlex28(Med-ElGmbH,Innsbruck,Austria)wasused,achievingafullinsertionofallelectrodeswithoutanydifficulty.Intraoperativeneuralresponsetelemetrytestswerepositive.Followingmapping,programming,andauralrehabilitation,thepatient’sauditoryperformancewasexcellentwithcategoriesofauditoryperformance(CAP)of7.Onfollow-up,heexperiencednoproblemsforeightmonthsConclusion:Cochlearimplantationprovideseffectiveauralrehabilitationinseveretoprofoundhearinglossfollowingtemporalbonefractures.However,somepointsmustbeconsideredbeforeperforming


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cochlearimplantation.Temporalbonefracturesmayleadtoossificationofthecochlea.Therefore,werecommendcochlearimplantationassoonaspossibleafterapatientisdeafenedbybilateraltemporalbonefractures.Also,whenthereisasignificanttimedelaybetweentheinitialimagingstudies(CTandMRI)andcochlearimplantation,repeatedimagingstudiesareessentialtoruleoutlabyrinthitisossificansandotherstructuralabnormalitiesthatmayinhibitsuccessfulplacementofelectrodes. AbstractID:314PosterNumber:188Title:DoesElectricalStimulationImproveNeuralSynchronisationafterCochlearImplantation?AComparativeStudyinSensorineuralHearingLoss,AuditoryNeuropathySpectrumDisorderandHypoplasticCochleovestibularNervesAuthors:NeevitaNarayan,BSc,MBA1,PrabhashKumar,BSc,MSc1,AmeetKishore,FRCS2;1SpHearSpeech&HearingClinic,NewDelhi,India,2IndraprasthaApolloHosp.,NewDelhi,India.Abstract:Introduction:Theelectricallyevokedcompoundactionpotentials(ECAP)measurementsaremostpopularobjectivemeasureduetotheeaseofrecordingandlesstimerequiredforrecording.ECAPmeasurementshavethesensitivityof89%andspecificityof96%(Botros,Dijk&Killian,2007).Thereisincreasingnumberofcochlearimplantationbeingcarriedoutinauditorynerveanomaliesduetoadvancementincochlearimplanttechnologyandprovenoutcomesinthispopulation.StudieshavereportedimprovementinneuralsynchronisationmeasuredthroughECAPmeasurementsinchildren/adultswithnonerveanomalies(Mouraetal,2014;Caldasetal,2015).Throughthisstudyweaimedtodemonstratesimilarresultsinrecipientswithauditorynerveanomaliesalso.InourstudyweaimedtolookforanimprovementinauditorynervesynchronisationfollowingelectricalstimulationoveraperiodoftimeinchildrenwithCochlearImplants.Tothencomparetheimprovementinauditorynervesynchronisationacrossdifferentgroupssuchas:SensorineuralHearingLoss(SNHL)withoutauditorynerveanomaly,AuditoryNeuropathySpectrumDisorder(ANSD)&SNHLwithhypo-plasticcochlea-vestibularnerves(CVN)Methods:45childrenintheagerangeof2to6yearswhounderwentcochlearimplantationwithaminimumof12monthsfollowupwereselectedforthisstudy.Ofthese,25childrenhadSNHLwithoutanyauditorynerveanomalies.TenchildrenwereintheANSDgroup.Tenchildrenwereinthehypo-plasticcochleo-vestibularnervegroup.Attheendofthecochlearimplantsurgery,Intra-operativeECAPmeasurementsweredoneinautoandmanualmodefor5electrodesacrossthearray.PostoperativelyECAPmeasurementswerealsodoneatregularintervalsof3,6,9and12months.AretrospectiveanalysiswasdoneonECAPmeasurementspost12monthsofelectricalstimulation.Thereasonforthisanalysiswastoseeifthereisanyimprovementinneuralsynchronisationfollowingelectricalstimulationovertime.WelookedatthechangeinT-NRTvaluesandN1-P1amplitudeatT-NRTlevel.ComparisonoftheresultsofSNHLgroup,ANSDgroupandhypo-plasticcochlea-vestibularnervegroupwasdone.Thedatawasanalysedstatistically.Results:ElectricalstimulationoveraperiodoftimehasimprovedtheneuralsynchronisationofauditorynerveinallthechildrenwithcochlearimplantsasseenbyanimprovementintheN1-P1amplitudesatT-NRT.Analysisshowedastatisticallysignificantimprovementinneuralsynchronisationinallthreegroupsofrecipients.TheSNHLwithnormalauditorynervegroupdemonstratedthemostsignificantimprovement,followedbytheANSDgroupascomparedtohypo-plasticCVNgroup.Conclusion:Overallthereisanimprovementinneuralsynchronisationpostelectricalstimulationwithcochlearimplantsovertime.Thishadbeenpreviouslyreportedincochlearimplantuserswithoutanynerveanomalies(Mouraetal,2014;Caldasetal,2015).Wetoohavedemonstratedimprovementin


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neuralsynchronisationpostelectricalstimulationinallourcochlearimplantrecipients.Inaddition,wehavebeenabletoshowthatchildrenwithauditorynerveanomaliessuchasANSDandCVNanomalieshavealsodemonstratedimprovementinneuralsynchronisationfollowingcochlearimplants.Thisgivesusconfidencetotakeupsuchchildrenforcochlearimplantationwhenweseesuchimprovementinobjectivemeasuresaswell. AbstractID:316PosterNumber:76Title:ManagementofSurgicalDifficultiesDuringCochlearImplantwithMalformedEarAuthors:djilaliaiadkhaled,Maitredeconferencesmédecine,chusidibelabbes,sidibelabbes,Algeria.Abstract:Introduction:Innerearmalformationsconstituteabout20%ofcongenitalsensorineuralhearingloss;thecochlearMalformationsareofspecialinterestnowadays,astheindicationforcochlearimplantsurgeryisexpanding.Inaretrospectiveevaluation,theaimofthisstudywastoassesstheoutcomesofcochlearimplantationinchildrenwithinnerearmalformationsMethods:Aretrospectivereviewof43childrenwhoreceivedimplantsfromJune2008tonovember2015wasperformed.sixofthemhadradiologicevidenceofinnerearmalformations,Thepreoperativeevaluations,intraoperativefindings,postoperativecomplications,andperformanceoutcomeswereanalyzed.Results:Wenotedaclearmaleprevalence;thesexratioisoffiveboysforagirl.Amongthe6childrenhavingacochlearmalformationwenotedtheconceptofmarriagebetweenbloodrelationsintheparentsinatonlycase16,67%ofthesechildrenhavingcochlearmalformationhaveamajordeafcasesinthefamily.16,67%ofthe6childrenestablishedinourservicepresentanothercaseinthefamilyThesimilarcasesinthesiblingswereseenat16,67%ofourchildrenThenotionoffeverwasnotedat16,67%ofthechildren.Onepatienthadabronchiolite,anotherhadhyperpyreticconvulsions,16%ofthepatientshavingmalformationofinnerearearshadastandardsero-mucousotitis66,66%ofthechildrenhavingcochlearmalformationhadastandardmalformationmondini,thevestibulardilatationandofthevestibularaqueduc50%,and16hadacommoncavitywasnoted.Thecochlearossificationminimwasnotedin16%ofourpatients,andtheprocidenceoffacialnerveinonecase.Therewerenoseriouspostoperativecomplications.AllchildrenwithInnerearmalformationachievedopen-setspeechperceptionabilities,andshowedprogressiveimprovementoftheirspeechperceptionabilitiesovertime.TherewerenostatisticallysignificantdifferencesinperformancemeasuredbytheCommonPhrasestestbetweenthegroups.Althoughtherepeated-measuresanalysisofvarianceindicatedthatchildrenwithInnerearmalformationperformedmorepoorlythanthosewithanormalinnerear.Conclusion::Theresultsofthepresentstudyshowthatcochlearimplantationcanbeperformedrelativelysafelyindeafchildrenwithinnerearmalformationandthattheyreceiveconsiderablebenefitfromtheirimplants AbstractID:317PosterNumber:54Title:SurgicalOutcomeofCochlearImplantationinPatientswithChronicOtitisMedia.Authors:Jin-WoongChoi,M.D,Ph.D,Yong-SuLee,M.D,JeeHyeChung,M.S,Yong-HoPark,M.D,Ph.D;ChungnamNatl.Univ.Coll.ofMed.,Daejeon,Korea,Republicof.


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Abstract:Introduction:Thisstudyevaluatedthesurgicaloutcomesofcochlearimplantationinpatientswithchronicotitismedia(COM)Methods:Theclinicaldataof12casesofcochlearimplantationinpresenceofCOMwasanalyzedretrospectively.Ratesofpostoperativeinfections,complicationsandpost-implantspeechperformancewereanalyzedResults:.Sixpatientsunderwentone-stageoperationinvolvingsubtotalpetrosectomyassociatedwithexternalauditorycanalclosureandmastoidandEustachiantubeobliteration.Theother6patientshadtwo-stageoperationinvolvingtympanoplastyorcanalwalldownmastoidectomywithmiddleearandmastoidobliterationandblindsacoftheexternalauditorycanalfollowedbycochlearimplantation.Therewerenoinfectionsormedicalcomplicationsafterimplantationexceptonepatientwhohadabreakdownofexternalauditorycanalclosurewithelectrodeexposure.Allhadgoodspeechperformancescoresat1yearpost-implantation(medianCAP,6;meansentencetest,72.3±26%).Therewasnosignificantdifferenceinspeechperformanceaccordingtotheoperationmethods.Conclusion:CochlearimplantpatientswithCOMhavenoincreasedriskofpostoperativeinfectionsorcomplications.Inaddition,thesepatientshavegoodspeechperformances.CochlearimplantationisasafeandeffectivetreatmentforpatientswithseveretoprofoundhearinglosssecondarytoCOM. AbstractID:319PosterNumber:192Title:EffectsofaNovelSoundProcessingStrategyonMusicPerceptionandEnjoymentinCochlearImplantUsersAuthors:BjørnPetersen,Ph.D.1,AnneSofieAndersen,Medicalstudent2,ElviraBrattico,Ph.D.,Professor2,ThereseOvesen,MD,DMSc3,HanneOwen,MD4,FranckMichel,M.Sc.EE4,MinnaSandahl,Audiologist4,PeterVuust,Ph.D.Professor1;1Dept.ofClinicalMedicine,HealthAarhusUniversity,Ctr.forMusicintheBrain,Aarhus,Denmark/RoyalAcademyofMusic,Aarhus,AarhusC,Denmark,2Dept.ofClinicalMedicine,HealthAarhusUniversity,Ctr.forMusicintheBrain,Aarhus,Denmark,AarhusC,Denmark,3Dept.ofClinicalMed.,AarhusUniv.andENTdepartment,Hosp.UnityWest,Denmark,AarhusC,Denmark,4ClinicofAudiology,AarhusUniv.Hosp.,AarhusC,Denmark.Abstract:Introduction:Withtheconsiderableadvancesmadeincochlearimplant(CI)technologywithregardtospeechperception,itisnaturalthatmanyCI-usersand-candidatesexpresshopesofachievingmusicenjoyment.However,duetolimitationsinthesoundtransmission,musiclisteningwithaCIischallenging,leadingtoreducedmusicperceptionandenjoymentforCIusers.AcrucialelementinaCIisthesoundprocessingstrategywhichusuallyintegratesautomaticgaincontrol(AGC)withthepurposeofadaptivelyreducinginputdynamicrange(IDR)atthefront-endandlimitthedifferenceinintensitybetweeninputandoutput.However,thisapproachmayresultinlossesinsoftsoundsanddistortionsinloudsoundswhicheventuallycouldleadtolostinformation.Anewback-endoutputcompressionsystem(xDP)usedinthetheSaphyrNeoandtheNeuroOnespeechprocessordevicefromOticonMedical(OM)operateswithacontinuouslywideIDRwhichhaspreviouslyprovenbeneficialforCIusers.Thus,thisstrategycouldprovideabetterlisteningexperience,andpossiblyaugmentmusicenjoymentforCIusers.Thisstudyaimstotesttwohypotheses:1)ACIsoundprocessingstrategyincorporatingback-endmulti-channelcompressionmaysignificantlyenhanceaccuracyindiscriminationofdetailsinmusicatboththeneurophysiologicalandthebehaviorallevelandaugmentmusicappreciationinCIuserscomparedtoafront-endAGCbasedstrategy.2)AfterthreemonthsofCIexperience,CIusers’musicdiscriminationaccuracyatboththeneurophysiologicalandthebehavioral


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levelaswellasself-reportedmusicappreciationlevelswillbesignificantlyenhanced.Furthermore,evokedbrainresponsestosalientfeaturechangesembeddedinawholepieceofmusic,indexingthepossibilityofautomaticextractionofsimplesoundfeaturesfromarealisticsoundenvironmentwillincreaseandextendtomoresubtlefeaturechangesafterthreemonthsofCIexperience.Methods:Usingelectroencephalographyandanadaptedno-standardsmusicalmultifeatureparadigm,wewillrecordthemismatchnegativity(MMN)responsetofourdifferentdeviants(pitch,intensity,timbre,rhythm)presentedinfourlevelsofdeviationmagnitude.Asanadditionalmeasurement,EEG-recordingswillbeperformedusinganaturalisticparadigmwithentirepiecesofmusicwithandwithoutlyrics.Complimentarybehavioraltestsincludeamultifeaturemusicdiscriminationtest,anemotionalspeechrecognitiontestandcontinuousbehavioralratings.Furthermore,CIusersarerequestedtocompleteaDanishversionoftheIOWAMusicalBackgroundQuestionnairetosurveymusichabits,experienceandenjoyment.Testswillbecarriedoutoneweekafterswitchonoftheimplant(T1)andagainafter3months(T2).ParticipantsincludeOMimplantusersaswellasusersofCochlear,AdvancedBionicsorMed-ELbrands.Normalhearingcontrolswillprovidereferencedata.Results:Thisisworkinprogress.Resultswillbepresentedattheconference.Conclusion:ThisstudyoffersthecapacitytoguidethedevelopmentofnovelsoundprocessingstrategiesinCIs,whichmayimproveperceptionofmusicinCIrecipientsand,aspositiveside-effects,eventheirperceptionofdetailsinspeechandqualityoflife.Inawideperspective,theresultsmayrepresentasubstantialstepforwardinthedevelopmentofCIoutcome,impactingdailylifeofadultandpediatricCIusersworldwide. AbstractID:322PosterNumber:46Title:CochlearImplantOutcomeAuthors:khabtiA.Almuhanna,dr.,md.ORL,PSMMC,Riyadh,SaudiArabia.Abstract:CochlearimplantoutcomewithmalformedcochleaPrimaryinstigator:Dr.KhabtiAlmuhannaAbstractThecochlearimplant(CI)designedtorestoresomesenseofhearingforchildrenandadultswhoreceivelittleornobenefitfromhearingaids.ItiswellestablishedthatTheimpactmalformedCochleawillaffecttheimplantationoutcome.CochlearimplantationprogramisinplaceatPSMMCsince2009,Successofanyprogramdependon:Theteamworkovert,Effectivecollaboration,Leadershipsupportandhigherauthoritysupport.TheaimofthestudytoassesstheperformanceandtheoutcomeofourCochlearimplantationprogramInregardtomalformedcoclea.Fifteencasesoutofthe180caseswerefoundtofitthecriteria.Resultandconclusions:Theaverageagegroupattheimplantwas3.5yearsandrangedbetween1-9yearswhichishigherthanotherreports.Substantialimprovementwasrecordedinbothspeechandauditorylevelspostimplantationoutcomeofmalformedcochleagoingtobementionedincomparisonwithnormalcochlea. AbstractID:326PosterNumber:204Title:HearingPerformancewithDifferentGenerationsofFineStructureStrategies


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Authors:TobiasRottmann,Dipl.-Ing.,ManfredSchwebs,B.Sc.,ThomasLenarz,Prof.Prof.Dr.,AndreasBüchner,Prof.Dr.;DepartmentofOtolaryngology,Med.Univ.ofHannover,Hannover,Germany.Abstract:Introduction:Codingstrategiesofcochlearimplantsystemsconcerningtheirperformanceinspeechunderstandingcouldbeconstantlyimprovedoverthelastdecade.TheclassicCIS(ContinuousInterleavedSampler)strategystillformsthebasisformanyCIcodingstrategies.Basedonthisbasicprinciple,MED-ELhasbeendevelopeddifferentgenerationsoffinestructurecodingstrategies.Therewithbetterlow-frequencyiscodedbydynamicallyadaptingthestimulationrateonthemostapicalchannelsdependingontheincomingacousticsignal.ThefirstgenerationofthefinestructurestrategiesiscalledFSP(FineStructureProcessing)whichtheoreticallyofferedratepitchinformationonthreebutonaverageonlyontwofinestructurechannels.Tobeabletoguaranteefinestructureprocessingonfourapicalchannelsregardlessofmappingparameters,amoreadvancedversion,FS4,hasbeendeveloped.Furtheroptimizationproceduresleadtothenewestiterationoffinestructureprocessing,theso-calledFS4HRstrategy.HRstandsforHighRateandoffersanincreasedstimulationrateinthenon-finestructureCIS-typechannelsincontrasttoFS4LR(LowRate).Theaimofthetwostudiespresentedherewastocomparespeechperceptionoutcomesofthethreefinestructureimplementationsmentionedabove(FSP,FS4LRandFS4HR).Methods:15subjects(1ststudy)and20subjects(2ndstudy)withaminimumageof18yearsandaminimumhearingexperienceof6monthswiththeFS4LR(1ststudy)andwiththeFSP(2ndstudy)strategyhavebeenrecruited.Allsubjectswererequiredtoyieldaminimumscoreof20%intheHSMsentencetestinnoisetobeabletoparticipateinthestudies.WithinbothstudiesspeechtestswereconductedrightbeforeandafterswitchingthesubjectsfromFS4LRtoFS4HR(1ststudy)andfromFSPtoFS4HR(2ndstudy),respectively.Inthe2ndstudyacontrolgroupwasincludedkeepingtheFSPstrategyforthreemonths.TestingmaterialconsistedoftheOldenburgsentencetestinnoise,theHSMsentencetestinnoiseandtheFreiburgmonosyllabicwordtest.Thecompletetestbatterywasrepeatedthreemonthsaftertheswitch-overagainforbothstrategiesinbothstudies.Results:ThefinaldataoftheFS4LRandFS4HRcomparisonshowssignificantlybetterresultsfortheFS4HRstrategyintheFreiburgmonosyllablesandintheOldenburgsentencetest.PreliminaryresultsoftheFSPandFS4HRcomparisonshownosignificantdifferences.Conclusion:ThefinaldataoftheFS4LRandFS4HRcomparisonshowssignificantlybetterresultsfortheFS4HRstrategyintheFreiburgmonosyllablesandintheOldenburgsentencetest.PreliminaryresultsoftheFSPandFS4HRcomparisonshownosignificantdifferences.Onthebasisofthecurrentstudyresults,itseemsviabletogivearecommendationfortheuseofbothFS4HRandFSPinthedailyclinicalroutine.Furtherstudyresultsmayshowifoneofthesestrategieswouldbegenerallypreferable. AbstractID:331PosterNumber:79Title:CochlearImplantationinthePatientwithOpenMastoidCavityAuthors:ChoonDongKim,MD,PhDOtolaryngology-HeadandNeckSurgery,VeteransHlth.Servicemedicalcenter,Seoul,Korea,Republicof.


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Abstract:Introduction:Profoundhearinglosscanbefollowedbytheprocessofchronicotitismedia.Theaimofthestudyistoevaluatemanagementoptionsincochlearimplantationinpatientswithopenmastoidcavity.Methods:Theauthorsperformed13casesofcochlearimplantationinopencavitymastoidectomystatepatientswithoutobliterationofmastoidorwiththepartialobliterationofmastoidfromJuly2011toAugust2014.Ofthesefourteenpatients,eightpatientsreceivedcochlearimplantationinopenmastoidcavityandothersinnormalmastoid.Themedicalrecordsandradiologicalfindingswerereviewedretrospectively.Results:Threeofeightpatientswhohadundergoneopencavitymastoidectomydidnotperformmastoidcavityobliterationbeforecochlearimplantation.Anotherfivepatientswithanopencavitymastoidhadundergonethepartialobliterationofmastoidduringcochlearimplantation.Todate,Protrusionofelectrodewasseenononepatientwithoutobliterationofmastoid.Conclusion:Thelackofprotectionbytheexternalauditorycanal(EAC)andthetympanicmembraneheightenstheriskofelectrodearrayextrusion.Amongthevarioussurgicalstrategiesproposedintheliteraturetoavoidthesecomplications,EACclosure,associatedwithcavityobliterationandEustachiantubeocclusion,isoneofthemostreported.Itismandatorytosecureaninfection-freeearbeforeimplantation.Itisalsoessentialtocreateastrongprotectivelayeroftissuecapableofcoveringtheelectrodearrayespeciallyinthemastoidcavity. AbstractID:332PosterNumber:74Title:TheImpactofElectrodeTypeonIntraoperativeandPostoperativeTelemetryMeasuresinCochlearImplantusingDifferentSurgicalTechniqueAuthors:AmrG.Ismail,MDdegree,AssistantProfessorofOtolaryngologyENT,TheNatl.EgyptianHearingandSpeechInst.,Tanta,Egypt.Abstract:Introduction:Cochlearimplantation(CI)islargelyconsideredsuccessfulbasedonthedevice’sabilitytoreliablysendelectricalsignalstotheauditorynervefibers.Telemetry(electrodeimpedance)isabidirectionalcommunicationsystem.ThetelemetrysystemallowsustotestthebasicfunctionsofaCIandtodetecttheelectricalproblemsineachelectrode.Methods:Aretrospectiveanalysisofimpedancedatafrom69CIsurgeriesoccurringattheHearingandSpeechInstitutewasconducted.Intraoperativeandpostoperativeimpedancevalueswereavailablein69pediatricandadultpatientsduringthefirstfitting3weeksto1monthpostoperatively.Thedataobtainedinthisstudyweredividedintofourgroupsdependingonthetypeofimplantedelectrodeanddeviceused.Inthisresearch,fourtypesofelectrodes(MidScala,1J,Flex28,andStandard)andtwosurgicaltechniques(cochleostomyandroundwindow)wereused.Results:Findingsshowedthatthereisastatisticallysignificantdifferencebetweenintraoperativeandpostoperativemeanaverageoftelemetrymeasurefor1JandFlex28electrodesthatincreasedpostoperatively.Therewasnostatisticallysignificantdifferencebetweenintraoperativeandpostoperativemean±SDofeachofthetwoelectrodes(MidScala,1J,Flex28,andStandard).Comparisonbetweenintraoperativeandpostoperativeaverageofthefourelectrodesshowsstatisticallysignificantdifferenceinintraoperativeaverage.Thestudyalsoshowedthatthereisnostatisticaldifferencebetweentelemetryresultswheneithercochleostomyorround-windowapproacheswereused.Conclusion:Findingsofthisresearchshowedincreaseinpostoperativeimpedancewithalltypesofelectrodes,whichcanbereferredtotheabsenceofelectricalstimulationpriortoinitialactivationofthe


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device.Thereisstatisticallysignificantdifferenceinintra-operativetelemetryaveragebetweenfourtypesofusedelectrode. AbstractID:333PosterNumber:112Title:ASystematicReviewofSafetyOutcomesforImplantableBoneConductionandMiddleEarDevicesAuthors:MichaelUrban,MBA,MSc,RuthZoehrer,PhD,BettinaSchlick,PhD,SeverinFuerhapter,PhD;BUVibrant,MED-ELMed.Electronics,Innsbruck,Austria.Abstract:Introduction:Incasesofhearingloss,malformations,andothermedicalconditionsoftheear,implantablehearingdevicesfillaclinicalneedthatoftencannotbesuitablytreatedbyconventionalhearingaids.Duetotheirinvasivenature,however,oneofthemostobviousconcernswiththeuseofimplantablehearingdevicesistheirsafety.Inthisstudy,publicationsreportingcomplicationsofdifferentBoneConductionandMiddleEarImplants,whichhavebeensystematicallyreviewed,willbecompared.Methods:PubmedandDIMDIdatabasesweresearchedusingacomprehensivesearchstrategytoidentifyarticlespublishedbetween1996and2016.Results:Atotalof3215recordswereidentified.Afterremovalofduplicates,titlesandabstractswerescreened,unrelatedtitleswereremoved,andthefulltextsoftheremaining518publicationswereextracted.Atotalof259studiescomprisingdatafrom14030subjectsreportedonsafetyoutcomes.Theinvestigateddevicesprovedtobesafeandeffectiveinmeansofhearingrehabilitation.Surgicalcomplicationratesaredevicespecific,andpostoperativeproblemsareminimal.Themostoutstandingcomplicationisconnectedtoskinrelatedconditionsinthepercutaneousgroup(bothintheBAHAandPonto,with38.9%,39.1%),andinthetranscutaneouslyimplantedcohort(theSophono,with18.1%).ThisisparticularlysurprisingwiththeSophonobeingatranscutaneousimplant,aimingtoavoidsofttissuerelatedcomplications.TheBahaAttractsystemshowedthehighestoccurrenceof18.8%inpatientrelatedproblems,suchaspainetc.,followedbyskinrelatedissueswith10.9%.Thelowestpercentageofoverallsafetyoutcomesbyfar,wasseenintheBonebridgewith7.8%.Withregardstopartiallyimplantableactivemiddleearimplants,itisworthwhiletomentionthatcomplicationratesarenotonlydependentonthespecificdevicebutalsoontheindicationandunderlyingpathology,andthereforetypeofVibroplasty.Thisdirectlyaffectscomplicationratesinconductiveandmixedhearinglosscases(24.1%)thatoftencomprisepre-operatedearsandmalformationscomparedtosensorineuralhearinglosscases(19.6%)whichimplycompleteandhealthyanatomicalstructuresintheear.Conclusion:Comparingthesystematicallyobtainedresultswhichweregroupedintocategoriesofsafetyoutcomesonecanconclude,thatsubjectsimplantedwiththeBonebridgeexperiencetheleastnumberofcomplicationswith7.2%(+0.6%revisionsurgery).ThosepleasingresultsarefollowedbytheSoundbridge.EmphasisneedstobedrawnondifferencesinsafetyoutcomesdependentontheunderlyingpathologyandthereforetypeofVibroplasty.Assumingsimilarbeneficialaudiologicaloutcomes/benefitsoftheherepresenteddeviceswithintheirspecificindicationranges,theprosandconsregardingsurgery,long-termsafetyandqualityoflifeofthepatientneedtobetakenintoaccountwhendecidingonadevice. AbstractID:339PosterNumber:171


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Title:ElectricallyEvokedAuditorySteadyStateResponsesfromMED-ELCochlearImplanteesAuthors:HongmeiHu,Ph.D.1,KonradSchwarz,Ph.D.2,StefanStrahl,Ph.D.2,MathiasDietz,Ph.D.3,BirgerKollmeier,Ph.D.;M.D.1,StephanEwert,Ph.D.1;1MedizinischePhysikandClusterofExcellenceHearing4all,UniversitatOldenburg,Oldenburg,Germany,2MEDELGmbH,Vienna,Austria,3NationalCentreforAudiology,WesternUniv.,London,Canada.Abstract:Introduction:Theevokedauditorysteadystateresponses(ASSR)canbeusedtoobjectivelyestimatehearingsensitivityinindividualswithnormalhearingandwithvariousdegreesandconfigurationsofsensorineuralhearingloss.Recently,theuseofelectricallyevokedauditorysteadystateresponses(eASSR)withcochlearimplant(CI)userswasreportedinseveralstudies,wheretheywereabletosuccessfullyrecordandinterpreteASSRsinadultCochlearNucleusimplantusers.OneofthecriticalissuesofeASSR,especiallywithincreasingstimulationrate,istheelectricalstimulationrelatedartifacts.Unliketherandomnoisewhichcanbereducedbyaveragingresponsestoincreasesignal-to-noiseratio(SNR),someoftheCIstimulationrelatedartifactsaresynchronouswithstimulationandcannotberemovedbyaveraging.Thesephaselockedstimulusartifactsoverlapwiththeevokedresponseinboththetimeandfrequencydomains,suchthatconventionaltimewindowingandfrequencyfilteringareincapableofremovingstimulusartifactswithoutdistortingtheevokedresponse,particularlyforhigh-rateeASSR.Thisstudyaimsatdevelopingahigh-rateeASSRrecordingsystemforMED-ELCIusers,byusingnearspeechprocessorstimulationrate.Methods:InsteadoftheCIusers’ownprocessors,directstimulationviaaresearchinterfacebox(RIBII,manufacturedatUniversityofInnsbruck,Austria)wasusedinthisstudy.ThreeMED-ELCIuserswererecruitedinthemethoddevelopingstage.Differentparameters,e.g.,stimulationrates,modulationfrequencies,stimulationpolaritieswereinvestigated.Aseriesofartifactreductionmethodswerefurtherdevelopedinthisstudy,aimingatreducingCIstimulationcoherentartifactsineASSR.Themethodswerealsoappliedtodummyrecordingsinasalinesolutionthatonlycontainartifacts.Results:TheresultsshowthattheCIstimulationpulseartifactscanbereducedinsomeextent,butcouldnotbetotallyremovedatthisstage.EASSRcanberecordedfromallthesethreeCIusers,butcautionsshouldbetakenininterpretingtheResults:whereastheexistenceofaneuralresponsecanbeshown,themagnitudeoftheresponseremainsblurred.Conclusion:Withthemethodsdevelopedinthisstudy,wehopeitwill,atleasttosomeextent,closethegapbetweenexploratorystudiesandclinicalpracticeofeASSRmethods. AbstractID:343PosterNumber:103Title:SelectingtheAppropriateElectrodeArrayinCochlearImplantSurgeryAuthors:HoratiuE.Stefanescu,MD,PhD,CaiusDoros,MD,PhD,NicolaeC.Balica,MD,PhD,MarioaraPoenaru,MD,PhD;ENT,VictorBabesUniv.ofMed.andPharmacy,Timisoara,Romania.Abstract:Introduction:Inordertoquicklyestimateanindividual’scochlearductlength(CDL),aresearchsoftwareapplicationwasdeveloped.Clinicianscanusethisinformationtoselectthecochlearelectrodearraysizethatisindividuallysuitedtoeachcochlearimplant(CI)recipient.Furthermore,theresearchsoftwareapplicationallowstopost-operativelydeterminingthepercentageofcochlearcoverage,theinsertiondepthandtheinsertionangleofindividualelectrodecontacts.Methods:Beforesurgery,themaximumbasalturndiameter(value“A”)wasmeasuredonacoronalsectionofhigh-resolutioncomputedtomography(HRCT)ofthetemporalbone.Basedon“A”,the


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researchsoftwareapplicationcalculatedtheCDL,andeitherthelongestorashorterelectrodewaschosenforimplantation.Afterimplantation,theresultsof21consecutivepatients(23ears)obtainedusingtheresearchsoftwareapplicationswerecomparedtotheirpostoperativeX-raymeasurementsandtothesurgeon’sintraoperativenotes.Results:Theapplicationwasusedin21consecutivepatients19children,2adults).TheAdistancemeasuredonCTscansvariedfrom7.8mmto9.7mmwithameanvalueof9.14mm;SD=0.415.Themeasured“A”distancescorrespondtoCDLsvaryingfrom28.5mmto36.4mm.ThemeanCDLwas34.05mm;SD=1.72.Fullinsertionwasachievedinallbut2casesbuttherewerenoelectrodesoutsidethecochlea.Therewasnoelectrodefoldoverdetectedonimaging.Weinsertedtheelectrodemostlythroughtheroundwindow(18/23).For17longelectrodearrays,thesoftwareapplicationsuggestedaninsertiondepthof30.7mmanditwas29.4mmonaverageaccordingtomeasurementsontheX-ray.For5shorterelectrodearrays,thepredictedinsertiondepthusingthesoftwareapplicationwas27.4mmanditwas26.6mmonaverageaccordingtomeasurementsontheX-ray.Inonecaseweusedanevenshorterelectrode.Conclusion:TheresultssuggestagoodcorrelationbetweentheinsertiondepthspredictedpreoperativelyusingthesoftwareapplicationandcalculatedpostoperativelyusingtheX-ray.TheinsertionlengthpredictedbysoftwarewasalwayslongerthanthatcalculatedonXray. AbstractID:344PosterNumber:115Title:CochlearImplantation-LessonsfromourDeceasedPatientsAuthors:DavidLow,MBBS,DavidShipp,MAFAAA,GeorgeKurien,MDFRCSC,TrungLe,MDFRCSC,JosephChen,MDFRCSC,VincentLin,MDFRCSC;Otolaryngology-HeadandNeckSurgery,SunnybrookHlth.Sci.Ctr.,Toronto,Canada.Abstract:Title:Cochlearimplantation–LessonsfromourdeceasedpatientsIntroductionGiventheincreasedprevalenceofadultcochlearimplants,therewillinevitablybeearlymortalityinsomerecipients,witharesultantshortdurationofutilization.Theoutcomeandutilityofcochlearimplantsinthesepatients,manyofwhomareelderlyorwithsignificantcomorbidity,remainsdebatable.Ourobjectivewastoreviewtheoutcomeandutilityofcochlearimplantationinthisgroupofpatients.MethodsAsearchofthecochlearimplantdatabaseofatertiaryhospitalwasperformed.Patientswhodiedintheyears2011to2016wereidentified.Thesepatientswerefurtherstratifiedbasedontheirdurationofutilization.Theirelectronicandpaper-basedrecordswerereviewed,anddatawascollected.Specificoutcomemeasuresanalyzedincludesurgicalandanestheticcomplications,postoperativespeechperceptionscoresandquality-of-life(QOL)measures(SF36andHHIscores).Results80patientswereincludedinourstudy.Themeanageatimplantationwas69yearsandmeanageofdeathwas76years.Ofthosewithavailabledata,theHINT-Qscoresobtainedwerecomparabletothoseintheaverageadultcochlearimplantrecipient.TheirpostoperativeHHIscoresshowedacorrespondingimprovementbuttheirSF36scoresdidnotreflectanimprovementintheiroverallQOL.Complicationsarerare.Conclusion


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Thisreviewofourdeceasedpatientssuggestthatdespiteashorterdurationofuse,cochlearimplantationisstillofbenefitandsafetoperforminelderlypatientsandthosewithsignificantcomorbid.ThelackofimprovementintheiroverallQOLislikelyconfoundedbytheirpoorerstateofhealth.AbstractID:346PosterNumber:157Title:MusicPerceptionandListeningwithElectricHearingAuthors:ChhabinavKumar,MASLP,PadmaPriyaD,MASLP,SreevidyaSherla,MASLP,AnirbanDasgupta,Au.D;AUDIOLOGY,HELENKELLERSINSTITUTEOFSPEECH&HEARING,SECUNDERABAD,India.Abstract:Introduction:MusicandSpeech,themostcomplexprocessesofsoundmadebythehumanspecies,formanimportantpartofmanypeople’slives.Musicperceptiondependssolelyonintactspectralcue(Yucel&Mediterr,2006).Oneofthemajordifferencebetweenspeechandmusicisthedistributionofspectralenergy(Boldue&Jonathan,2006).McDermott,2004-reportedthatperformanceonrhythmicpatternperceptiontaskswassimilarforimplantusers&normallyhearinglisteners.Manyimplantusersdescribemusicasunpleasantordifficulttofollowasenjoymentofmusiciscloselylinkedtotherecognitionofafamiliarsongormelody.TheabilitytoidentifyfamiliarmelodiesisoneofthemostcommonassessmentsofCI-mediatedmusicperception.Whenpost-linguallydeafenedCIusersarepresentedwithpreviouslyfamiliarmelodies.CIrecipientsareconsistentlyimpairedwhencomparedtonormalhearingsubjects.Thisimpairmentisreducedwiththeadditionofvocallyricsandmusicalaccompaniment(Shin,etal.,2003).Methods:FivechildrenwithCIwereincludedinthestudy.Fiverhymeswereselectedwithlyricsandwerepresentedintwomodes,theinstrumentalversionandelectronickeyboard.Theresponsesobtained.Results:Alldidnotenjoylisteningtomusicwiththeirdeviceand3ofthempresentedlowerscoresoflisteninghabitsafterimplantation.Resultsindicateawiderangeofsuccesswithmusic.Musicalenjoymentisinfluencedbythelisteningenvironmentandfeaturesofthemusic.3subjectsshowedgoodabilitytorecognizerhymeswithinstrumentalaccompanimentbutpoorabilityanelectronickeyboardwithoutverbalcues,indicatingthattheywererecognizingtherhymesbyverbalcuesratherthanbymusicalqualitiessuchastonesandmelodicintervals.Conclusion:Trendsinthepatternsofcorrelationbetweenspeechandmusicperceptionsuggest,musicpatternsaredifferentiallyaccessibletoCIusers.Newprocessingstrategiesmayimprove.Musicremainsanextremelychallengingcategoryofauditorystimuliforimplantusers.Surveysofcochlearimplantusers’musiclisteninghabitsindicatethataquietlisteningenvironmentandpre-existingfamiliaritywiththemusiccorrelatewithanincreasedenjoymentofmusic. AbstractID:347PosterNumber:50Title:RacialDisparityinAgeofInitialCochlearImplantationinChildren:ALocalandNationalPerspectiveAuthors:CarlynM.Atwood,BS,MeredithA.Holcomb,AuD,ShaunA.Nguyen,MD,DavidR.White,MD;Otolaryngology-Head&NeckSurgery,Med.Univ.ofSouthCarolina,Charleston,SC.Abstract:Introduction:Agrowingbodyofevidencesupportsimprovedspeech,language,anddevelopmentaloutcomesincongenitallydeafchildrenwhoundergocochlearimplantation(CI).The


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purposeofthisstudyistodeterminewhetherdisparitiesexistinageofinitialCIinourlocalpopulationandinanationalpediatricsurgicaldatabase.Methods:The2012-2014AmericanCollegeofSurgeonsNationalSurgicalQualityImprovementProgram-Pediatric(NSQIP-P)ParticipantUseDataFileswerequeriedforcaseswithCurrentProcedureTerminology(CPT)codeforcochlearimplantation(69930)andagelessthan3yearsatthetimeofimplantation.Also,alocaldatabasecontainingCIcasescollectedfromasingle,academicinstitutionintheUSfrom2000-2016wasevaluated.CasesinthelocalCIdatabasewereincludedifthepatientwaslessthan3yearsoldatthetimeofinitialimplantation.CIrevisionsandpatientswithadiagnosisofauditoryneuropathyspectrumdisorderwereexcluded.Onlythefirstearwasincludedwhenthepatientunderwentsequentialbilateralimplantation.Themedianageatimplantationwascomparedacrossavailabledemographicfactors.Duetonon-normaldistributionofthedata,theMann-WhitneyUtestandtheKruskal-WallisHtestwereusedtocompareageofimplantationbetweengroups.Results:Therewere889casesevaluatedfromNSQIP-Pdatabase,withamedianageatimplantationof566days.Thepopulationwasprimarilywhite(N=649).PatientsidentifiedaswhiteunderwentCIatayoungermedianage(545days)comparedtononwhitepatients(641days).Theagedistributioncomparisonshowedthatthewhitecohortmeanrankwassignificantlylowerthanthenonwhitegroup(p=0.001,MannWhitneyUtest),indicatingthatwhitesubjectsunderwentimplantationatasignificantlyyoungerage.Ourinstitutionaldatabaseincluded129patients,70ofwhichidentifiedaswhite.Inthisdatabase,childrenidentifiedaswhitereceivedtheirfirstCIatayoungermedianage(419days)comparedtotheirnonwhitepeers(609days).Thewhitegrouphadasignificantlylowermeanrankcomparedtothenonwhitegroup(p=0.009,Mann-WhitneyUtest),againdemonstratingthatwhitepatientswereimplantedearlierthantheirnonwhitepeers.Whenthesamepatientswereanalyzedbyprimarypayer,therewasnosignificantdifferenceinthemeanrankbetweenthosewithMedicaid(medianage=511days),Tricare(medianage=402days),orprivateinsurance(medianage=475days;p=0.768,IndependentSamplesKruskal-WallisTest).BecausetheNSQIP-Pdatabasedoesnotincludeinformationonpayersource,itcouldnotbeevaluatedinthisnationaldatabase.Conclusion:InboththeNSQIP-Pdatabaseandourlocalpopulation,nonwhitechildrenunderwentCIroughly3-6monthslaterthantheirwhitepeers.Inourlocaldatabase,thisdisparityisnotdrivenbyprimarypayer.Furtherstudiesarerequiredtoidentifyunderlyingcausesofthisdisparity. AbstractID:348PosterNumber:33Title:AnAnalysisforInformationandExpectationsofParentsofaChildwithCochlearImplantAuthors:AyseSanemSahli,PhD1,RabiaKucuk,Msc2,MesutKaya,MD3;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAINIGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FONEMSPECIALTRAININGCENTER,ANKARA,Turkey,3OZELILGIENTHOSPITAL,ANKARA,Turkey.Abstract:Introduction:Theaimofthepresentstudywastoanalyzeinformationandexpectationsofparentsofthechildrenbetween1and12yearsofagewhohadhearinglossandcochlearimplantation(CI)withoutanyadditionaldisability.Oneoftheobjectiveswastousethedataobtainedthroughoutthestudytoincreaseservicesandsupportbeforeandafterthecochlearimplantationprocedurethroughtheinformationgatheredfromtheparents.Methods:"Family/ChildGeneralInformationForm"andTurkishversionof"ParentApproachtoChildrenwithCochlearImplantation"whichisusedatinternationalplatformand"InformationandExpectationAssessmentFormforParentsWhoHaveChildwithCochlearImplant"whichwasadoptedtoourcountry


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wereused.Totally48questionsincluding19questionsaboutpreoperativeperiodofcochlearimplantationand29questionsaboutpostoperativeperiodofcochlearimplantation.Intheresearchgroup,111parents(motherorfather)whohaveachildbetween1and12yearsofagewithCIwithoutadditionaldisabilityotherthanhearinglosswereenrolled.Apvalueof0.05wasdeterminedasasignificanceleveltointerpretalltestresultsandsignificancewasdeterminedatp<0.05level.Results:Asaresultofourresearch,mainsourceofinformationfortheparentswhousemanyinformationresourcesaboutcochlearimplantwasaudiologists(63.1%).Inthepresentstudy,effectsofeightdifferentvariablesonthequestionsaskedaboutpreoperativeandpostoperativeperiodofcochlearimplantationandstatisticallysignificantcasesweredetected(p<0.05).Accordingtothefindingsobtained,genderwasfoundsignificantlyeffectiveonschoolattendanceofthechild,academicskilllevelgainedaftercochlearimplantation,consideringuniversityhospitalsasguidingandsupportiveinstitutionsforcochlearimplantationprocedures.Conclusion:Attheendofthestudy,satisfactionleveloftheparentsandchildrenaboutcochlearimplantwasfoundhigh.Althoughtheparentsfindtheinformationbeforecochlearimplantationsufficient,trainingaboutcochlearimplantdeviceandmoredetailedinformationabouttheproceduremayaffecttheirexpectationsaftertheimplantation.Webelievethatourstudywouldhelptodetectinformationandexpectationstatesoftheparentsaboutcochlearimplantation,tounderstandneedsandexpectationsoftheparentsbetteranddeveloptheservicesprovidedtothepatientsandtheirfamilyduringdifferentstagesofcochlearimplantprocess AbstractID:349PosterNumber:185Title:CochlearImplantationinChildrenwithBorderlineHearingLossAuthors:EunjungNa,MSc,PhD(c)1,ElizabethFitzpatrick,PhD1,JoAnneWhittingham,Msc2,JanetOlds,PhD3,RosemarySomerville,BA,LSLSCert.AVT3;1RehabilitationSciences,Univ.ofOttawa,Ottawa,Canada,2Children'sHosp.ofEasternOntarioRes.Inst.,Ottawa,Canada,3Children'sHosp.ofEasternOntario,Ottawa,Canada.Abstract:Introduction:Determiningcochlearimplantcandidacycriteriahasproventobeachallengeduetosignificantimprovementsinmedicalandtechnology.Asresult,childrenwithresidualhearingareincreasinglybeingconsideredforcochlearimplantationhowever,decision-makingcanbedifficultandtendstooccuronacase-by-casebasis.Theaimofthispopulation-basedstudywastoinvestigatecochlearimplantcandidatesinoneregionofCanadawhoseaudiologicalprofilewasbetterthantypicalaudiologiccochlearimplantcandidacycriteria.Weexaminedtheirclinicalprofilesincludingetiology,ageatdiagnosis,timetoimplantation,ageatimplantation,andpre-implantspeechperception/auditoryfunction.Inaddition,thisstudyexaminedwhethercochlearimplantationoccurredlaterforthesechildrenandthereasonsaffectinglateragesatimplantation.Methods:Inthisretrospectivestudy,wereviewedthemedicalchartsforallchildrenwhoreceivedcochlearimplantsineasternOntario,Canadafrom1993to2016.Weextractedmedicalandaudiologicinformationforallchildrenwhosepre-operativePTAthresholdwasbetterthan90dBHL.Inadditiontodegreeofhearingloss,wealsodocumentedotherfactorsrelatedtoageatimplantationfortheseborderlinechildren.Results:Atotalof348childrenunderwentcochlearimplantsurgeryfrom1993to2016intheeasternOntarioregion.Ofthese,39(11.2%)childrenhadresidualhearingwhichwasbetterthantypicalcochlearimplantcandidatecriteria.Since2010thesechildrenrepresent30to40%ofchildrenimplantedeachyear.Themedianageofcochlearimplantationforthesechildrenwas49.3months(interquartile


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range:31.2,84.6)months,andthemedianpreoperativePTAwas85.0dBHL(interquartilerange:78.3,88.3).Ofthe39children,11(28.2%)presentedwithauditoryneuropathyand15(38.5%)hadknownprogressivehearingloss.Theremaining33.3%ofthechildrenpresentedwithotherfactorsthatinfluenceddecisionmakingsuchasspeech-languagedevelopmentconcerns.Conclusions:Inthispopulation-basedstudy,11.2%ofchildrenimplantedpresentedwithhearinglevelsoutsidetypicalaudiologiccriteriaforimplantation.Primaryreasonsforproceedingwithlatercochlearimplantinterventionforthemajorityofthesechildrenwererelatedtothepresenceofauditoryneuropathyandprogressivehearingloss. AbstractID:351PosterNumber:135Title:BilateralCochlearImplantation-DoPatientswithDevicesfromDifferentManufacturersPerformWorsethanthosewithDevicesfromtheSameOne?Authors:JafriKuthubutheen,MBBS(Hons),DavidLow,MBBS,KariSmilsky,MCISc,DavidShipp,MAFAAA,GeorgeKurien,MDFRCSC,TrungLe,MDFRCSC,JosephChen,MDFRCSC,VincentLin,MDFRCSC;Otolaryngology-HeadandNeckSurgery,SunnybrookHlth.Sci.Ctr.,Toronto,Canada.Abstract:Title:Bilateralcochlearimplantation-Dopatientswithdevicesfromdifferentmanufacturersperformworsethanthosewithdevicesfromthesameone?IntroductionBilateralcochlearimplantationinadultsisgainingpopularity.Inourcohortofbilateralsequentialimplantrecipients,somehavereceivedimplantsfromdifferentmanufacturersduetothetenderingprocess.Ourobjectiveistocomparetheoutcomesinthesepatientstothosepatientswithimplantsfromasinglemanufacturer.MethodsSpeechperceptionoutcomesandqualityoflifemeasureswerecollectedprospectivelyinourbilateralcochlearimplantrecipients.ResultsTherewasnosignificantdifferenceinspeechperceptionoutcomesandqualityoflifemeasuresbetweenthe2groupsinourcohortofpatients.ConclusionOurresultssuggestthatpatientswhohavebilateralcochlearimplantsfromdifferentmanufacturersperformjustaswellasthosefromthesamemanufacturer.Thismaymeanthatpatientsanddoctorsneednotremainwiththesamemanufacturerwherethereareconstraintswithcostandavailability. AbstractID:353PosterNumber:2Title:AssessmentofqualityoflifeinadolescentswithcoclearimplantAuthors:HelenaG.F.Alves,Graduation,GraçaC.C.Oliveira,Masters,JorgeH.F.Martins,Masters,LuísF.S.Silva,Masters,PedroTomé,Graduation;ORL-CochlearImplantsFunctionalUnit,CHUC,Coimbra,Portugal.Abstract:Introduction:Withthisstudyitwaspretendedtounderstandtheinfluenceofthecochlearimplant(CI)inadolescents,implantedatayoungage,qualityoflive.


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Methods:ConsideringallthemultidimensionalinvolvementoftheCI,itwasconsideredofgreatimportancetoevaluatenotonlytheeffectivenessregardingtheauditoryandcommunicativeabilitiesofthecochlearimplant,butalsoaspectsrelatedtotheestablishmentofaffectiverelations,autonomyindailytasksandemotionalchangesthatmayaffectthequalityoflifeofyoungcochlearimplantsrecipients.Inthisstudyitwasrequestedto50adolescents(11to20yearsold)withseveretoprofoundcongenitalbilateraldeafnessandCIuserstoanswerthequestionnaire"QualityoflifeinadolescentswithCI-QVAPIC".Thequestionnaireconsistsof33closedandsimplequestions,groupedintosixdimensionsandtherespondentmustchoosetheanswerqualitatively.ThecollecteddatawereanalyzeddescriptivelyinprogramSPSS17.Results:Ofthe50youngrespondents,78%areverysatisfiedwiththeoutcomeoftheirCIand52%reportthattheirCIhaslittleinfluenceonthelimitationsoftheirdailyactivities,beingthat38%statesthatithasnodifficultyinestablishingrelationswithotherand58%thattheCIdoesnotaffecttheirparticipationinsocialactivities.Mostindividualsreporthavinglittledifficultyunderstandingtheworldthatsurroundsthemand40%reportedthattheyparticipatedquitefrequentlyincommunicativeactivitieswithfriends.Communicatingwithstrangersisdifficultfor44%oftherespondents.TheCIisnotseenasafactorthatalterstheirphysicalappearancefor56%oftheindividualsand50%oftherespondentsdon’ttakeanyspecialcaretoconcealtheirCI.Halfoftherespondentsconsiderthatpublicservicesarenotpreparedforthehearingimpaired,butonly38%reportthattheyrarelyfeelexcluded.Finally,86%considerhavingagoodorverygoodqualityoflife.Conclusion:TheadolescentsfeelthattheCIallowsthemgoodcommunicationandpersonalandsocialintegration,notfeelinglimitedbyitsuse,althoughtheyconsiderthatthesocietyisnotpreparedforthehearingimpaired.ForthemajorityoftheadolescentsinterviewedtheCIallowsagoodqualityoflife. AbstractID:355PosterNumber:136Title:UnilateralCochlearImplant:ImpactonQualityofLifeMeasuredWiththeGlasgowBenefitInventoryAuthors:DavidLow,MBBS,HosamA.Amoodi,MDFRCSC,DavidShipp,MAFAAA,GeorgeKurien,MDFRCSC,TrungLe,MDFRCSC,JosephChen,MDFRCSC,VincentLin,MDFRCSC;Otolaryngology-HeadandNeckSurgery,SunnybrookHlth.Sci.Ctr.,Toronto,Canada.Abstract:Title:TheUtilityoftheGlasgowBenefitInventoryinUnilateralAdultCochlearImplantRecipientsIntroductionUnilateralcochlearimplantationinadultpatientswithbilateralseveretoprofoundhearinglossisnowconsideredthestandardofcare.OurobjectivewastousetheGlasgowBenefitInventory(GBI)toquantifytheimprovementinqualityoflifeinourpatients.MethodsThiswasaprospectivestudyinatertiarycarecenter.Atotalof500post-linguallydeafenedadultswereenrolledinthestudy.Theirpre-andpost-operativeGBIandHINTscoreswerecollectedandanalysed.ResultsInterimanalysisofthefirst224patientsshowsasignificantimprovementinthetotal(+39.77),generalhealth(+53.53)andsocial(+23.36)scoresoftheGBI.Theimprovementinphysicalscoreswerenotsignificant.ThetotalandgeneralhealthscoresoftheGBIcorrelatedsignificantlywiththepostoperativeHINTscoreandthechangeinHINTscore.Conclusion


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TheGBIreflectstheimprovementinquality-of-life(QOL)afterunilateralcochlearimplantationinadultpatients.ThisfindingconcurswithotherQOLinstrumentsandprovidesyetanotherQOLmeasureincochlearimplantrecipients. AbstractID:356PosterNumber:22Title:CochlearImplant(Re)habilitationinDevelopingCountryofIndonesiaAuthors:EkaK.Hikmat,MSpecEdProgram,RumahSiputIndonesiaFndn.,SouthJakarta,Indonesia.Abstract:Introduction:BasedontherecentUnitedNation'sestimate,thecurrentpopulationofIndonesiaisabout262,225,009billion.ThismakesIndonesiathe4thmostpopulatedcountriesintheworld.Themajorityofthisdemographiclivesin6,000ofthe17,508Indonesianislands.ThefirstcochlearimplantsurgeryinIndonesiawasconductedinDecember1999.After17yearssincethefirstsurgery,areviewontheprofileofcochlearimplantrecipientsandhowtheyaccess(re)habilitationserviceswasneededtomapthecurrentconditionsaswellastoidentifyfuturegoalsofhearingproblempreventionandinterventioninadevelopingcountrylikeIndonesia.Theprimaryobjectiveofthisstudyistocharacterizetheprofileofrecipientsofcochlearimplantandhowtheyaccess(re)habilitationservicesinIndonesiathroughanalysisoftheirpersonaldatafromhearing(re)habilitationcentersweretheyareenrolledacross4majorcitiesinIndonesia.ThedataanalysiswasbasedfromtheperiodofApril2012toDecember2016.Theauthorconsideredthefollowingaspects:etiologyofdeafness,degreeofhearingloss,age,sex,pre-andpost-lingualproportionofpatients,previoususeofahearingaid,timeofscreeninganddiagnosis,presenceorabsenceofotherdisabilities,where,whenandhowthecochlearimplantrecipientsaccessed(re)habilitationservices.Methods:Weuseddescriptivemethodof318casesandexaminedetiologicalaspectsofdeafness,degreeofhearingloss,age,sex,pre-andpost-lingualproportionofpatients,previoususeofahearingaid,timeofscreeninganddiagnosis,presenceorabsenceofotherdisabilities,where,whenandhowthecochlearimplantrecipientsaccessed(re)habilitationservices.Datawerecollectedfromrecipientpersonaldatasubmittedduringtheirenrollmentinhearing(re)habilitationcentersin4majorcitiesinIndonesiafromApril2012toDecember2016.Results:Theetiologyofdeafness,degreeofhearingloss,age,sex,pre-andpost-lingualproportionofpatients,previoususeofahearingaid,timeofscreeninganddiagnosis,presenceorabsenceofotherdisabilities,where,whenandhowthecochlearimplantrecipientsaccessed(re)habilitationserviceswillbedescribed.Conclusion:ThisstudyallowedustomapthecurrentconditionaswellasidentifyfuturegoalsofhearingproblempreventionandinterventionindevelopingcountryofIndonesia.Moredetaileddescriptionofthiswillbepresented. AbstractID:360PosterNumber:190Title:AuditoryBrainstemImplantinChildrenwithCochlearNerveAplasiaandHyplopasiaAuthors:NormaPallares,M.A.,VicenteDiamante,PhD;CentrodeImplantesCocleares"ProfesorDiamante",CABA,Argentina.


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Abstract:Introduction:TheAuditoryBrainstemImplant(ABI)systemisdesignedtorestoreadegreeofhearingsensationtopatientswhohavebilateraldysfunctionoftheauditorynerve.Thisisachievedbydirectelectricalstimulationofthecochlearnucleuscomplexinthebrainstem.ChildrenwithprofoundhearinglosscanbehabilitatedwithaCochlearImplant(CI).Aconditionforsuccessfulauditorystimulationisadevelopedcochleaandthepresenceofanadequatenumberofcochlearnervefibers.BasedontheresultsofAuditoryBrainstemImplant(ABI)innontumoraladults,begantheuseofthisdeviceinchildrenwithcochlearnerveaplasia.Methods:Thisisaretrospectivecasereviewstudy.Eightchildrenwithcochlearnerveaplasiaandonechildwithhypoplasiaofthecochlearnerve(3yearsold)underwentretrosigmoidapproachforplacementoftheABI.Childrenunderwentotological,radiological,audiological,neurological,psychologicalevaluationspre-ABI.IneightchildrentheMRIshowedbilateralcochlearnerveaplasiaandonechildhadbilateralhypoplasiaofthecochlearnerve.InthischilditwasperformedCIinthebetterearwithoutaudiologicalresults,soitwasmadeanABIinthecontralateralside.ThecorrectpositioningoftheelectrodeswasmonitoredthroughtheElectricalAuditoryBrainstemResponses(eABR).Itwasalsousedashelpinprogrammingthedevice.TheaudiologicaloutcomeswereevaluatedusingtheCIDSpeechPerceptionCategories(Geers,1994)throughtestsoftheLatinAmericanProtocol,FreeFieldwithABI,it-MAISandMAISscales.Results:Nosurgicalorpostoperativecomplicationswereobserved.Allchildrenusethedeviceinapermanentway.Theyshowvariableandpositiveauditoryimprovementsinspeechperceptionthroughspecifictestsandinit-MAISandMAISScalesthroughtheparents’opinion.ChangesinqualityoflifewereevaluatedthroughtheGlasgowInventoryTest.Statisticalstudieswillbepresented.Conclusion:Thisstudysuggeststhatsurgery,programming,auditoryandlanguagehabilitation,parentalinvolvement,ageatimplant,otherhandicaps,arevariablesthataffectresults.Speechrecognitioninopensetwasobserved. AbstractID:362PosterNumber:72Title:SpontaneousMigrationofaLateralWallElectrodeNecessitatingReimplantationAuthors:SamuelGubbels,MD,NyssaF.Farrell,MD,DarcyStrong,AUD;Otolaryngology,Univ.ofColorado,Aurora,CO.Abstract:Spontaneous,SignificantMigrationofaLateralWallElectrodeNecessitatingRe-implantationIntroduction:Migrationofcochlearimplantelectrodeshasbeenreportedtooccurinupto9%ofpatientsandappearstooccurprimarilyinlateralwallelectrodes.Migrationgenerallyoccursinadelayedfashion,spontaneouslyandinvolvesonly1-6electrodes.Methods:Retrospectivecasereportofsurgical,radiologicalandaudiologicaldatawithliteraturereview.Results:Migrationof10contactsofalateralwallelectrodeoccurredwithoutprecipitatingheadtrauma.Migrationbecamefirstevidentat3monthsafteruneventfulimplantationandactivation.Initialimplantationofallelectrodeswasconfirmedwithintraoperativeimpedanceandneuralresponsetestingalongwithnormalelectrophysiologicalandfunctionalperformanceinthepostoperativeperiod.Alteredimpedancesanddecreasedfunctionalperformancewerethesentineleventswhichthenpromptedcomputedtomographicevaluationdemonstratingmigrationofhalfoftheelectrodearrayoutofthecochlea.Migrationwasconfirmedatrevisionsurgeryandthepatientwasreimplantedwithanewdeviceandperimodiolararrayuneventfully.Atre-activationthepatienthasrestorationofhisperformancetolevelssimilartothosepriortothemigrationhavingoccurred.Thepatient’sresidualhearingthatwaspreserveduponinitialimplantationwaslostuponreimplantation.


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Conclusion:Migrationofcochlearimplantelectrodesgenerallyislimitedtoasmallnumberofelectrodesandmaynotnecessitatereimplantation.Moresignificantmigrationoflateralwallelectrodecontactscanoccurspontaneouslyasinourpatientandcansignificantlyimpairbenefitfromthedevicenecessitatingreimplantation.Reimplantationwithaperiomodiolarelectrodedesigncanrestorefunctionalbenefitofthedevicebutmaycompromiseanyacoustichearingthatwaspreserveduponinitialimplantation. AbstractID:367PosterNumber:196Title:ConsideringTreatmentOptionsforChildrenwithUnilateralSeveretoProfoundHearingLossAuthors:BernadetteRakszawski,AuD1,JamieCadieux,AuD1,JanetVance,AuD1,MeghanHunt,MA1,AndreaGregg,MS1,JillFirszt,PhD2,RuthReeder,MS2,LisaDavidson,PhD2,JudithLieu,MD2,KeikoHirose,MD2,CraigBuchman,MD2,RichardChole,MD2;1St.LouisChildren'sHosp.,St.Louis,MO,2WashingtonUniv.Sch.ofMed.,St.Louis,MO.Abstract:Introduction:Unilateralsensorineuralhearinglossoccursin3-6%oftheschool-agepopulation.Researchoverthepast30yearshasdocumentedthatthesechildrenareathigherriskforspeechandlanguagedelays,educationaldifficulties,andbehavioralconcerns.Childrenwithunilateralseveretoprofoundhearingloss(SPHL)andthosewithasymmetrichearingloss,thatisoneearwithSPHLandtheotherwithmildtomoderatehearingloss,havedocumenteddifficultieswithsoundlocalizationandunderstandingspeechinnoise.Giventhatbestpracticeforchildrenwithbilateralhearinglossisbilateraldevicefitting(hearingaidsorcochlearimplants),morefamiliesandprofessionalsareseekingtreatmentforunilateralandasymmetrichearinglossinchildren.Inaddition,cochlearimplantationoftheSPHLearisbeingdiscussedasanoptioninsomecases.Thepurposeofthisstudywasthetrialofaprotocoltoguidecliniciansandfamiliesthroughthevarioustreatment(ornon-treatment)options.Methods:Currentclinicalinterventionsinclude:Observation,Osseointegratedimplants,Contralateralroutingofsignalhearingaids,andhearingassistivetechnology.ThebenefitsandlimitationsvaryamongtheseoptionsaswellasamongchildrenofvariousageswiththesingleexceptionthatnoneprovidesoundstimulationtotheSPHLear.Understandingthepotentialbenefitsandlimitationsforaspecificchildispivotalforcliniciansandfamiliestodeterminethebesttreatmentoption.Theimplementedprotocolfocusedonfamily/childeducation,trialperiods,observationandbehavioralmeasures.Results:Useoftheprotocolhashelpedfocusevaluationoftreatmentoptionsandassessoutcomes.Individualcasesandresultswillbesharedforchildrenwhoconcludedthetrialwithobservationonly,asoftbandBAHA,aCROShearingaid,oracochlearimplantforthepoorear.Resultsincludeadiscussionoftestconditionsandmetricstoconsiderwhenhearingispresentinasingleear.Conclusion:Theneedsofeachchildandfamilyvaryandthereisnosingletreatmentoptionthatisoptimalforallchildren.Evaluationofavailableoptionsisparticularlycriticalifcochlearimplantationisconsideredforchildrenwithunilateralorasymmetrichearingloss. AbstractID:368PosterNumber:36Title:LanguageSamplingPracticeswithChildrenwhoareDeafandHardofHearingAuthors:MeganShannahan,B.S.,KristinaBlaiser,PhD,CCC-SLP;CommunicationSciences&Disorders,IdahoStateUniv.,Meridian,ID.


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Abstract:Introduction:Languagesamplingcanbeaninvaluabletoolforspeech-languagepathologiststoassessthecommunicativeoutcomesofchildrenwhoareDeaf/Hard-of-Hearing.Thisisparticularlyimportantas,inisolation,normreferencedassessmentsarenotsensitivetoidentifyerrorpatternsintheuseoromissionofhighfrequencynounandverbmorphology,errorsthatarecommoninchildrenwithhearingaidsandcochlearimplants.However,arecentstudyreportsthatprofessionalswhoworkwithchildrenwithcochlearimplantsdonotfrequentlyuselanguagesamplingandmostoftenusestandardizedassessmentsandcheckliststoevaluateandmonitorprogressofchildrenwithcochlearimplants(Neussetal.,2013).Thepurposesofthisstudyisto1)identifycommonlanguagesamplepracticesofprofessionalswhoworkwithchildrenwhoareDHH,2)identifyhowprofessionalsareusinginformationgainedfromlanguagesamplesand3)outlinecommonpracticesandproposeaclinicalprotocolforlanguagesampleuseMethods:Anelectronicquestionnairewasdisseminatedtoaudiologists,SLPsandEducatorsoftheDeafintheUnitedStates.ParticipantresponseswerecodedinanExcelfileandcheckedforcompleteness.DescriptivestatisticswereusedtoanalyzetrendsResults:Atotalof168participantsparticipatedinthesurvey(16.8%responserate).Approximately77.3%(n=129)ofparticipantsreportedthatover75%oftheircaseloadwaschildrenwhoareDHH.Additionally,75%(n=123)oftheparticipantsreportedthattheyhadworkedwithchildrenwhoareDHHforover10years.Mostparticipants(n=153;91.6%)reportedthattheyuselanguagesamplingasapartoftheirinterventionwhenworkingwithchildrenwhoareDHH.Despitethis,approximatelyhalf(n=63;51.2%)ofparticipantsreportedusingnorm-referencedtestingmostoftenwhenevaluatinglanguageofchildrenwhoareDHH.Whenaskedhowtheyuseinformationobtainedfromlanguagesamples,participantsreportedmostoftentomonitorprogressofclients(n=79;62.7%),andtosetgoalsforclients(n=75;60.0%).Participantsoverwhelminglyagreedthattheyfoundlanguagesamplesusefulwiththepopulationstheyserve(n=130;94.9%)andthattheycouldofferinformationthatnorm-referencedassessmentscouldnotprovide(n=133;97.1%),despitethembeingmostpopularlyusedforevaluationofchildrenwhoareDHH.However,despitetheseadvantages,theywereleastlikelytouseinformationobtainfromlanguagesamplestodetermineeligibilityofservices(n=27;23.0%).Conclusion:Resultsfromthecurrentstudyreflectthatmostrespondentsbelievelanguagesamplesofferauniquelookintoachild’slanguagedevelopmentthatnorm-referencedassessmentsarenotsensitiveenoughtodetect.Despiteprofessionals’frequentuseoflanguagesamplestoevaluatelanguageabilitiesandmonitorprogress,thelackofstandardizationmaycontributetotheincreaseduseofnorm-referencedtestingtodetermineeligibilityforchildrenwhoareDHH.ItisproposedthattheresultsofthisstudymayhelpestablishastandardizedlanguagesampleprotocolthatwouldguidepracticesintheuseoflanguagesampleswithchildrenwhoareDHH. AbstractID:369PosterNumber:23Title:SynchronousversusMetachronousCochlearImplantationinSmallChildren-DoesitMatter?Authors:LauraC.Holtmann,M.D.1,PiaHasskamp,M.D.1,HeikeBagus,Audiologist2,StephanLang,Ph.D.,M.D.1,SonjaDockter,M.D.1,DianaArweiler-Harbeck,M.D.1;1EarNoseThroat,Univ.Hosp.Essen,Essen,Germany,2CochlearImplantCentrumRuhr,Essen,Germany.Abstract:Introduction:Atpresentthereisnoclearconsensusontheimpactofbilateralsynchronousversusmetachronouscochlearimplantationonhearingoutcome.Short-termandlong-termhearing


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results,speechdevelopment,durationofsurgeryandperioperativemorbidityinthesetwogroupsarecomparedupto3yearsaftercochlearimplantation.Methods:Hearingandspeechdevelopmentaftersynchronousandmetachronouscochlearimplantation(15patientspergroup,ageatimplantation4-47months)werecomparedretrospectively(6,12,24,36monthsaftersurgery).HearingthresholdsinpuretoneaudiometryandhearingresultsintheMainzeraudiometricspeechtestwerecompared.AuditiveperceptionandcommunicativeskillswerequantifiedusingthetestsofSchmid-GiovanniniandPollack.StatisticalanalysiswasperformedbyboxplotanalysisusingSPSSandExcelSoftware.Results:Meanimplantationagewas18,1monthsinthesynchronousgroupandinthemetachronousgroup20,2monthsforthefirstCIand34,6monthsforthesecondCI.Atendencyofbetterdevelopmentofspeechandauditoryskillsinthesynchronousimplantationgroupespeciallyinshorttermcomparisonwasfound,however,thiseffectwasnotstatisticallysignificant.Whencomparingtheearsindividuallythesynchronousgroupshowedsignificantlybetterresults.Totaldurationofsurgeryandanesthesiaweresignificantlyshorterinthesynchronousimplantationgroup.Conclusion:Bothapproachesleadtosignificantimprovementsofhearingandspeechdevelopment.Simultaneousbilateralcochlearimplantationallowsthereductionoftotalsurgerytimeandrequiresjustonehospitalizationandrehabilitationprocesswithcomparableperioperativecomplicationrates.Wepostulateanadvantageregardingspeechandhearingdevelopmentduetosimultaneousdevelopmentofauditorypathways.FurtherinvestigationswillconcentrateoncomparingdirectionalperceptionandhearingabilitieswithbackgroundnoisewhenchildrenreachelementaryschoolAge. AbstractID:370PosterNumber:77Title:EpidemiologicStudyofBilateralDeepDeafnessImplantedinOurCenterAuthors:djilaliaiadkhaled,MaitredeconferenceA,djilaliaiadkhaled,MaitredeconferenceA;médecine,chusidibelabbes,sidibelabbes,Algeria.Abstract:Introduction:Thecochlearimplant(IC)isusedtoallowthechildrenreachedofaneurosensorydeafnesstoacquireahearingperception,acomprehensionofthewordandlanguageacquisitionThemajorityofthesechildrenhavefactorsassociatedwiththeirprofounddeafness,whichconditionthefunctionalresults.Methods:Weundertookanexploratorydescriptiveandanalyticalstudyoveraperiodof7ansbetweenayear2008and2015inconnectionwith43childrenimplantedinourdepartmentandfollow-ups.Objectivesofthisstudy:TostudythefactorsassociatedwithbilateralprofounddeafnessinthechildrenimplantedinENTdepartmentofSidibelabbesinthewestofAlgeria:Wearestudymultiplesfactorssocio-demographicPersonal,familyantecedents:consanguinity,presenceofthesimilarcasesinthefamilyandthesiblingsClinicalfactorsaswellastheradiologicaldataofthecochleaTostudytheeffectofsomeofthesefactorsontheaudiometricandorthophonicresultsResults:Wenotedadiscretemasculinepredominance,thesexratioisof1,04boyforagirl.MiddleAgeisof3years9month,astandarddeviationof19months,withanextremeof19monthminimalandmaximumageof7years41%hadsimilarcasesinthefamily.21%oftheimplantedchildrenhadtwodeafcasesinthefamily,14%hadthreecases,twoimplantedchildrenhadfourprofounddeafnessinthefamily,andonehadsevendeafcasesinthefamily.Wenotedthepresenceoftwocasesdeafinthesiblingsin18%oftheestablishedchildren,andthreedeafpersonsormoreinthefamilyin6,98%oftheimplantedchildrenWenotedtheconceptoffeverinthepersonalantecedentsat23,26%,twocasesofmeningitiswereannounced,andpersistenceofarterialchannelamongtwopatients,04childrenhad


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hyperpyreticconvulsions.18,60%ofthesechildrenhadanotitisassociatedwithdeafnessatthetimewiththediagnosis,takendrugsduringthepregnancywasnotedat27%ofthecasesTheradiologyfindsapathologicalcochleain16%ofthepatients,cochleadeformityin14%,cochlearossificationin2%,adilationofthevestibularaqueductin7%ofthechildren,procidenceofthefacialnerveinonepatient,andprocidenceofthesidesinein12%ofthechildren.Thecongenitalcausesofdeafnesswasnotedin95,35%,53,49%aregeneticsyndromic,and32,56aregeneticnoune-syndromic,othersharethetypeacquiredin4,6%whicharepost-meningeal.Thechoiceoftheoperatedear:wasmadeaccordingtoseveralparameters:dexterity,residualhearing,andthedisordersvestibular.WeplacedaMedelimplanttodatein51%,Cochlearimplantin49%,theinsertionoftheimplantbytheroundwindowat83%andbytheopeningofthecochleostomyin16,28%,thegeyzerwasseenin9,30%.wecarriedoutanaudiometricevaluationinfreefieldandorthophonicofourpatients,theconsanguinityisadeterminingfactorinhearingperceptiontheproductionofthelanguage,therelationissignificantthePisequalto0,05,thesecondfactoristheageofimplantation,weobtainedbetterresultsamongpatientsoperatedatearlyage,a0-2years,and2-4yearsincomparisonwiththechildrenoperatedwithagemorethan4years.Conclusion:Thestudyoftheassociatedfactorswithdeepdeafnessinthechildallowstounderstandthehearingevolutionofthedeafpatients,andtoreinforceanorthophonicreeducationinamorerigorouswayinordertoimprovetheseresults. AbstractID:376PosterNumber:146Title:InfluencesofWorkingMemoryonHearingAbilitiesinCochlearImplantUsersAuthors:HannaBoenitz,M.Sc.1,BjoernLyxell,Professor2,ThomasLunner,Professor3,AndreasBuechner,Professor1,BrunoKopp,Professor4,MareikeFinke,PhD1;1DepartmentofOtolaryngology,HannoverMed.Sch.,Hannover,Germany,2LinköpingUniv.,Linköping,Sweden,3EriksholmRes.Ctr.,OticonA/S,Snekkersten,Denmark,4DepartmentofNeurology,HannoverMed.Sch.,Hannover,Germany.Abstract:IntroductionWorkingmemoryappearstobeanimportantcontributortospeechunderstanding.The“Easeoflanguageunderstanding”modelbyRönnbergandcolleagues(2013)statesthatindifficultlisteningsituations(e.g.withacochlearimplant(CI))theworkingmemoryisneededtocompensatethemismatchbetweentheheardwordandthestoredwordpattern.Inourstudyweaimedtoinvestigatetheinfluenceofauditorydistractionontheworkingmemorycapacity,whilebeingengagedinavisualworkingmemory/n-backtask.Weinvestigatedadultcochlearimplant(CI)usersbymeansofelectroencephalography(EEG).MethodsThirteenadultCIusersweretestedinthisstudy.TheEEGwasrecordedwhiletheparticipantsperformedavisualn-backtask.Participantswerepresentedwithasequenceofnumbers.Intheeasiestcondition,theparticipantshadtodecideifthenumberwasoddoreven.Inthemorecomplexconditions,participantshadtocomparethepresentnumbereithertothepreviousortheprevioustolastnumber,dependingontheloadconditionofworkingmemory.Bymeansofabuttonpress,theyhadtoindicatewhetherthetwonumberswereidentical.Duringthevisualtask,additionalauditorydistractorstimuliwerepresented.Participantswereinstructedtoignorethosestimuli.Auditorystimuliincludedstandardandnovelsounds(25%).Thenovelsoundsconsistedofdifferentenvironmentalsounds.Duetotheexperimentalsettingwecouldanalyzeauditoryevent-relatedpotentials(ERPs;


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N1aud,Novelty-P3),visualERPs(N1vis,Target-P3)andvisualERPsfollowinganovelorastandardtone.TheanalysisofthelatterERPsofferstheopportunitytoinvestigatetheinfluenceofauditorydistractiononthetaskperformance.ResultsBehavioralresultsindicateslowerandlessaccurateresponsesinthehigherloadconditions.Additionally,theresponsesfollowinganoveltoneweresignificantlyfastercomparedtothestandardtones.ThesensoryauditoryERPs(N1aud)suggestreducedamplitudesforthemoredifficultconditionandadditionallyshowedreducedamplitudesinresponseofastandardtonecomparedtoanoveltone.TheearlyvisualERPs(N1vis)alsoshowedarelationtoworkingmemorycapacity:asthetaskdemandsincrease,theamplitudedecreases.Thepost-perceptualvisualERPs(Target-P3)showedau-shapedrelationinregardtolatency.Preliminaryresultsregardingtheeffectsofdistractiondisplayedaninfluenceofworkingmemoryaswellastypeofstimulation.Visualresponsesfollowingthenovelstimuliwereincreasedtostandardtones.ConclusionBehavioralandalsovisualresultsindicatethatCIusersshowaworkingmemorymanipulation.ThereducedamplitudesoftheauditoryERPssuggestaninfluenceofworkingmemoryonhearing-notonlyforspeech,butalsofortonalstimuli.Behavioral,butalsoelectrophysiologicalresultsindicateafacilitationeffectratherthanadistractioneffectofthenovelsounds.ThenoveltonemaycauseanunspecificstateofreadinesswhichmightleadtoamodulatedERPsresponse.AllinalltheseresultsunderlinetheroleofcognitioninhearingwithCIs.FurtherinvestigationswillbeconductedincludingattemptstoalsoexpandtheseresultstoCIimplantedchildren. AbstractID:379PosterNumber:24Title:ReadySteadyGo:OptimizationofaProcess-AssessmentandPlanningforCochlearImplantationinChildrenandAdultsAuthors:RadiJonsson,MDPhD,JunisHagberg,ServiceCoordinator,YlvaDahlinRedfors,MDPhD;Otorhinolaryngology,SahlgrenskaUniv.Hosp.,Gothenburg,Sweden.Abstract:Introduction:Childrenandadultswithsevereandprofounddeafnesscanbenefitfromcochlearimplantation(CI).Candidacy,assessment,implantation,habilitation/rehabilitationandfollow-uparemadeavailablebymultidisciplinaryteams.Theteamisdependentonpre-defined,availableandtimelyprocessesinordertoprovideefficientandrelevantcare.Involvementofthepatientandsignificantothershasbeenshowntoimprovethequalityofhealthcarebyfocusingonmattersconsideredasrelevantbypatients.TheaimofthequalityimprovementprojectwastocatertospecificneedsofpatientsandparentsintheCIprocess.Afurtheraimwastoadjusttheteamprocessestopatients'needsaswellastoapre-definedmodelfromreferraltoassessmenttosurgery.Methods:Co-operationwithrepresentativesfromtworegionalpatientassociationswasinitiatedbytheCIteam.Theseformerpatientsandparentswereinvolvedinacollaborationinseveralsteps.Afocusgroupinterviewmodelwasemployedinordertoreachconsensusonqualityimprovementareasbyshareddecisionmaking.Newwrittenpatientinformationwasgeneratedandco-designed.Anagreementwasmadeonacceptabletimespansbetweenreferralandassessment,assessmentandmultidisciplinaryteammeeting,meetingandvisitforCIdecision,andtotimeforsurgery.Thetimespanswereinaccordancetogeneralnationalguidelines.Theworkschedulesoftheprofessionalsworkingwithintheimplantteamwereadaptedtothemutuallyagreed-onprocesses.Aquestionnaire,adopted


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fromtheSwedishnationalpatientsurvey,wassenttoconsecutivepatientsandsignificantothers(parents)sixmonthsafterCIsurgeryorcessationoftheassessmentprocess.Results:Newpatientinformationpamphletswerewritten,oneforparentsandoneforadults.Thequestionnairewasansweredbythirty-ninepatients/parents,witharesponserateof79%.Allpatients/parentsreportedthattheyhadreceivedbothwrittenandverbalinformation,andthattheinformationontheprocessstepswasverygoodtoexcellent.Theinformationsharedwasdescribedasbeinginagreementwiththeactivitiesduringtheassessmentprocess.Thepersonaltreatmentbytheprofessionalswasreportedastotallyrespectfulandconsiderateby95%.Thepatientsandsignificantothersstatedthatrisksandadvantageswiththeimplantsurgeryhadbeenexplainedinacomprehensibleway,andthatonefeltinvolvedinthedecisionofsurgery/nosurgery(fullyparticipatedinthedecision,95%).Theparentsofthepediatricpopulationratedtheirsatisfactionsomewhathigherthantheadultgroup.Forthepediatricgroup,themediantimefromreferraltoassessmentwas34days,fromassessmenttodecisionforCI14days,andfromdecisiontosurgery43days.Themediandaysfortheadultswere72,14and130.Anumberoffactors,bothwithintheCIteamaswellasthepatients,wereidentifiedforoutlyers.Conclusion:Shareddecisionmakingbypatientparticipationcancontributetohigherqualityinhealthcareprovisionandsatisfaction.Thisproject,"Ready,Steady,Go"utilizedtheopportunityofcollaborationinordertoimproveinformation,decision-making,satisfaction,waittimeandinternalworkprocesseswithinaCIteam.Thefocusgroupinterviewmodelcanbeusedtoco-designandfurtherimplementqualityimprovementactivities.Evaluationoftheprojecthasshownpositivefeed-backfrompatientsandgivesnewinsightsforfurtherimprovement. AbstractID:380PosterNumber:53Title:ElectrocochleographyforMonitoringofResidualHearingduringandafterCochlearImplantationviaIntracochlearElectrodeContactsAuthors:AndreasBuechner,PhD1,SabineHaumann,PhD1,BenjaminKrueger,MSc1,ThomasLenarz,MD,PhD2;1HearingCenter,Med.Univ.ofHannover,Hannover,Germany,2Med.Univ.ofHannover,Hannover,Germany.Abstract:Introduction:Inclinicalotology,electrocochleography(ECochG)isawell-establishedtoolforevaluatingtheinnerearandauditorynervestatus.WiththeexpansionofCIindicationcriteriatowardsmoreresidualhearing,themeasurementofthosepotentialsduringCIsurgeryaswellasduringfollow-upvisitsbecomesincreasinglyinteresting.InCIuserswithsignificantlowfrequencyhearing,responsestoanacousticallypresentedstimuluscanberecordedthroughtheintracochlearcontactsoftheelectrodearrayusingtheimplant`sbuilt-inamplifier.Thesedataarebufferedintheinternalmemoryoftheimplantandregularlytransmittedtotheoutsidecomputerforfurtherprocessing.Thistechniquecanbasicallybeappliedtoallstagesofacochlearimplantprovision,startingwiththeinsertionofthefirstelectrodecontactsintothecochlearrightuptousingthemeasurementduringpostoperativeaftercarecheck-upsofthesubjects.Methods:InaclinicalstudyonECochGatotalof20subjectswithresidualhearingtobeimplantedwiththeHiFocusMidScalaelectrodearraybyAdvancedBionicsarecurrentlybeingrecruited.Duringtheelectrodeinsertionaswellasattheendofthesurgery,ECochGshallberecordedfromintracochlearelectrodecontacts.Postoperatively,subjectswillbecomingbacktotheclinicinregularintervals.Duringthefirst4months,ECochGandpuretonethresholdswillbemeasuredateachvisit.Toinvestigatethe


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relationofECochGthresholdstopost-operativehearingthresholdsorchangesinhearingthesholdsovertime,theECochGresultsshallbecomparedtoairconduction(AC)thresholds.Pre-andpost-surgicalACthresholdsshallberelatedtotheintra-operativerecordingsoftheECochGthresholds,particularlylookingatthecourseoftherecordedamplitudesduringtheinsertionprocess.Moreover,post-surgicalACthresholdsshallbecomparedwithpost-surgicalECochGthresholdsfromthesamedates.Duetotheshortdistancebetweenthepotential`soriginandtherecordingsite,onlyfewaveragesarerequiredtogetasufficientlystrongsignal,resultinginarecordingtimeofjust1-2secondsperdatapoint.Thisregularsamplingwithminimaldelayallowstogivetimelyfeedbacktothesurgeonduringtheinsertionprocessandthesurgeonmayadapthistechniqueaccordingly.Results:Sofar,intensubjectsECochGhasbeenregisteredtelemetricallyviatheimplantintra-aswellaspostoperatively.Agoodcorrelationbetweenpost-surgicalACthresholdandECochGthresholdscanbeobserved.Correlationinabiggersampleandoveralongertimespanwillbeshownanddiscussedinthepresentation.Conclusion:Inconclusion,themeasurementofECochGmightbeusedasanintraoperativetooltoinstantaneouslydetectchangesinhearingthreshold,therewithsupportingatraumaticinsertionoftheelectrodearray.Potentially,itcouldalsobeusedtoobtainthresholdestimatesfortheprogrammingofEASdevices,whichmightbeespeciallyusefulinchildren. AbstractID:381PosterNumber:205Title:SpeechPerceptionBottlenecksinCochlearImplantedSubjects:IntegrationoftheWordsandIndexicalCuesinSpeechisanAdditiveRatherthanaSynergisticTaskAuthors:ChadRuffin,MD,JaniceL.Farlow,Ph.D.,TaylorCurry,BS,CullenTaylor,BS,CharlesYates,MD;DepartmentofOtolaryngology,IndianaUniv.Sch.ofMed.,Indianapolis,IN,IN.Abstract:IntroductionPerceptionofthewordsinspeechwithcochlearimplantsrequireshighcognitiveloadthatmayinterferewiththesimultaneousintegrationofindexicalspeechcues.Ourcentralhypothesisisthatthenumberofindexicalcuesperceivedbyalistenerwhilesimultaneouslymaintainingmaximallevelsoflinguisticspeechperceptionissignificantlylessthanifeachwereassessedindependently.MethodsExperiment1:Theclinically-usedAzBioSentenceListswerepreviouslyverifiedtobesimilaringenderandspeakeridentificationundernoise-vocodedconditionswithnormal-hearinglisteners.Cochlearimplantedadultsubjects(N=3)thenlistenedtothenon-vocodedAzBioSentences.Theperceptionofindexicalcueswasassessedintwoconditions,(1)Indexical-onlyperceptionand(2)combinedSentences+Indexicalspeechperception.Inthefirstcondition,alisteneridentifiedthegenderandspeakerintheAzBiosentencetoken.Inthesecondcondition,theprimarytaskwastofirstrepeatthesentence.Thenthelisteneridentifiedindexicalcues.Eachsubjectperformedbothconditionsinsignal-to-noiseratios(SNR)from30to-10dB.Experiment2:TheAzBioSentenceListswerere-recordedtoincludemorespeakersandemotion.Thesestimuliwereprocessedthroughanoisebandvocoder.Eachof3differentgroupsofnormalhearinglisteners(N=15pergroup)performeddifferenttasksonthesamegroupofsentences.TheSentence-onlygroupperformedonlysentencediscrimination.TheIndexical-onlygroupidentifiedindexicalcues.TheprimarytaskoftheSentences+Indexicalgroupwassentenceperceptionfollowedbythesecondarytaskofidentifyingindexicalcues.Results


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Experiment1:TherewerenodifferencesinindexicalperformancebetweentheIndexical-onlyandSentences+Indexicalconditions.Themeantimetocompleteeachsentencewasnotsignificantlydifferentbetweenconditions.Experiment2:ThespeechdiscriminationperformanceintheSentences-onlyandSentences+IndexicalconditionswassimilartotheunmodifiedAzBioSentenceLists.IndexicalperformancewassignificantlybetterintheIndexical-onlycomparedtotheSentences+Indexicalgroupongenderdiscriminationandemotiondiscrimination.Therewerenodifferencesinspeakeridentificationbetweenconditions.ThemeantimeforcompletingbothSentences+Indexicaltaskstogether(16.8seconds)wasessentiallythesumtimeofindividualtaskcompletion.ConclusionCIsubjectscanintegratealimitednumberofindexicalcueswhensimultaneouslyperceivingthewordsinspeech.Anoise-bandvocodermodelsuggeststhatCIusersmaybesignificantlylessfluentatintegratingagreaternumberofandmorecomplexindexicalcuessuchasprosody.Thishasimportantimplicationsforhigher-orderlanguageprocessingandpatientcounselinginbothpediatricandadultCIpopulations. AbstractID:383PosterNumber:38Title:ConsonantProductionAbilitiesofChildrenwithCochlearImplantsAuthors:MadhuSundarrajan,PhD1,AndreaWarner-Czyz,PhD2,EmilyTobey,PhD2;1CommunicationSciencesandDisorders,Univ.ofTexasatAustin,Austin,TX,2CommunicationSciencesandDisorders,Univ.ofTexasatDallas,Richardson,TX.Abstract:Introduction:Cochlearimplants(CIs)havepositivelyimpactedthecommunicationabilitiesofchildrenwithsensorineuralhearingloss(SNHL).WithaccesstoauditorystimulithroughaCI,childrenwithSNHLshoulddemonstratesystematicdevelopmentintheirspeechproductionskillsandpotentiallyachieveperformanceoutcomesonparwithtypicalhearing(TH)children.Thepurposeofthisstudywastocomprehensivelyexplorethedevelopmenttrajectoryofconsonantaccuracyoveranextendedperiodoftime.Inaddition,wecomparedthedevelopmenttrajectoriesofconsonantaccuracyinchildrenwithCIsandTHchildren.Furthermore,weexploredtheassociationbetweenvariablessuchasageatimplantation,durationofdeviceuse,levelofresidualhearing,andconsonantaccuracyskillsinchildrenwithCIs.Methods:OnehundredandtwentyeightpediatricCIrecipientsandseventyTHchildrenparticipatedinthestudy.Participantswerefollowedfrom4to7yearsafterimplantation.Consonantaccuracywasassessedusingasentenceimitationtaskandscoreswerecomputedbycalculatingapercentageofconsonantscorrectlyproduced.Growthcurvemodelingwasusedtoexaminetheconsonantaccuracytrajectoriesandtheassociationofconsonantaccuracyscoresandfactorssuchasageatimplantation,durationofdeviceuse,andlevelofresidualhearingResults:THparticipantsexhibitedflattrajectoriesandachievedover95%consonantaccuracyatthestartofthestudy.ParticipantswithCIsdisplayedcurvilineargrowth,withalinearincreaseinproductionskillsfrom4to5yearsofdeviceuseandaplateauinperformancefrom5to7years.Theplateauinperformanceoccurredbeforethecochlearimplantedparticipantsreached95%consonantaccuracy.Ageofimplantationwasassociatedwithconsonantaccuracyscoresatthe4yeartestingsession,withlaterimplantedparticipantsachievinglowerconsonantaccuracyscores.Levelofresidualhearingwasalsoassociatedwiththeconsonantaccuracyscoresofchildrenwithcochlearimplants.Childrenwithhigher


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levelsofpreoperativeresidualhearingexhibitedhigherconsonantaccuracyscoresat4yearsofdeviceexperience.Conclusion:ThisstudyprovidedvaluableinformationregardingthegrowthinconsonantaccuracyskillsinpediatricCIrecipients.Ourinvestigationindicatedaplateauinperformance,occurringoncetheparticipantsreached5yearsofdeviceuse.Fortysevenpercentofthecochlearimplantedparticipantsachievedover95%accuracyafter7yearsofdeviceexperience. AbstractID:384PosterNumber:60Title:ComparisonoftheInsertionDepthandHearingPreservationResultsbetweentheHiFocus1jandHiFocusMidScalaElectrodesinAdultsandChildrenAuthors:ShwetaS.Deshpande,MastersinAudiologyandSpeechLanguagePathology1,NeelamVaid,MS(ENT)DNB1,AjimshaKm,Au.D.2,DzemalGazibegovic,ClinicalResearchScientist3;1BIGEARS,K.E.M.Hosp.,Pune,India,2AdvancedBionicsIndiaPvtLtd,Bangalore,India,3AdvancedBionicsClinicalRes.Intl.,Cambridge,Switzerland.Abstract:IntroductionDifferentvarietyofelectrodetypesareavailablewitharangeoffeaturesanddesignstofulfilvariousanatomicalandgeometricalvariationsofcochlea.TheHF1jelectrodedevelopedbyAdvancedBionicsLLCisalateralwallelectrodedesignedtocoverupto1.5turnsoruptoapp.540°ofthecochlea.AnewerversionoftheHiFocuselectrodegroupMidScalawasrecentlyintroduced.Theelectrodeisdesignedforstructurepreservationandforatargetinsertiondepthof420°.BothelectrodesmaybeinsertedusingdedicatedinsertiontoolsofferedbyAB.OBJECTIVESTheprimaryobjectivesofthisstudyaretoevaluatetheaverageinsertiondepthandvariationandtoassessthepotentialforhearingpreservationoftheHiFocus1jandMidScalaelectrodesinchildren.METHODSAgroupofpostlinguallydeafenedchildrenaged1yearorolderwithregularanatomywhowillreceivetheHiRes90KimplantandeithertheHiFocus1jorMidScalaelectrodewillundergoaplainradiography(x-ray)investigationshortlyafterthesurgerytodeterminetheangularinsertiondepth.Audiometricthresholdsdeterminingtheamountofresidualhearingwillbeperformedpriorsurgeryandthenmonitoredatdeviceactivation,one,three,sixandtwelveMonthslater.RESULTSUptonow15subjectsareenrolledanddataforten(fiveperelectrodegroup)arepresentatthetimeofsubmission.Ameaninsertiondepthof480°(SD=46°)isestimatedforthe1jand424°(SD=31°)fortheMidScalagrouprespectively.Acompletepreservationwithin10dBHLwasachievedforseven(fourMidScalaand21j)andpartiallossfortheremainingtwo1jsubjects. AbstractID:385PosterNumber:42Title:SemanticDevelopmentinElementarySchool-AgeHearingImpairedChildrenwithCochlearImplantsand/orHearingAidsComparedtoChildrenwithTypicalHearingAuthors:DeenaWechsler-Kashi,Ph.D.1,MiriamFaust,Ph.D.2;


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1DepartmentofCommunicationSciencesandDisorders,OnoAcademicColl.,KiryatOno,Israel,2TheLeslieandSusanGonda(Goldschmied)MultidisciplinaryBrainResearchCenter,Bar-IlanUniv.,RamatGan,Israel.Abstract:Introduction:Youngimplantedcochlearimplant(CI)usersshowgreatachievementwiththeirCIs.However,attheinitialstagesofdevelopmentmanyofthesechildrendisplaysmallervocabularies,andlargeinter-subjectvariabilityisreported.Insomecases,thesedelayscontinueinlaterstagesofdevelopmentandpersistthroughouttheelementaryschoolyears.Theaimofthepresentstudywastodevelopcomprehensivesemanticprofilesofschool-ageHIchildren,inordertoassesshowsemanticknowledgeunfoldsthroughoutdevelopment.Thisisrelevantspecificallyinthesemanticdomain,whichhasshowntobeaprimarysourceofdifficulty.Methods:Fourteenhearingimpaired(HI)childrenand14childrenwithnormalhearing(NH),matchedforageandgender,participatedinthecurrentstudy.Allchildrenattendedregularelementaryschoolsandwereingrades1-4(Averageage8.33,S.D.=0.91).IntheHIgroup,fivechildrenusedCIswith/withouthearingaids(HAs)andnineusedHAs.Toexplorethechildren’slexical-semanticabilities,weusedthe“MAASE”test(Rom,Morag,&Peleg,2007),astandardizedlanguagetest,designedtoevaluatecomplexsemanticlanguageabilitiesofschool-agechildren.Thetestconsistsoffivesubtests,whichprovideacomprehensiveprofileofthechildren’ssemanticabilities.Thesesubtasksinclude:categorization,similarities,differences,multiplemeaningsandattributes.Results:Preliminaryresultsshowthat,asagroup,NHchildrenoutperformedchildrenwithHIs.Thesedifferenceswerestatisticallyreliablefortheoverall“MAASE”scoreandforallofthesubtasksexamined,exceptforthesubtaskdifferences.Moreover,inthesmallgrouptestedthusfar,childrenwithCIsshowedhigherscoresintheoverallscoreandinallofthefivesubtasksadministered,comparedtotheHAgroup.However,thesedifferencesdidnotreachstatisticalsignificanceinthesmallsampletestedtodate.Qualitativeanalysisrevealeddifferencesinthesemanticprofilesdisplayedbythethreegroupstested(NH,CI,HAusers).Inaddition,certainretrievalandorganizationaldifficulties,uniquetotheHIgroupsemerged:TheHIgroupsseemedtoshowdifficultiesnamingless-commonobjectsandpaidmoreattentiontolesssalientattributesofwordsintestitems.Conclusion:TheresultsofthecurrentstudyrevealdifferencesinthesemanticlexiconofHIschool-agechildren,andofCIusersinparticular.ThesefindingspointtodifferencesinthedegreeofknowledgeandcharacteristicsofsemanticrepresentationandorganizationofCIusers,consistentwithrecentlyreportedresults.Thesefindingshaveimportantclinicalimplicationsformoreeffectiveevaluationandinterventioninschool-agechildrenwithCIs.Incorporatinglanguagetherapyandimprovingsemanticknowledgemayenhancelanguageandacademicachievement. AbstractID:386PosterNumber:7Title:CollaborativePartnershipstoImproveOutcomesforChildrenwhoareDeaf/Hard-of-HearingAuthors:KristinaBlaiser,PhD,CCC-SLP1,MeganShannahan,MA1,JoyKane,MA2,PaulaMason,MA3;1CommunicationSciences&Disorders,IdahoStateUniv.,Meridian,ID,2IdahoEd.alServicesfortheDeafandBlind,Meridian,ID,3IdahoServicesfortheDeafandBlind,Gooding,ID.Abstract:Introduction:PartnershipsbetweenuniversitiesandpublicschoolsettingscanprovideasymbioticrelationshipofferingbothentitiesopportunitiestobetterservechildrenwhoareDeaf/Hard-of-Hearing.LanguagesamplingisanassessmenttoolthatiseffectiveinidentifyingthespecificneedsofchildrenwhoareDeaf/Hard-of-Hearing,yetmanyeducationalprofessionalslackthetimetoobtainandanalyzethesesamplesonaregularbasis.ACommunicationSciencesandDisordersdepartmentanda


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schoolfortheDeafandBlinddevelopedacollaborativerelationshiptocollectandanalyzelanguagesamplesofthechildrenenrolledinthepreschoolprogramandusetheresultsforeducationalmonitoringandstudenttraining.Thispresentationwilloutlinethecollaborativemodelthatwasusedanddemonstratehowthedatawasusedasatrainingtool,aprogressmonitoringprotocol,andplatformforresearch.Methods:Undergraduateandgraduatestudentsinspeech-languagepathologycollectedandanalyzedmonthlylanguagesamplesof21childrenenrolledinalisteningandspokenlanguagepreschool.Languagesamplestakenwerefiftyutteranceslongandtakenduringafreeplayandnarrativeactivity.Sampleswereanalyzedbyuniversitystudentsfor1)MeanLengthofUtterance,2)Intelligibility,3)NumberofTotalWords,4)NumberofDifferentWords,and5)Wordsperminute.Additionally,languagesampleswereanalyzedfornumberofnouns,verbsandothertypesofwordstodeterminecomplexityofvocabularylexicon.Aftercompletingthelanguagesamples,universitystudentswereaskedtoratetheirconfidenceduringthesampleanddescribelanguagefacilitationtechniquesused.Results:Ingeneral,studentconfidenceobtainingandanalyzinglanguagesamplesimprovedovertime(Greenwoodetal.,2016),however,therewasnoclearcorrelationbetweenlanguagefacilitationtechniquesusedandconfidence.Aggregatestudentresultsweresharedwiththeeducationalprofessionalsanddiscussedintermsofeducationalopportunities,studentsofconcern,andcurriculumchanges.Parentreportsweregeneratedquarterlyincludinginformationonchild’sprogressacrosscommunicationdomains,homegeneralizationactivities,andinformationrelatedtoachild’sacousticaccess.Conclusion:Communitypartnershipsbetweenschoolsanduniversitiescanofferasymbioticrelationshipbyprovidinguniversitystudentsanopportunitytopracticetheirlanguagesamplingandanalysisskills;educationalprofessionalstobetterunderstandadata-drivenperspectiveonhowchildrenintheirclassroomareprogressing;andresearcherstoexaminethelanguagedevelopmenttrendsforyoungchildrenwhoareDeaf/Hard-of-Hearing. AbstractID:387PosterNumber:31Title:TheQualityofLifeinSmallChildrenintheFirstTwoYearsAfterCochlearImplantationAuthors:LuminitaRadulescu,Dr.1,CristianMartu,Dr.1,CorinaButnaru,Dr.2,AlexandraDoroftei,Res.3,SebastianCozma,Dr.2;1ENT,Univ.ofMed.andPharmacy”GrigoreT.Popa”,Iasi,Romania,2ENT,Univ.ofMed.andPharmacy”GrigoreT.Popa”,Iași,Romania,3ENT,ClinicalRehabilitationHosp.,Iași,Romania.Abstract:Introduction:Cochlearimplantationisaveryefficientwaytotreatcongenitalhearinglossandbringsanewperspectiveinthefutureofhearingdisabledchildren.Thestudyevaluatedpatientswithcochlearimplantusingaparents’perspectivequestionnaireandanalysisofsignificantparameters.Methods:ThestudyincludespatientswhounderwentcochlearimplantationintheClinicalRehabilitationHospital,Iasibetween2015and2016.Theparentswereaskedtoanswerthequestionnaire.Evaluationperiodwasbetween1and22monthsafterimplantactivation.Results:Theageatthemomentofimplantationforthe22patientsincludedinthestudywasbetween9and36months.Intotal,anumberof21parentsweresatisfiedwiththecochlearimplant.Someparentsconsiderenrollingtheirchildreninkindergarten/integratingtheminagroupofnormal-hearingchildrentakingintoaccountthefavorableevolutionafterimplantation.Eventhoughtheyweresatisfiedwiththeamountofinformationtheyreceivedconcerningthesurgeryandtheuseoftheimplantitself,7outof22questionedparentsexpectedtheirchildrentospeakimmediatelyaftertheimplantactivation.


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Conclusion:Thecochlearimplantcertainlyhasapositiveimpactonthequalityoflife,parentsshowingconcernintheearlypreoperativeandpostoperativeperiodsregardingthesurgicalactitself(77,2%)butalsoregardingthepossibilityoftheimplantbreakingdown(66,3%). AbstractID:388PosterNumber:149Title:TheUseofDifferentMicrophoneSettingsinBimodalCISubjectstoImproveSpeechPerceptioninAdverseListeningEnvironmentsAuthors:AndreasBuechner,PhD,SilkeKlawitter,MSc,NogueiraWaldo,PhD,ThomasLenarz,MD,PhD;HearingCenter,Med.Univ.ofHannover,Hannover,Germany.Abstract:Introduction:Modernbeamformertechnologyhassignificantlyimprovedspeechunderstandinginhearingaidandcochlearimplantusersinadverselisteningscenarios.Generally,beamformersbecomemoreeffectivewhensignalsfromseveralmicrophonesaretakenintoaccount.Thepossibilitytowirelesslytransmitthemicrophonesignalsbetweentwohearingdeviceswornoneachearallowsforcomputingmorefocusedforward-facingbeamformers,potentiallyyieldingbetterspeechunderstandinginfacetofaceconversations.Anotheradvantageofthistechnologyisthepossibilitytostreamaspeechsignalfromoneeartotheotherear,whichshouldimprovespeechperceptionwhenthespeakerislocatedasideorincaseofanasymmetrichearingloss.Theaimofthisinvestigationistodeterminethebenefitofthesefeatures(i.e.StereoZoomandZoomControl)inbimodalcochlearimplantrecipientsandcompareittoomnidirectionalsettingofthemicrophoneaswellasthemonauralbeamformerUltraZoom.Methods:SpeechperceptionoftwelveadultsubjectswasmeasuredwiththespeechsignaloftheOldenburgsentencetestpresentedfromthefront,whilespeechshapednoisewaspresentedfrom+/-45°toinvestigatetheeffectofthebinauralbeamformerStereoZoom.Inthissetup,fourconditionsweretested:(a)CIonly,(b)CI+HAwithindependentomnidirectionalmicrophones,(c)CI+HAwiththemonauralbeamformerUltraZoomindependentlyworkingoneachdeviceand(d)CI+HAwiththebinauralbeamformerStereoZoomactivated.ToevaluatetheeartoearstreamingZoomControl,speechwaspresentedontheHAsidewiththenoisecomingfromtheCIside(+/-90°).ResultswithZoomControl(e)werecomparedtotheconditions:(f)CIonlyaswellas(g)CI+HAwithindependentomnidirectionalmicrophones.Moreover,subjectivefeedbackwascollectedviaquestionnairesinalongtermtake-homephase.Results:Asexpected,theCIonlycondition(a)yieldedthepoorestresults,whiletheadditionoftheHA(b)alreadygaveanimprovementof2.5dBSRT.ThemonauralbeamformersettingUltraZoom(c)gavea1.6dBimprovementovercondition(b),whileStereoZoomyieldedanother1.5dBimprovementovercondition(c).EartoearstreamingZoomControl(e)ledtoasignificantimprovementof1.5dBoverthebimodalomnidirectionalcondition(g).PreliminaryresultsforthesubjectivefeedbackshowpositiveratingsfortheuseofStereoZoomandZoomControlinchallengingsituationsineverydaylife.Conclusion:Modernbeamformertechnologysignificantlyimprovesspeechunderstandinginanumberofdifficultlisteningscenarios.Thewirelessaudiotransmissionbetweenhearingdevicesopensupadditionalpossibilities,whichallowforanevenhigherdegreeofadaptationtodifferentacousticenvironmentsandthereforepotentiallyhigherlevelsofhearingperformance. AbstractID:389PosterNumber:91


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Title:TheImpactofPost-OperativeAir-BoneGapsonSpeechRecognitioninCochlearImplantationforthePurposeofHearingPreservationAuthors:JamesonK.Mattingly,MD,ReneeBanakisHartl,MDAuD,SamuelGubbels,MD,StephenCass,MDMPH;Otolaryngology,Univ.ofColoradoSch.ofMed.,Aurora,CO.Abstract:Introduction:Individualswithbilateralhigh-frequencyhearinglosswithmostlypreservedlowfrequencythresholdsexperiencesignificanthearingdifficulties.Althoughexistinghearingaidtechnologyisinadequate,cochlearimplantationwithanelectrodethatelectricallystimulatesthehigherfrequenciesandpreservesthelowerfrequenciesforacousticamplificationhasproventobebeneficial.Inordertorealizethisbenefit,optimalfunctionalresidualacoustichearingmustbepreserved.Whilesensorylossesoccurpost-operatively,werecentlyreportedonthesurprisinglyhighincidenceofpostoperativeair-bonegaps(ABGs)(Mattinglyetal.OtolNeurotol2016).Asanythresholdincreasecouldpotentiallycompromisetheabilityofthelowfrequenciestobeaided,itremainsunclearwhatimpacttheseABGshaveonspeechrecognitionscores.Here,weexaminethisrelationship.Methods:Thiswasaprospective,non-randomized,multicenterclinicaltrialoftheCochlearNucleusHybridL24implantsystemin50adultsubjects.Standardaudiometry,includingspeechrecognitiontests(AzBio,CNCimplantalone,CNCHybridmode),wereperformedpre-operativelyandatmultiplepointspost-activationfor1year.Subjectsweregroupedbasedupontheirairandbonethresholdsat12monthsindicatingNoABG,vibrotactile/non-responses(VT/NR),ABG15-29dBHL,andABG≥30dBHL,andcomparedtooneanother.Results:MeanAzBioscoresat250HzfortheNoABGgroupwas72%,ABG15-29dBHL65%,andABG≥30dBHL42%;CNCimplantonlyfortheNoABGgroupwas56%,ABG15-29dBHL62%,andABG≥30dBHL54%;CNCHybridModefortheNoABGgroupwas82%,ABG15-29dBHL83%,andABG≥30dBHL67%.MeanAzBioscoresat500HzfortheNoABGgroupwas67%,ABG15-29dBHL61%,andABG≥30dBHL58%;CNCimplantonlyfortheNoABGgroupwas57%,ABG15-29dBHL58%,andABG≥30dBHL77%;CNCHybridModefortheNoABGgroupwas83%,ABG15-29dBHL82%,andABG≥30dBHL79%.Significantinteractions(p=0.05)amongstthegroupsat250and500Hzwereonlyseenat250HzintheAzBioscores.Significantdifferences(p<0.05)incomparisontotheNoABGgroupwereonlyseenwiththeVT/NR(notshown)at500HzintheAzBioandCNCHybridModegroups.Conclusion:Post-operativeABGsinthoseundergoingcochlearimplantationforthepurposeofhearingpreservationhavenosignificantdifferencesinspeechrecognitionscorestested12monthsafteractivationcomparedtothosewithNoABG.ItshouldbenotedthattherewasatrendinthosewithmoresevereABGs(≥30dBHL)tohavelowerspeechrecognitionscoresthantheNoABGandABG15-29groups.Thislackofsignificancemaybeduetothelownumberofsubjectsineachgroup. AbstractID:391PosterNumber:78Title:CochlearImplantationinPost-MeningitisCandidatesAuthors:RiadKhnifes,MD,MHA,NoamYehudai,MD,MHA,TalmaShpak,PhD,DanaEgra-Dagan,MA,OsnatRot,MA,MichalLuntz,MD;DepartmentofOtolaryngology—Head&NeckSurgery,BnaiZionMed.Ctr.,Haifa,Israel.Abstract:Introduction:Outcomesofcochlearimplantation(CI)incandidateswithmeningitisrelatedseveretoprofoundsensorineuralhearingloss(SNHL)ischallengingtopredictduetoapossiblelossofneuralstructures,associateddifficultiesrelatedtomeningitisanddifferentlevelsofcochlear


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obliteration.TheaimofthestudywastoevaluateoutcomesofCIinpostmeningitiscandidatescomparedtoCIincandidateswithSNHLduetootherreasons.Methods:Aretrospectivestudyincluding6adultsand5children(meanageatCI31.3±11and4.8±3.6years,respectively)whounderwentCIduetomeningitisrelatedSNHL,between1998and2013.Eachcandidatefromthemeningitisgroupwasmatchedwithanon-meningitisCIuseraccordingtoageatCIandfollowupperiod.Results:Meangroupfollow-upwas10.7±3.4years.MedianpostCImonosyllabicwordsscoreinquietforchildrenandadultswithmeningitisrelatedSNHLwas70%(range,0-90%)and20%(range,0-50%),respectively.Thepatientswithpost-meningitisimplanteesperformedsignificantlyworsecomparedtothecontrolgroup.Asexpected,patientswithassociateddifficultiesweretheworst.Conclusion:Post-meningitisCIuserswhowereimplantedasadults,performsignificantlyworsethanthoseimplantedaschildren.Post-meningitischildrenwithSNHLwhoareinitiallyseemtobenefitfromhearingaidsandarenotimplantedimmediatelyafterthemeningitis,shouldundergoclosehearingevaluationmonitoringandperiodicalimagingofthecochleainordertoreceiveacochlearimplantasearlyaspossible. AbstractID:392PosterNumber:202Title:DataloggingAnalysisinPaediatricCochlearImplantUsersAuthors:NataliaRossi,Lic.,AliciaCansler,Lic.,NormaPallares,M.A.,VicenteDiamante,PhD;CentrodeImplantesCocleares"ProfesorDiamante",CABA,Argentina.Abstract:Introduction:Dataloggingrepresentsapowerfultooltohelptounderstandhowoftenassistivelisteningdevicesareusedandinwhattypesoflisteningenvironments.It’sanobjectivemeasureofgreatutilityforaudiologiststhatprovidesimportantinformationforprogrammingandtravel-shooting.Especiallyinpaediatricpopulation,thisinformationisveryhelpfultoguideparentsandcaregiversaboutproperusageofdevices.Methods:Thisisaretrospectivestudy.Dataloggingof40paediatricCIuserswereanalyzed.Datawasobtainedfor:averagehoursofdailyuse,numberoftimesthecoillosstheconnectionwiththeimplantandaveragedailyhoursthechildisexposedtodifferentlisteningenvironments.Thisdatawasrelatedwithage,presenceofotherdisabilitiesandauditoryskillsachieved.Results:Thereisatendencytohigheraveragehoursofdailyuseastheageofthechildrenincreases.Thegroupofyoungerchildrenaremorelikelytoexperiencelossofconnectionbetweenthecoilandtheimplant.Schoolagechildrenremainagreateraverageofdailyhoursinnoisyenvironments.Conclusion:UsingdatalogginginCIsoundprocessorsprovidesaccurateandobjectiveinformationabouttheusageofthosedevicesinchildren.Thisinformationisofgreathelpforaudiologistsbothinprogramingandinhelpingparentsandcaregiverstolearnaboutmoreappropriateuseofdevices. AbstractID:393PosterNumber:130Title:EvaluationoftheBeamformeroftheSONNETAudioProcessorwithRespecttoSpeechUnderstandinginNoisyEnvironmentsAuthors:AndreasBuechner,PhD,ManfredSchwebs,MSc,LutzGärtner,PhD,TobiasRottmann,MSc,ThomasLenarz,MD,PhD;HearingCenter,Med.Univ.ofHannover,Hannover,Germany.


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Abstract:Introduction:Cochlearimplantmanufacturersareconstantlyimprovingspeechunderstandinginnoisyenvironmentsbyimprovingthesignalprocessinginsidethespeechprocessors.In2014,MED-ELhaslaunchedthenewSONNETaudioprocessor,equippedwithadvancedsignalenhancementcapabilities.Byusingtwomicrophonesinconjunctionwithaspecialsignalprocessingalgorithm,thedirectionalcharacteristicsofthepinnahavebeenmimickedwithinthisdevice.Thisfunctioniscallednaturalbeamformer.Thesignalfromthetwomicrophonescanalsobeusedtocomputeamoreforward-facingdirectionalmicrophone,asocalledadaptivebeamformer.Thistechniqueshallleadtoimprovedspeechunderstandinginnoisyenvironmentsbyestimatingandreducingdisturbingsoundcomingfromlateraldirectionsandfrombehind.TheprimaryaimofthisstudyistoevaluatetheeffectivityofthedirectionalityimplementedintheSONNETprocessoranditsimpactonspeechunderstandinginnoise.Furthermoreitwillbeanalyzed,ifthepatients’listeningeffortinnoiseisbeingreducedwhenusingthebeamformer.Methods:20postlingualdeafenedsubjectswithaminimumageof18yearsandaminimumCIexperienceofthreeyearsandatleastthreemonthsexperiencewiththeSONNETaudioprocessorwererecruitedforthestudy.Allsubjectshadtoachieveaminimumscoreof15%intheHSMsentencetestinnoise(10dBSNR)tobeabletoparticipateinthestudy.Inasound-treatedroomthesubjectwasplacedinthemiddleofamulti-loudspeakerarray(0°,±70°,±135°,180°).Atoneacuteappointment,differenttestsinnoisewereconductedineachsubject:theOldenburgsentencetest(OLSA),theJustUnderstandingTest(JUST)andavisualanaloguescaletoassesshearingeffort.Threedifferentmicrophonesettings(naturalbeamformer,adaptivebeamformerandomnidirectionalmicrophone)wereusedforthetests.Results:FortheOLSAandtheJUSTthefinalresultsofthestudyshowasignificantlyimprovedspeechunderstandinginnoiseusingboththenatural(ΔOLSA=3,6dB;ΔJUST=3,0dB)andtheadaptivebeamformer(ΔOLSA=5,5dB,ΔJUST=4,4dB)whencomparedtotheomnidirectionalsetting.Theseandfurtherresultswillbeshownanddiscussedindetail.Conclusion:Basedonthesefindings,weanticipateimprovedspeechunderstandingforCIpatientsusingtheSONNETaudioprocessorinadverselisteningscenarios,especiallyinfacetofaceconversations. AbstractID:396PosterNumber:197Title:UtilizingElectroacousticStimulationinIndividualswithEnlargedVestibularAqueducts:AnAnalysisofFourCasesAuthors:JuliaReid,B.A.,HollyTeagle,Au.D.,LisaPark,Au.D.,ErikaGagnon,Au.D.,JenniferWoodard,Au.D.,KevinBrown,M.D.;Otolaryngology-HeadandNeckSurgery,TheUniv.ofNorthCarolinaatChapelHill,Durham,NC.Abstract:Introduction:EnlargedVestibularAqueductsyndrome(EVA)isaninnerearmalformationassociatedwithfluctuatingandoftenprogressivehearingloss.Ashearingdeclines,manyindividualswithEVApursuecochlearimplantation.Withadvancesinhearingpreservationsurgicaltechniques,someoftheseindividualsareabletomaintainlowfrequencyresidualhearing.Electroacousticstimulation(EAS)offersawaycochlearimplantrecipientswithmildtomoderatelowfrequencyresidualhearingtousebothanacousticsignalandelectricsignalinthesameear.BecauseoftheprogressivenatureofEVA,thispopulationmaybemoreamenabletoelectroacousticstimulation.Aninvestigationintoourcenter'spatientswithEVAwhowerefitwithEASwasconductedtoexplorethefollowingquestions:a)couldpatientswithEVAwhoundergocochlearimplantationshowimprovementsinspeechperceptionmorequicklywiththeuseofEASthantraditionalfullyelectricprograms?b)Ifresidual


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hearingcontinuestodeclineafterbeingfitwithEAS,couldtheinitialuseofEASearlyonhelpthetransitiontoafullyelectricmaplateron?Methods:AretrospectivechartreviewwascompletedonfourindividualswithEVAwhoreceivedsequential,bilateral,fulllengthcochlearimplantsandwerefitwithEASinoneearandafullyelectricprogramintheother.Lowfrequencypuretonethresholdswereassessed,andchangesinspeechperceptionscoreswerecomparedforeachsubject.Timebetweenimplants,internalelectrodearrayandageatimplantationwerealsoreported.Results:ThreesubjectswerefitwithafullyelectricprograminthefirstearimplantedandtheirsecondearswerefitwithEAS;onesubjectwasfitwithEASinhisfirstearandafullyelectricprograminthesecondear.TwosubjectsarecurrentlyusingfullyelectricprogramsbilaterallyasaresultoflosingresidualhearingafteraperiodoflisteningwithEAS.OfthetwostillutilizingEAS,onesubjectcontinuestoexperiencefluctuationinunaidedhearingandtheothersubject'sthresholdsappeartobeslowlydeclining.ThreesubjectsachievedbetterspeechperceptionscoreswiththeEASearatafasterratethanthefullyelectricear.Whenonesubjectwholostresidualhearingwasconvertedtoafullyelectricmap,speechperceptionimprovedatafasterratecomparedtotheearthatwasinitiallyfitelectrically.Conclusion:IndividualswithEVAwhoutilizeEASmayneedmorefrequentmonitoringduetotheprogressionandfluctuationthatoftenpresentwiththismalformation.Whileitmaybelikelythatthepatientwilleventuallyutilizeafullyelectricmap,capturingthelowfrequencyhearingthatcanbeadequatelyamplifiedinanEASsystemmayeasethetransitionfromhearingaidtocochlearimplant. AbstractID:399PosterNumber:99Title:HearingPreservationinPost-LinguallyDeafenedAdultsafterCochlearImplantationAuthors:ElisaL.Franco,BSc,JuliaS.C.Chiossi,BSc,FabianaDanieli,MSc,MariaS.A.Amaral,MSc,AnaC.M.B.Reis,PhD,MiguelA.Hyppolito,PhD;Oftalmologia,OtorrinolaringologiaeCirurgiadeCabeçaePescoço,Univ.edeSãoPaulo,RibeirãoPreto,Brazil.Abstract:Introduction:Inrecentyears,thereisanincreasedinterestinminimizingintracochleartraumaandpreservingresidualhearingduringcochlearimplantation.ThepossibilityofpreservingapicalstructuresoftheOrganofCortimayprovidetheindividualwithsomedegreeofacoustichearingandmakespossibletotakeadvantageofnewtechnologiesthatmayleadtoregenerationoftheinnerearinthefuture.Thisstudyaimedtoinvestigatethehearingpreservationrateinadultswithconventionalaudiologicalindicationstocochlearimplantsurgery.Methods:Elevenpost-linguallydeafenedadults,men(27.3%)andwomen(72.7%),aged20to76years(averageof48.0±20.4years),receivedacochlearimplantintheright(64%)orleftear(36%).Thesurgicalmethodusedemployedaroundwindowinsertionofelectrodearrayandtheuseoftopicaldexamethasoneandhyaluronicacid.Fourtypesofelectrodeswereused,i.e.Nucleus24kContour©;CI24REContourAdvance™;Med-ElStandardelectrode;andHiFocus™Mid-Scala.Residualhearingwasmeasuredinpuretoneaudiometry,beforecochlearimplantationandtwelvemonthsaftersurgery,toinvestigatehearingpreservation.Hearingpreservationratewascalculatedandthencomparedwithage,sideoftheimplantanddesignoftheelectrodearray.Results:Allsubjectspresentedsomelevelofhearingpreservationtwelvemonthsaftercochlearimplantsurgery.Tensubjects(81%)presentedcompletehearingpreservationandtwosubjects(19%)presentedminimalhearingpreservation.Whencorrelatedwithage,sideofimplantordesignoftheelectrodearray,themeanthresholdvariationsdidnotreachstatisticalsignificancewithanyofthesevariables.


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Conclusion:Hearingmaybeconservedinpost-linguallydeafenedadultsaftercochlearimplantation,independentlyofageorelectrodearray. AbstractID:400PosterNumber:158Title:CochlearImplantationinSiblingswithRiboflavinTransporterDeficiencyAuthors:KateDavid,Au.D.Audiology,TheCtr.forHearingandSpeech,Houston,TX.Abstract:Introduction:TheaimofthiscasestudyistoreviewRiboflavinTransporterDeficiency(RTD)andoutcomes&cochlearimplant(CI)mappingstrategiesinmalesiblingswithRTD.RTDisarareprogressivemotorneurondisorder.It'scausedbyagenemutationofSLC52A2orSLC52A3.Mutationsinthesegenesleadtoanabnormalriboflavintransporterproteinwhichresultsinareductionofriboflavinavailableinthebody.ChildrenwithRTDexperienceproximalanddistallimbweakness;breathingproblems;gaitataxia;opticatrophy;bulbarpalsy;andSNHL.Theonsetisusuallyininfancyandchildhoodbeforetheageof8;0.Inthemajorityofpeople,SNHLhearinglossisdiagnosedfirst.ThetimebetweenonsetofSNHLandpresentationofothersymptomsvariesbutisgenerallywithin1-2years.DuetothedelayinmanifestationsfromtheinitialdiagnosisofSNHLandthepresentationofothersymptoms,aCImayberecommendedwiththenotionthatSNHListhemaindisability.Methods:PatientApassedhisnewbornhearingscreening;howeveraregressioninexpressivespeech&languagewasnoticedattheageof3;0.AnABRat3;2revealedbilateralANSD.Hewasfitwithbilateralhearingaidsat3;5.Hewasdiagnosedwithbilateralopticatrophyat3;5.Hedevelopedprogressiveataxiawithsignificantweaknessinhislowerextremities.HereceivedanAdvancedBionics(AB)CIforhisrightearat3;10andanABCIforhisleftearat4;3.HewasdiagnosedwithRTDat4;8.Followingoraladministrationofhighdosesofriboflavin,hedemonstratedsignificantgaitimprovement.PatientBistheoldersiblingofPatientA.PatientBpassedhisnewbornhearingscreening.HewasdiagnosedwithbilateralANSDat7;11.Hewasfitwithbilateralhearingaidsat8;0.Hewasthendiagnosedwithmildopticatrophyandataxia.PatientB’ssymptomsweremildercomparedtohisbrother’s.HereceivedanABCIinhisleftearat8;8.PatientBwasdiagnosedwithRTDat9;0.Hedemonstratedgaitimprovementfollowinghighdosesoforalriboflavin..PatientAhasahistoryofpooraidedsounddetectionwithCIusedespiteadvancedmappingtechniques.Hedoesnothaveclosed-setoropensetwordrecognition.PatientBhasimprovedsounddetectionwithCIuse;howeverhisclosed-setandopen-setwordrecognitionispoor.Results:ChildrenwithlateonsetANSDandRTDmayrequireuniquemappingtechniquestoprovideoptimalaccesstosound.Bothpatientsrequiredunconventionalmappingchangestoprovidethemimprovedaccesstosound.Thesemappingchangesincluded:highstimulationlevels;deactivationofnumerouselectrodes;highthresholdlevels;andchangeinprocessingstrategy.Despitenotablemappingchanges;PatientAcontinuestohavelimitedbenefitwithCIuse.Hedoesnothaveclosed-setoropensetwordrecognition.PatientBreceivesimprovedsounddetectionwithCIuse.AlthoughPatientBcancomprehendspeechinopenandclosedsettests,hiswordrecognitionremainspoor.Conclusion:Furtherinvestigationintoachild’smedicalhistoryandadditionaltestbatteriesarewarrantedinchildrenwhopresentwithlateonsetANSD.CochlearimplantationinthesechildrenmayprecedethediagnosisofRTD.Resultsfromadditionalinquirieswillprovidemoreinsightforthecliniciantodeterminerealisticexpectationsandcounselingtechniques.Eveninsiblings,spokenlanguageoutcomesremainvariable.CIaudiologistsshouldconsiderutilizingadvancedmappingtechniquesinpursuitofbestpossibleoutcomes.


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AbstractID:401PosterNumber:94Title:ImagingtheBraininCICandidacyAssessmentAuthors:JanetOlds,PhD1,EmilyGreevy,RN2,DavidR.Schramm,MD3;1Neuropsychology,Children'sHosp.ofEasternOntario,Ottawa,Canada,2ENT,Children'sHosp.ofEasternOntario,Ottawa,Canada,3Otorhinolaryngology,Univ.ofOttawa,Ottawa,Canada.Abstract:Introduction:Itisnowrecognizedthatupto40%ofchildrenwithseveretoprofoundhearinglosswhoarecandidatesforcochlearimplantation(CI)maypresentwithotherhealth,includingdevelopmental,conditions.Forsomechildren,theseconditionswillbeapparentatthetimeofCI,whileforothers,concernswillbecomeapparentaschildrendevelop.Someoftheseconditionsmaybeassociatedwithatypicalbraindevelopment,anditispossiblethatimagingofthebrainmaybemedicallyindicatedatsomelaterpointindevelopment,afterCIhastakenplace.ApreviousstudyexaminedbrainMRIimagesaspartofCIcandidacyinchildrenandadults,andonthebasisofpositivefindingsin41%ofthesample,recommendedroutineimagingofthebrainaspartofcandidacyassessment.However,giventheimplicationsofthisrecommendation,replicationofthesefindingsinapediatricsampleiswarranted.TheobjectiveofthepresentstudywastoexamineMRIoftheheadconductedatthetimeofimagingofthecochleaforthepresenceofincidentalfindingsofbrainabnormalities,andtoexaminesubsequentspecialtyservicesconsultedtoaddressthesefindings,andtheimplicationsforcandidacyassessmentandcounselling.Methods:AretrospectivechartreviewofconsecutivecasesofchildrenwhohadundergoneCIcandidacyassessmentovera2yearperiodatasinglepediatricacademicCIprogramwasconducted.MRIassessmentsofthebrainaswellasthecochleawereexaminedforabnormalities.Forthosechildrenwithbrainabnormalities,subsequentreferralsweredocumented,aswellasinterventions,suchasneurosurgery,asaresultofthefindingswerealsoanalyzed.Results:Atotalof35chartswerereviewed,representingcandidatesforbothbilateralandunilateralCI.Patientswerebetween9monthsand15yearsatthetimeofcandidacyassessment.ExaminationofMRIofthebrainindicatedthatabnormalfindingswerepresentinthebrainsof13patients(34%),witharangeofcorticalandsubcorticalabnormalitiesdocumented.Onthebasisofthesefindingsreferralsweremadetoneurosurgery(14%)andneurology(14%).Neurosurgicalprocedureswereperformedin2ofthepatientspriortofurtherconsiderationofcandidacy.Conclusion:TheresultsofthisstudyindicatetheMRIoftheheadrevealedincidentalfindingsofbrainabnormalitiesinasignificantproportion(34%)ofpatients,whichresultedinfollow-upandinterventionamonganumberofsubspecialties.Thesefindingsaregenerallyconsistentwiththosedocumentedinapreviousstudy,andhaveimplicationsforCIcandidacyandfollow-upafterCI.FurtherresearchisneededtoexaminewhethertherearespecificpatientorfamilyindicatorsforbrainMRI,whetherandhowthepresenceofabnormalitiesimpactscandidacydecision-making,aswellwhetherlaterdevelopmentisimpactedbythepresenceoftheseabnormalities. AbstractID:404PosterNumber:218Title:MalformationoftheEarinJuvenilePaget'sDisease-CaseReportAuthors:JudithArnolds,surgeon1,StephanLang,headofdepartment1,CorinnaGrasemann,headofdepartment2,DianaArweiler-Harbeck,seniorsurgeon1;


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1Ear,Nose,andThroatDisease,Univ.Hosp.Essen,Essen,Germany,2Centerofrarediseases,Univ.Hosp.Essen,Essen,Germany.Abstract:Introduction:JuvenilePaget’sdiseaseisanextremelyrarediseaseofthebonewithonsetduringearlychildhood.MutationsinTNFRSF11Bgenecausesalossoffunctionofosteoprotegerin,resultinginastimulationofosteoclastsvianuclearfactor-κB(RANK)pathway,leadingtoanincreasedboneturnover.Clinicalmanifestationsaremicrosomia,deformitiesofthelongbones,fractures,deformitiesoftheskull,andprogredienthearingloss.Methods:Athreeyearoldboywaspresentedatourcochlearimplantconsultationhour.Malformationsofthefemurhadbeenevidentprepartal,andwereconfirmedafterbirth.Newbornhearingscreeningwasconspicuous.HearinglosswasconfirmedinABRattheageoftwomonths(90dBforclicksontheright,65dBontheleft).Hearingaidswerefitted.Geneticdiagnosticsrevealedahomozygousmutationinexon1ofosteoprotegerin-gene.Bothparentsarecarriers.Thehearinglossappearedtobeprogressive.Attheageof20monthstherewasnomeasurablestimulusresponseonbothsidesupto100dBintheABR.MRIandCTrevealedacysticmalformationofthecochleawithoutdefinablecochlearturns.IACwerefunnel-shaped,nomiddleearstructurescouldbeidentified.Results:Duetohighintra-andperioperativeriskthepatientcouldnotbeimplantedyet.Heistaughtsignlanguagetoprovidecommunication.RegardingjuvenilePaget’sdiseasethepatientistreatedwithmonthlybisphosphonate.Conclusion:JuvenilePaget'sdiseaseisextremelyrareandthemalformationsoftheearcausedbythisdiseasearedescribedseldomly.Withthiscasewewouldliketodrawattentiontothishardlyknowndisease. AbstractID:405PosterNumber:207Title:TurkishAdaptation,ValidityandReliabilityofMusicalPerceptionTest(MPT):T-MPTAuthors:AyseSanemSahli,PhD1,ErolBelgin,PhD2;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAININGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FACULTYOFHEALTHSCIENCES,AUDIOLOGYDEPARTMENT,MEDIPOLUNIVERSITY,TURKEY-ISTANBUL,Turkey.Abstract:Introduction:Thehearingaidtechnologies(CI,HA)atpresentdayperformwellontheskillsofpatientswithhearinglosstohearingandunderstandingofspeechsounds,butnotontheskillsofmusicalperceptionasmuchasexpected.Musicalperceptionisstilloneofthemostimportantproblemsufferedbypatientswithhearingloss.However,thereisnovalidandreliablemusicalperceptiontestinourcountrytoassesstheskillsofmusicalperceptionofbothpatientswithnormalhearingandthosewithhearingloss.ThepurposeofthisstudyistotranslateandadapttoTurkishthe“MusicalPerceptionTest”widelyusedforinternationalscientificresearch,determinethevalidityandreliabilitythereofand,bringtoourcountryatestthatobjectivelyassessestheskillsofmusicalperception.Methods:100individualsattheageof18-40withnormalhearingandwithoutanyprofessionalmusiceducationhaveparticipatedinthestudy.AfterthetranslationandadaptationtoTurkishtheMusicalPerceptionTest(MPT)consistingof4fieldsincludingRhythm,Pitch,TimbreandMelodyand,11subteststeps,soundrecordshavebeencompletedinaprofessionalstudioand,thevolunteerstookpartinthetest.A“ParticipantGeneralInformationForm”wasprovidedtocollectinformationonthesociodemographicattributesofthesubjectsand,theirinterestandexperienceinmusic.Thedataobtainedinthismannerhavebeenstatisticallyassessedand,thefindingsonthevalidityandreliabilityofthetesthavebeenanalyzed.


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Results:Asaresultofthisstudy,itisfoundoutthatthetotalpointaverageofthesubjectsfortheMusicalPerceptionTestis97,5±12,2(Min:69,Max:120),theInternalConsistencyValueis0,898,andthetest-re-testcorrelationis0,997.ThisresultshowsthattheMusicalPerceptionTestisaveryreliabletest.Inthestudy,thehighestpointreceivedbythesubjectswasforRhythmIdentification(9,2±1,2),whilethelowestpointwasfortheIdentificationofNumberofInstruments(4,2±1,3).Inaddition,althoughthereisnorelationshipbetweenthetotalpointfromtheMusicalPerceptionTestand,theageofthesubjects,thegenderandeducationalbackgroundisastatisticallysignificantdeterminantonthetotalpointoftheMusicalPerceptionTest.Nonetheless,ithasconcludedthatthereisastatisticallysignificantrelationshipbetweenthelevelofinterestinmusic,frequencyoflisteningtomusicandmusicgenre,andthemusicalperceptiontotalpoint.Conclusion:Music,oneoftheindispensablefactorsinourlives,isalsoveryimportanttothosewithhearingloss.Asavalidandreliabletestthatobjectivelyassessallthefieldsofmusicinourcountry,theTurkishMusicalPerceptionTest(T-MPT)isthefirstandonlytestbothforpeoplewithnormalhearingandthosewithhearingloss.Anobjectiveassessmentofmusicalperceptionskillsofpeoplewillprovidebenefitinthedeterminationofmusicalperformanceforthosewithnormalhearingand,inthedevelopmentofdiagnosis,re/habilitationandamplificationsystemsforthosewithhearingloss. AbstractID:407PosterNumber:106Title:ClinicalEvaluationofEstimationMethodsforCochleaLengthAuthors:MaxE.Timm,MedicalDoctor,ThomasLenarz,Professor;ENT,MedizinischeHochschuleHannover,Hannover,Germany.Abstract:Introduction:Priortocochleaimplantation(CI),anelectrodearraywellsuitedforthatspecificpatientmustbechosen.Inordertodososeveralfactorsmustbetakenintoaccount.Oneofthesefactorsisthelengthofthecochlea.Withinthisstudy,differentestimationmethodsforlengthandshapeofthecochlearlateralwallwerecompared.Methods:Theanalysiswasperformedbasedonpreoperative,clinicalimagingdataof150patientswhowereimplantedattheHannoverMedicalSchool.UsingthesoftwaretoolOsiriX,thecochlearlateralwallwassegmentedanditslengthwasmeasuredforeachoneofthedatasets.Inaddition,otherglobalcochleadimensions(e.g.thedistancefromtheroundwindowtothecontralateralsideofthecochlea,commonlyreferredtoastheAvalue)weredeterminedwhichsubsequentlyservedasinputparametersforlengthandspiralshapeestimationmethodsproposedintheliterature.TheseestimationswerethencomparedtotheOsiriXmeasurements.Results:Itcouldbeshownthatingeneral,severalofthemathematicalandparameterizedaveragemodelsincludedintothisstudyarewellsuitedforcochlealengthestimations.However,highdeviationsfromtheactualshapeandlengthofacochleaoccurredforsomeoftheanalyzedcochleae.Thiswasmostlythecaseifacochleadidnotadheretocertainaveragecorrelationassumptionstheappliedmodelsarebasedon.Conclusion:Itwasfoundthatmodelbasedestimationsofthecochlealengthandshapeinaclinicalsettingarepossible.However,increasedestimationerrorsmayoccurinspecificcases,i.e.theseestimationsarenotreliable.Incontrastthereto,measurementsliketheonesperformedinOsiriXareapplicableforanycochlea,andthemeasurementaccuracyisnotdependentoncertaincorrelationsofcochleadimensions.Hence,thismeasurementtechniqueshouldbeusedifdecidingwhichelectrodearrayshouldbechosenforaspecificpatient.


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AbstractID:408PosterNumber:212Title:ImprovedContralateralHearingafterUnilateralCochlearImplantationinaChildwithAuditoryNeuropathySpectrumDisorderAuthors:RonaldJ.Vilela,MDOtolaryngology,TexasChildren'sHosp.,Houston,TX.Abstract:Introduction:Neithertheindicationsnortheoutcomesforcochlearimplantationinpatientswithauditoryneuropathyspectrumdisorder(ANSD)havebeenaswelldefinedasforpatientswithstandardsensorineuralhearingloss.Accordingtotheliterature,researchersandprofessionalshaveyettoarriveataconsensusregardingthebenefitsofcochlearimplantsforANSDalthoughmostwouldagreethat,forselectpatientswithANSD,cochlearimplantusecanimprovedetectionofspeechanddiscrimination.Methods:Wepresentacasereportofa21montholdfemalewithauditoryneuropathyspectrumdisorderdiagnosedat17monthsofageandapre-operativereceptivelanguagedelayequivalenttoafivemontholdwhounderwentunilateralcochlearimplantation.Wereviewherrehabilitationfollow-upwithaudiologyandspeechtherapyoverthetwo-yearpost-operativetimeframe.Results:Testingdonetwoyearsaftercochlearimplantationdemonstrateanimprovementofherreceptivelanguagetobeequivalenttothatofanormal4-year,3monthold,aremarkableamountofprogressinsuchashortamountoftime.Moreimpressiveistheinexplicableimprovementofhearinginhercontralateral,non-implantedearfrom50dBspeechdetectionthresholdpre-cochlearimplantto20dBspeechreceptionthresholdthreemonthsafteractivationofhercochlearimplant.Conclusion:CochlearimplantationinthispatientwithANSDhasprovidedastonishingimprovementandreceptivelanguagewithanunusualfindingofimprovedhearinginthecontralateral,non-implantedear.Thishasyettobedescribedintheliterature. AbstractID:413PosterNumber:34Title:TurkishAdaptation,ValidityandReliabilityofPreschoolLanguageScale-FifthEdition(PLS-5):TurkishPreschoolLanguageScale-5(TPLS-5)Authors:AyseSanemSahli,PhD1,ErolBelgin,PhD2;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAININGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FACULTYOFHEALTHSCIENCES,AUDIOLOGYDEPARTMENT,MEDIPOLUNIVERSITY,TURKEY-ISTANBUL,Turkey.Abstract:Introduction:Speechandlanguageassessmentisveryimportantinearlydiagnosisofchildrenwithhearingandspeechdisordersespeciallyinpreschoolperiod.But,stilthereisnotastandard,reliableandvalidlanguagetestinourcountrytoevaluatereceptiveandexpressivelanguageskillsofpreschoolers.AimofthisstudyistodeterminethevalidityandreliabilityofPreschoolLanguageScale(5thedition)testwithitsTurkishtranslationandadaptation.Methods:Ourstudyisconductedon1320childrenagedbetween0-7years11months.While1044ofthesechildrenhavenormalhearing,languageandspeechdevelopment,276ofthemhavereceptiveand/orexpressivelanguagedisorder.AftertheEnglish-TurkishandTurkish-EnglishtranslationsofPLS-5madebytwoexpertscommandofbothlanguages,someofthetestitemsarereorganizedbecauseofthegrammaticalfeaturesofTurkishandtheculturalstructureofthecountry.Throughoutthetest,adheredtoquestionsandpicturesinthePictureManuel.Thetestwhichisreorganizedinthelightof


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dataobtainedinpilotapplication,isappliedtochildrenchosenrandomlywithlayeringtechniquefromdifferentregionsofthecountryespeciallyfromAnkara,thecapitalofTurkey,then15dayslaterthefirsttestappliedagainto120children.Results:While1044of1320childrenagedbetween0and7years11monthsarenormal,276ofthemhavereceptiveand/orexpressivelanguagedisorder.While98of103healthychildrenof120takenunderthesecondevaluationhavenormallanguagedevelopment,8of9whousedtohavelanguagedevelopmentdisorderinthepaststillremaining.(Kappacoefficient:0,468,p<0,001).PearsoncorrealtioncoefficientforTPLS-5standardgaugeare;IArawscore:0,937,IEDrawscore:0,908andTDP:0,887respectively.CorrelationcoefficientforageequivalanceisfoundasIA:0,871,IED:0,896,TDP:0,887.Conclusion:TPLS-5isthefirstandonlylanguagetestinourcountrythatcanevaluatereceptiveandexpressivelanguageskillsofchildrenbetweentheageof7years11months.ResultsofthestudyshowthatTPLS-5isavalidandreliablelanguagetestfortheTurkishchildren.Inthelightofdatagatheredbyevaluating1320children,receptiveandexpressivelanguageskillsofchildreninourcountrycanbeevaluatedbyareliablelanguagetestfromthebirth.Thus,childrenwithhearingandspeakingdisordercanbediagnosedearlyanderalyinterventioncanbemade. AbstractID:414PosterNumber:64Title:FactorsImpactingLossofResidualHearingandPotentialOtoprotectiveStrategiesAuthors:AdrienEshraghi,MD,FACS,KadriIla,MD,JamalAhmed,MD,FredF.Telischi,MD,SimonAngeli,MD,SandraPrentiss,MD,DianeMartinez,MD,SandraValendia,MD;universityofMiamiMillerSch.ofMed.,Miami,FL.Abstract:Introduction:Cochlearimplantelectrodeinsertioncausesinnereartrauma,resultinginpossiblelossofresidualhearing.Thereisnumerousbenefitsfrompreservationofinnerearstructuresandhearingpostimplantation.Thoseincludeimprovedunderstandinginbackgroundnoise,theabilitytomaintainsoundawarenesswithoutwearingtheexternaldeviceandbenefitincasethatreimplantationisnecessary.Theobjectiveofthisstudyistoanalyzevariousclinicalandsurgicalfactorsthatimpactpreservationofresidualhearingpost-implantation.Methods:Aretrospectivestudyisperformedtoanalyzelossofresidualhearinginacohortof300patientsimplantedinalargeacademiccenter.64patientsmetinclusioncriteriaforanalysisofhearingpreservation(HP)data.TheHPisgradedandanalyzedusingaformulaoutlinesbySkarzynskiandcolleagues.Theimpactofageatimplantation,etiologyofhearingloss(HL),respectofsoftsurgeryprincipals,cochleostomyvs.Roundwindowinsertion,partialvs.fullinsertionandeffectofinitialstimulationwereanalyzedusingappropriatestatisticalanalysis.Results:Theoverallhearingpreservationratewas64%.Nocorrelationwasobservedwithageatimplantation,etiologyofhearingloss,fullelectrodeinsertion,gender,sideofimplantorpre-lingualdeafnessvspost-lingualdeafness.Thecochleostomygrouphadsignificantlyhigherproportionsofpatientswithcompletelossofresidualhearingthantheroundwindowapproach.Therewasasignificantincreaseinrateofcompletelossofresidualhearingwithnon-softsurgerygroupwhencomparedtothesoftsurgerygroup.Thereisasignificantchangeinresidualhearingpostinitialstimulationonlyat6kHz.Conclusion:Respectofsoftsurgerytechnicsandroundwindowinsertionhelptoprotectresidualhearing.Furtherstudiesareneededtoevaluatetheimpactoftheelectricalstimulationonorganofcortiandhaircells.


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AbstractID:415PosterNumber:21Title:Teletherapy:FactorsthatPromoteSuccessAuthors:SandraHancock,MS,HannahEskridge,MSP,LillianHenderson,MSP,MaeganEvans,PhD,ErinThompson,MS,ChristineKramer,MS;Children'sCochlearImplantCtr.atUNC,NC,NC.Abstract:Introduction:"Telepracticeisanappropriatemodelofservicedeliveryforaudiologistsandspeech-languagepathologists"(ASHA,2010).ConductingListeningandSpokenLanguagesessionsthroughteletherapyhasbeenshowntoresultinpositiveoutcomesinspeechandlanguagedevelopmentforpatientswithhearingloss(Houston,T.K.etal,2016).Benefitsofteletherapyincludesavingsoftimeandresources,however,thereremainfactorsthatcanmaketeletherapychallengingforfamilies.Thispresentationwilldiscussfactorsthatcontributetoanddetractfromsuccessfulteletherapyexperiences.Methods:Thepotentialtoparticipateinteletherapyserviceswasconsideredthroughparentandtherapistcommunicationduringanaudiologicalorspeechandlanguageevaluationappointment.Patientfamilieswereidentifiedforinclusionbasedontheirexpressedinterestinteletherapybysubmittinganapplicationrequestingthisservice.Aquestionnairewasdevelopedandsenttofamiliestoassesstheeffectofcertainfactorsonparticipationinteletherapy.Results:Resultsrevealfactorsimpactingfamilies'participationinteletherapy.Thesefactorsincludescheduling,comfortwithtechnology,behaviormanagementofthechild,parentperceptionofeffectiveness,andparentperceptionoftheneedfortherapy.Conclusion:Despitetheavailabilityandeffectivenessofteletherapyforthedevelopmentofspokenlanguageforchildrenwithhearingloss,therecontinuetobeobstaclestoovercomeinmakingthisserviceaperceivedacceptableoptiontoawiderpatientpopulation. AbstractID:416PosterNumber:156Title:IncreasingPerceptionofBass/Low-frequenciesviaPhantomElectrodeStimulationImprovesMusicAppreciationinCochlearImplantUsersAuthors:JosephCrew,PhD,AniketSaoji,PhD,LeoLitvak,PhD;ResearchandTechnology,AdvancedBionics,Valencia,CA.Abstract:Introduction:Cochlearimplants(CIs)areexpectedtogivehighlevelsofspeechunderstandinginquietandeasylisteningconditionstomostrecipients.Withthisdramaticimprovementinoutcomesovertime,nowthefocusisbeginningtoshifttomusicperceptionandappreciationaswellasspeechcomprehensionindifficultlisteningenvironments.Formusic,attemptstorestore“fine-structure”cuesviatheCI(e.g.,timecoding,currentsteering)havebeenlimitedinimprovingobjectivemeasuresofmusicperception(e.g.,melodiccontouridentification,melodyidentification,instrumentidentification).Aparallelapproachofimprovingsubjectiveaspectsofmusicappreciationseemstobeamorefeasibleshort-termgoal.Previousworkusingphantomelectrodestimulation(SaojiandLitvak,2010;Saojietal.,2013;Nogueiraetal.,2015)hasshownincreasedperceptionoflowfrequenciesandageneralimprovementinoverallperceivedsoundquality.Inthepresentstudy,wemeasuredsubjectiverankingsinmusicappreciationforanumberofexperimentalstrategyphantommapsandcontrolconditionprograms.


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Methods:Subjectiverankingsofagivenstimulationprogramrelativetoapatient’sownbaselineprogramwererecordedformanyCIpatientswhilelisteningtoshortsamplesofmusic.Themusicmaterialconsistedoffivesongsthatwerethesameforeveryoneandfivesongssolicitedfromtheresearchpatient.Therewasnorequirementofatypeofmusic,andtherewasnorequirementforaparticulartypeofCIpatient(e.g.,unilateral,etc.).AlltestingwasacutelyperformedviaadirectconnectinterfacetoasingleCI.Patientswerenotinstructedthattheirbaselineprogramwasoneoftheexperimentalprogramstoberanked,thusgivingablindplacebocontrolcondition.Experimentalmapsincludedacontrolconditioninwhichthelowfrequencycutoffwasextended,phantomstrategieswiththephantomchannelstimulatedatdifferentpointsinastimulationframe,andphantomstrategieswithcompensatoryhighfrequencygains.Results:Whensimplyaddingaphantomchannel,nodifferenceinrankingswasshownrelativetothebaselineprogram.Inthissituation,thepatientsreportedthattheincreasedbasscompetedwiththelyrics/vocalsleadingtoaneutralranking.Whencompensatoryhighfrequencygainswereintroducedtotheexperimentalphantomstrategy,patientsratedtheseprogramsasmuchbetterrelativetobaseline.Patientreportsindicatethatbasswasincreasedbuttonalbalancedwasmaintainedandthevocalswereclearerandmoreintelligible.Controlconditionsinwhichhighfrequencieswereadjustedortheinputfiltercutoffswereadjustedshowedaslightimprovementrelativetobaselinebutasmallerimprovementrelativetothephantomstrategywithhighfrequencygains.Afinalcomparisonofatweakedphantomstrategyrelativetobaselineshowedadramaticimprovementinmusicappreciationacrosssubjects.Additionally,subjectsindicatedthattheywouldusethisnewprogrammostorallofthetime.Conclusion:Theresultsfromthisstudysuggestthatsimplyaddingaphantomelectrodechannelwillnotincreasemusicappreciationonaverage.However,ifhighfrequenciesareadjustedtocompensatefortheincreasedperceptionoflowfrequenciesviaphantom,patientsconsistentlyratethisexperimentalprogrambetterforlisteningtomusic. AbstractID:421PosterNumber:73Title:ComplianceWithCDCPneumococcalVaccinationSchedules:AnImportantChallengeForPediatricCochlearImplantProgramsAuthors:StephenR.Hoff,MD,BushraAyub,MD,NancyM.Young,MD;PediatricOtolaryngology,NorthwesternUniv./Ann&RobertH.LurieChildren'sHosp.ofChicago,Chicago,IL.Abstract:Introduction:In2002,theCDCissuedvaccinationrecommendationsforpediatriccochlearimplant(CI)candidatesandrecipientstominimizetheriskofpneumococcalmeningitis.Nonationalunifiedapproachtoensuringchildrenreceivetherecommendedschedulehasbeenagreedupon.Thescheduleincludesapneumococcalconjugate(PCV7orPCV13)andpneumococcalpolysaccharide(PPV23)vaccination.PneumococcalconjugatevaccinationsarepartofthescheduleofrecommendedvaccinationsforallchildrenintheUS.Theyareeffectiveinchildrenunderage2years.Polysaccharidevaccinationisgivenonlytochildrenatincreasedriskofpneumococcaldisease,includingCIcandidatesandrecipients.Itisnotadministeredbeforeage24months.TheCDCschedulehasbeenmodifiedasknowledgeandvaccinationshaveevolved.Ensuringthatchildrenreceivetherecommendedscheduleislaborintensive.OurprogramhasnotedthatchildrenwhotransfercareoftenrequirevaccinationsaftertransfertomeettheCDCschedulerecommendation.Itisimportanttodeterminewhetherchildrenwho


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aretheresponsibilityofanimplantprogrammeetcurrentCDCguidelinesfromapatientsafetyandmedical-legalstandpoint.Methods:RetrospectivechartreviewofpediatricCIrecipientswhotransferredcaretoatertiarycarechildren’scochlearimplantprogrambetween2004and2016.Chartswerereviewedforpatientdemographicinformation,dateofimplant(s),vaccinationstatus,andriskfactorsforpneumococcaldisease.Arandomsampleofchildrenimplantedatourprogramwerealsoreviewedforcomparison.WhetherCDCvaccinationguidelinesforPCV7,PCV13andPPV23weremetattimeofimplantation(s)andattimeoftransferwasdetermined.Results:81pediatriccochlearimplantrecipientsweretransferredtoourprogramsince2004.Childrencamefrom95centersin25statesand4foreigncountries.78(96.3%)originatedfromUSinstitutions,and4(4.9%)wereinternationaltransfers.10(12.3%)patientshadadditionalriskfactorsformeningitis,includingcochlearmalformationandimmunodeficiency.26(32.1%)patientsmetCDCscheduleguidelinesinforceonthedateoftransfer,while55(67.9%)didnot.Ofthosewhohadnotcompletedtherecommendedscheduleofvaccinations,4(7.2%)hadnotreceivedtherecommendedpneumococcalconjugatevaccination(PCV7orPCV13).33(60%)hadnotreceivedthe23-valentpneumococcalpolysaccharidevaccine(PPV23),andanadditional18(32.7%)wereduallydeficientinnothavingreceivedPPV23andatleastoneoftheconjugatevaccinations.Atotalof51/55(92.7%)ofthosemissingvaccinationsweremissingPPV23,whichwas63%ofallpatientstransferred.Analysisofvaccinationofstatusofchildrenimplantedatourcenterwillbecompletedforcomparison.Conclusion:ThisstudyraisesconcernsthatimplantedchildrenfrequentlymaynotreceivethepneumococcalvaccinationsrecommendedbytheCDC.Reasonforthissituationincludechangesintherecommendationsovertimeandthelaborintensivenatureofdeterminingchildrens'vaccinationstatus.Thiscomplianceproblemisanimportantpublichealthissue.Challengestoimprovingthissituation,aswellasuseofelectronicrecordstobetterensurecompliancewillbediscussed. AbstractID:426PosterNumber:133Title:EstimationofResidualHearingUsingElectrocochleographyinChildrenwithCochlearImplantsAuthors:SarahCoulthurst,MS1,AlisonNachman,Aud1,MichaelMurray,MD1,AniketSaoji,PhD2,LeonidM.Litvak,PhD2,KanthaiahKoka,PhD2;1UCSFBenioffChildren'sHosp.Oakland,Oakland,CA,2ResearchandTechnology,AdvancedBionicsLLC,Valencia,CA.Abstract:Introduction:Incochlearimplantpatientswithpreservedresidualhearing,intra-cochlearelectrode/sfromtheimplantarraycanbeusedtomeasureelectro-cochleography(ECoG)thresholdinresponsetoanacousticpuretonestimulus.Thecochlearmicrophonic(CM)portionoftheECoGresponseisknowntocorrelatewithpuretoneaudiometricthresholdsinadultcochlearimplantpatientswithresidualhearing.ThegoalofthepresentstudywastodetermineifthresholdsestimatedbasedonCM(“CMthresholds”)canbeusedtopredictpuretoneaudiometricthresholdsinpediatriccochlearimplantpatientswithpreservedresidualhearing.Methods:Seven(meanage=7.4years,SD=4.7)AdvancedBionicspatientswithHiRes90kcochlearimplantandaHiFocusmid-scalaelectrodearrayparticipatedinthisstudy.Behavioralpure-tonethresholdsforwarbletonesweremeasuredusinginsertearphonesoverthefrequencyrangefrom125to2000Hzinninecochlearimplantearsfromsevensubjects.ECoGwaveformswererecordedonthemostapicalelectrodeoftheimplantarrayinresponsetocalibratedpuretonesandwereusedtoestimatetheCMthresholds.


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Results:CMthresholdsandbehavioralaudiometricthresholdscouldbemeasuredfor35(6subjectsmissing125Hzbehavioral,4testfrequenciesshownNoResponseathigheststimuluslevel)frequenciesfromtheninecochlearimplantears.Astrongcorrelation(r2=0.72,p<0.01)wasobtainedbetweenCMthresholdsandthebehavioralaudiometricthresholds.ThemeandifferencebetweentheECoGresponsesandaudiometricthresholdswas-2.6(±13.0)dB.Conclusion:CMthresholdscanbeusedtoroutinelymeasureandmonitorresidualhearinginpediatriccochlearimplantpatients. AbstractID:437PosterNumber:168Title:FacialStimulationinCurrentCochlearImplantRecipients:ContributingFactorsandManagementApproachesAuthors:JenniferHarris,AuD,AmandaGriffin,AuD,PhD,ElizabethEricksonO'Neill,AuD,MarilynNeault,PhD,GregLicameli,MD;ORL/CCE,BostonChildren'sHosp.,Waltham,MA.Abstract:Title:Facialstimulationincurrentcochlearimplantrecipients:contributingfactorsandmanagementapproachesIntroduction:Facialstimulationoccursasaninfrequentlyseensideeffectofelectricalstimulationproducedbyacochlearimplant.Cliniciansatourpediatriccenterreportanapparentincreaseintheincidenceoffacialstimulationamongrecentlyimplantedcochlearimplantrecipientswithinthefirstfewmonthsofuse.Reportsconsistofeyelidtwitchingorblinkingonthesideoftheimplant,typicallywhenmappingupperstimulationlevelsorwhenthedeviceisactivatedinlive-voicemode.Theaimsofthisstudyareto1)determineleadingfactorsresponsiblefortheobservedincreaseinfacialstimulationand2)reviewcurrentpracticesforthemanagementofthissideeffect.Methods:Retrospectivechartreviewwasconductedforallpatientswhoreceivedcochlearimplantprogrammingservicesatourcenterandwereimplantedwithinternaldevicesthatarecurrentlyavailableatthetimeofthissubmission.Fortwogroupsofpatients(thosewithvs.withoutdocumentedfacialstimulation),thefollowingvariableswereexamined:cochlearimplantmanufacturer,modelofimplantandelectrodearray,ageofpatient,surgicalapproachandinsertion,etiologyofhearingloss,andcochlearanatomy.Forpatientswithfacialstimulation,theseadditionaldatawererecorded:mapparametersincludingpulsewidthandprogrammingstrategy,andmapadjustmentsthatweremadetoreducefacialstimulation.Datawereanalyzedtodeterminethefactorsmoststronglycorrelatedwithobservedfacialstimulation.Further,managementapproachesforreducingfacialstimulationinpediatricpatientswereinvestigatedthroughchartreviewandclinicianinterview.ResultsandConclusions:Facialstimulationwasmanagedeffectivelyforallpatientsunderinvestigation,thoughthemethodofmanagementvariedconsiderably.Recognizingthefactorsthatincreaseapatient’sprobabilityofexperiencingfacialstimulationisvaluableinformationtotheprogrammingaudiologist.Resultsshouldbeconsideredincomparisonwithcorrelativefactorsandmanagementstrategiesforlegacyinternaldeviceusersaswell.Findingsfromthisstudycanhelpinformclinicalpracticeonhowbesttoavoidandmanageundesiredfacialstimulationinthepediatriccochlearimplantpopulation.


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AbstractID:438PosterNumber:142Title:ExaminingHearingAidFittingFormulasforMusicAppreciationforBimodalCochlearImplantListenersAuthors:JosephCrew,PhD,SmitaAgrawal,PhD,LeoLitvak,PhD;AdvancedBionics,Valencia,CA.Abstract:Introduction:Asmorehearingaid(CA)usersgetcochlearimplants(CIs),mappingofthesebimodal(CIinoneear;HAintheoppositeear)patientsbecomesagreaterconcern.Standardclinicalpracticeismovingawayfromfittingeachdeviceindependentlyandtowardscombinedbimodalfittinginwhichthesettingsfromonedeviceinfluencesthesettingsontheotherdevice.Previousworkhasfocusedonspeechintelligibilityinquietandinnoise;however,theeffectofHAprogrammingonmusicperceptionforbimodalCIusershasnotbeeninvestigated.Inthisstudy,weexaminedtheinfluenceofdifferentHAfittingformulasonsubjectmusicrankings.Methods:BimodalresearchpatientssubjectivelyrankeddifferentHAfittingformulas(AdaptivePhonakDigital,NAL-NL2,DSLv5a,andanewPhonakBimodalFittingFormula)whilelisteningtoshortsamplesofmusic.Themusicmaterialconsistedoffivesongsthatwerethesameforeveryoneandfivesongssolicitedfromtheresearchpatient.Therewasnorequirementofatypeofmusic.Alltestingwasacutelyperformedacousticallyusingthepatient’sownCIprocessorandanexperimentalNaidaLinkHA.Results:PreliminaryresultsshowthatthePhonakBimodalFittingFormulawasrankedhighestwhenlisteningtomusicwiththeDSLv5afittingformulacominginsecond;theNAL-NL2andAdaptivePhonakDigitalfittingformulaswererankedthelowest.Conclusion:TheresultsfromthisstudysuggestthatchangingtheHAfittingforabimodalCIusermayimprovemusicappreciation.FutureworkwillexaminewhataspectsoftheHAfittinginfluencesubjectivemusicperceptionaswellaswhataspectsofmusicmaybecontributingtoimprovedmusicappreciationviabimodallistening. AbstractID:440PosterNumber:155Title:CochlearImplantIndicationRelatedtoAuditoryNeuropathySpectrumDisordersPatternsAuthors:SebastianCozma,MD,PhD1,CristianMartu,MD,PhD1,OanaBitere,MD,PhD2,RalucaOlariu,MD.1,CristinaHera,MD.1,LuminitaRadulescu,MD,PhD1;1ENT,Univ.ofMed.andPharmacy”GrigoreT.Popa”,Iasi,Romania,2Audiology,RehabilitationClinicalHosp.,Iasi,Romania.Abstract:Introduction:Auditoryneuropathycanbeearlydiagnosedbyspecificelementsandtheirrelationsthatcanberevealedinabatteryofobjectiveauditorytests:otoacousticemissions,cochlearmicrophonics,electrocochleography,brainstemevokedresponseaudiometry(BERA)andauditorysteadystateresponse(ASSR).Inthisstudyweanalyzedthepatternsofourauditoryneuropathycasesrelatedwiththeindicationofcochlearimplantation.Methods:Thestudygroupincludedchildrendiagnosedwithauditoryneuropathyspectrumdisorders(ANSD),themajorityfromtheneonatalauditoryscreening.Theywerereferedtoourdepartmentafterthefailureofauditorytestsinmaternityorforfollow-upduetothepresenceofriskfactorsforhearingloss.Theauditoryassessmentincludedforeachchildthefollowingtests:otoacousticemissions,timpanometry,BERA,ASSR,freefieldadaptedaudiometry,cochlearmicrophonics.Weanalizedthedatabasefollowingtwoparticularpatterns:theevolutionofhearinglossintimeandthepresenceorthe


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associationofelementsdefiningthecategoryofauditoryneuropathyspectrumdisorders.Therelationofcochlearimplantationindicationwiththesetwopatternsisdiscussed.Results:Weidentified34childrenwithANSD,6caseswithnormalhearingand28withdifferentlevelsofhearingloss,3patientswithfluctuantdeafnessand7patientswithprogressiveforms.ThemainANSDcharacteristicelementsfoundinourgroupwere:thepresenceofcochlearmicrophonics,auditorydyssynchrony(BERA),mismatchofBERAthresholdsversusASSRthresholds,thepresenceofotoacousticemissionswithauditorythresholdsonBERAorASSRover40dB,freefieldtonalresponsesatbetterlevelsthanBERAor/andASSRlevels.Theindicationofcochlearimplantwasmadefor15children,12withcochlearimplantonlyand3withbimodalstimulation(cochlearimplantandhearingaid).16patientswereconventionalhearingaidsfitted(13withacousticstimulationonly,3withbimodalstimulation).Conclusion:Cochlearimplantationwasthefirstindicationforallchildrenwithhearinglossthresholdsover90dBHLbilaterally.Manychildrenwithauditoryneuropathyspectrumdisorderspresentprogressivehearinglosstotheprofoundformwithclearindicationofcochlearimplantation.WehadcaseswithmoderateorseverehearinglosswithCIrecommendationafteralongerperiodofhearingaidfittingandspeechtherapywithnoevidentprogressinspeechunderstandingandspeechproduction. AbstractID:444PosterNumber:35Title:InvestigationofthePerceptionsofParents'ChildrenwithCochlearImplant:TheInfluenceofMusicTherapyintheirChildren'sAuditoryRe/habilitationAuthors:AyseSanemSahli,PhD1,ErolBelgin,PhD2;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAININGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FACULTYOFHEALTHSCIENCES,AUDIOLOGYDEPARTMENT,MEDIPOLUNIVERSITY,TURKEY-ISTANBUL,Turkey.Abstract:Introduction:Thesupportthatparentsgivetotheirchildrenisveryimportantinthere/habilitationofchildrenwithcochlearimplant.Perspectiveofparentstothemusictherapyusedintheauditoryre/habilitationofthechildrenanddirectingthechildrentothemusicactivitiesaffectstheauditoryandspeech-languagedevelopmentofthechildpositively.Thepurposeofthisstudyistoinvestigatetheperceptionsofparentswhohaveachildwithacochlearimplantfortheuseandinfluenceofmusicinchildren'seducation.Methods:70parents(motherand/orfather)whocanhearnormallyandhaveachildwithcochlearimplantareinvolvedinthestudy.Allparticipantsareinformedverballybeforetheapplicationandtheysignedthe“informedvoluteerform”inwhichinformationaboutthecontentofthestudyisgiven.Also“volunteerapprovalform”isgiventoo."ChildandParentGeneralInformationForm"and‘’MusicEvaluationQuestionnaireforParentswereused.Apvalueof0.05wasdeterminedasasignificanceleveltointerpretalltestresultsandsignificancewasdeterminedatp<0.05level.72.4%ofparentswhohavecochlearimplantedchildsaidthatmusicisveryimportantintheeducationoftheirchildren,musicincreasesconcentration(82.7%)andcreativity(72.4%),musicisfunforkids(75.9%)andmemoryskillsofchildrendevelopwithmusic(75.8%).Results:72.4%ofparentswhohavecochlearimplantedchildsaidthatmusicisveryimportantintheeducationoftheirchildren,musicincreasesconcentration(82.7%)andcreativity(72.4%),musicisfunforkids(75.9%)andmemoryskillsofchildrendevelopwithmusic(75.8%).Conclusion:Inourstudy,itwasseenthatalargemajorityofparentswithachildwithacochlearimplantwerethoughtthatmusicisveryusefulmethodintheauditoryre/habilitationprocessofchildren.Music


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isamethodthatcanbeusedfordifferentpurposesintheeducationofchildrenwithhearingloss.Parents'perceptionaboutmusictherapyisveryimportantinplanningandimplementingthetrainingofcochlearimplantedchildren. AbstractID:447PosterNumber:141Title:UsingAugmentedRealitytoImprovePatientEducationinAuditoryBrainstemImplantSurgeryAuthors:KevinWong,BA,ElliottD.Kozin,MD,DanielJ.Lee,MD;Otolaryngology,MassachusettsEyeandEarInfirmary,Boston,MA.Abstract:Introduction:Patientsandtheirfamiliesarenowmoreconnectedthaneverandareoftenseekingnewwaystoaccesshealthinformationtohelpwithdecision-making.Smartphoneownershiphasreachednear-saturationlevelsforthefirsttimeinthehistoryoftheUnitedStates,andalmosthalfofadultsnowownsmarttablets.AlthoughmanysourcessuchastheInternetprovideawealthofinformationforcommonmedicalconditionsandprocedures,thesamehasnotshowntobetrueforrarertreatmentsanddiseaseprocesses.Atourinstitution,weareconductingaprospectiveclinicaltrialofauditorybrainstemimplants(ABI)innon-tumorpediatricpatients.Unfortunately,scanteducationalmaterialssuchasillustrationsordiagramscurrentlyexistforparentstryingtoconceptualizeahighlycomplex,intracranialplacementofanABIelectrodeandthiscomplicatescounselingofparents.Here,wedescribeanovelapproachtoimprovepatienteducationbygenerating3Daugmentedreality(AR)modelsofanABIimplant.Methods:IntracranialanatomywithanABIweredigitallyrenderedinto3DmodelsusingMeshmixer(SanRafael,CA)andAMIRA3DforLifeSciences(Burlington,MA).Themodelwasincorporatedintoathree-dimensional“gameenvironment”usingUnity3Dgameengine(SanFrancisco,CA)andprojectedintoanARfieldusingVuforia(Needham,MA).ThefinalproductiscompatiblewithiOSaswellasandroid-baseddevices,andcanbecoupledwithaGooglecardboardviewer(MountainView,CA)foralowcost,fullyimmersiveexperience.Results:ThedevelopmentofanARappwasachievedusingasuiteoffreeandopensourcesoftwareprograms.Coupledwithamobiledeviceandvirtualrealityviewer,thisappprovidesaneasilyaccessible,immersive,andhighlyvisualwayforparentstolearnanatomyandconceptualizeABIplacement.Usingthisapp,parentsenteranARenvironment,viewthe3Dprojectionofthebrainstemwiththeimplantinrealtime,andhavetheabilitytozoom,rotate,andclipthroughlayersofthemodels.Becausetheappisbasedontheopticalinputsofasmartphone,themodelishighlymobileandportableamonginstitutions.Conclusion:Wesuccessfullyexporteda3DmodelofanABIontoamobilesmartphoneusingARtechnology.FutureapplicationsofARtechnologyinmedicineincludeincorporatinguserinteractioncapabilitiesandexpansionofapplicationsforuseindiagnosisandsurgicalplanning. AbstractID:455PosterNumber:128Title:BenefitofDirectionalMicrophonesonSpeechPerceptioninNoiseofUnilateralandBimodalCochlearImplantUsersAuthors:KristinaAnton,MSc1,Rolf-DieterBattmer,Prof.Dr.1,MartinaBrendel,Dipl.-Ing.2,ArneborgErnst,Prof.Dr.1;


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1KlinikfürHals-,Nasen-undOhrenheilkunde,UnfallkrankenhausBerlin,Berlin,Germany,2EuropeanResearchCenter,AdvancedBionicsGmbH,Hanover,Germany.Abstract:Introduction:Forcochlearimplant(CI)usersunderstandingspeechinnoiseremainsachallenge.Insuchconditionstheuseofdirectionalmicrophones(beamformers)improvesthesignal-to-noiseratio(SNR)byattenuatingsoundsfrombackandsidesofthelistenerwhilemaintainingsignalsfromthefront.Adaptivebeamformersadapttheirmaximalattenuationdependingonthenoisesourceposition.AdvancedBionics(AB)offerssoundprocessorswithanomni-directionalmicrophonebehind-the-ear(BTE)aswellasaT-Mic.TheT-Micisamicrophoneplacedattheopeningoftheuser’searcanalwhichisanadvantageintermsofbetterspeechunderstandinginnoise.FurthermoreanABadaptivebeamformercalledUltraZoom(UZ)improvesspeechintelligibilityforCIusersinnoisylisteningconditionsaswell.ThenextABsoundprocessorwillofferanadditional,four-microphonebinauralbeamformercalledStereoZoom(SZ),inwhichbothprocessorsreceiveaudiodatafromthecontralateraloneinordertoformamorefocusedbeamformerandstrongerattenuationofnoise.Methods:InthisstudytenunilateralandtenbimodalexperiencedadultCIuserswithaNaídaCIprocessorwillberecruited.BothgroupswillperformspeechperceptiontestswithUltraZoomversusthetwoomni-directionalmicrophoneoptions,bimodalsubjectswillbetestedwithStereoZoominaddition.Speechperceptionthreshold(SRT)innoisewillbemeasuredviatheOldenburgsentencetest(OlSa).Speechwillbepresentedfromthefront(0°),whilenoisewillbepresentedintwodifferentloudspeakerconfigurations:(A)+/-60°,+/-120°and180°and(B)+/-30°,+/-60°and180°.Results:PreviousclinicalstudieswithtenbilateraladultCIusersshowedanimprovementinSRTsof4-4.5dBforUltraZoomcomparedtoomni-directionalmicrophonesand1.5dBinadditionforStereoZoom.ThesetestswereperformedwithasetupusingeightequallydispersedloudspeakersinacirclepresentingOlSasentencesinfrontofthelistener(0°)andnoisefromallotherloudspeakers.TechnicalmeasurementsofSNRswereconductedinbothsetups.Thebeamformersshowedbenefitsofaround4dB(UZ)and1.5dB(SZ)insetupAandaround2dB(UZ)and3dB(SZ)insetupB.ResultsfortheclinicalstudywillbeshownforthesetwobeamformersettingscomparedtotheBTEmicrophoneandT-Mic.Conclusion:Basedonpreciousstudyresultsandtechnicalmeasurements,UltraZoomandStereoZoomwilllikelyresultinimprovedspeechintelligibility.FurthermorethenarrowerbeamformerStereoZoomoffersbimodalandbilateralCIuserstofocusonasingletalkerforcommunicationinadifficultnoisesituation. AbstractID:457PosterNumber:189Title:TheBenefitofNoise-ReductionTechnologieswithandwithoutVisualCuesforCochlearImplantRecipientsAuthors:MichaelDorman,PhD1,SarahNatale,MS1,SmitaAgrawal,PhD2;1Speech&HearingScience,ArizonaStateUniv.,Tempe,AZ,2AdvancedBionics,Valencia,CA.Abstract:Introduction:CochlearImplantrecipientsoftenhaveaccesstoaudio-visualcuesforspeechunderstanding.Thatis,theyreportthatmostofthetimetheycanseethepersontowhomtheyarelistening.Ithasbeendemonstratedthataccesstovisualcuesleadstosignificantimprovementinperformanceinquietaswellasinnoise.Inthisexperiment,weevaluatedthevalueofnoise-reductiontechnologiesinenvironmentswherevisualspeechcuesarepresent.Methods:Speechunderstandingwasevaluatedintenadults(experiencedCIusersofAdvancedBionicsCIIand/orHR90Kimplants,5unilateralsand5bilaterals)usingaudio-visualspeechmaterialinrestaurantbackgroundnoise.Acomputermonitorwasplacedinfrontofthesubjecttopresentvisual


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speechcues.Threeprogramswerecreatedusingparticipants’everydayprogramonNaidaQ90processors:(1)omnidirectionalT-mic,(2)UltraZoom,and(3)RogerPen(70%/30%input).Participantsweretestedat(i)individualizedSNRatwhichscoreswithT-Micinnoisewere30-50%thatinquietand(ii)anadditionallychallengingSNRwith5dBmorenoiseaddedtotheindividualizedSNR.Testingwasconductedwithaudioonly(A-only)andwithaudio-visualcues(AV).Easeoflisteningratingswereobtainedineachconditionona5-pointscalerangingfromverydifficulttoveryeasy.Results:Intheabsenceofvisualcues,asexpected,UltraZoomandRogersignificantlyimprovedspeechscores(T-Mic<UltraZoom<Roger)atbothnoiselevels(p<0.001).AVscoresweresignificantlybetterthanA-onlyscoresacrossalltechnologyconditionswiththeincrementbeinghighestforT-Micperhapsduetoceilingeffects.Evenwithvisualcues,UltraZoomandRogercontinuedtoelicithigherperformancethanT-Mic.RogerscoresweresignificantlybetterthanUltraZoomscoresatthemorechallengingSNR(p<0.005).Similartrendswereobservedinthesubjectiveeaseoflisteningratings.Interestingly,theratingsalsoshowedthatwhileaddingvisualcuessignificantlyimprovedscoresinnoisewiththeT-Mic,listeningwasstillratedasmoderatetodifficult.ListeningwithRogerinthesamenoiseconditionswasratedaseasy.Conclusion:FindingsindicatedthatRogerPenperformedbetterthanUltraZoom,whichwasbetterthantheomnidirectionalT-Mic.TheRogerPenallowedspeechunderstandingscoresequivalenttoscoreswiththeT-Micinquiet.Concomitantvisualcuesadditionallyboostedperformanceby13-35%.Evenwithvisualcuespresent,currentlyavailablenoisereductiontechnologiescanrestorespeechunderstandinginnoisetoapproximatelevelsofunderstandinginquietwithconventionalmicrophones. AbstractID:460PosterNumber:57Title:TheReversedInternalMagnetofCochlearImplantafterMagneticResonanceImagingAuthors:Sung-WonChoi,MD,Se-JoonOh,MD,PhD,Soo-KeunKong,MD,PhD,Eui-KyungGoh,MD,PhD;OtorhinolaryngologyHeadandNeckSurgery,PusanNatl.lUniv.Hosp.,BUSAN,Korea,Republicof.Abstract:Introduction:Magneticresonanceimaging(MRI)hasalsobecomearoutinediagnosticimagingmodality,usedinthediagnosisofcommonconditionsaffectinglargesegmentsofthepopulation,includingstroke,backpain,andheadache.MRIusespulsesofradiowaveswithinmagneticfieldstogenerateimages.Currently,MRinstrumentsoperatingat1.5Tfieldstrengtharecommon.Wereportourrecentexperiencewithacaseinwhichinternalmagnetofthecochlearimplantwasreversedafter1.5TlumbarspineMRI.Methods:ApatientwithbilateralseverehearinglossunderwentleftNucleus24RContourAdvance(CochlearCorporation,Sydney,Australia)inourhospitalsevenyearsago.Herauditoryperformancewasexcellentascategoriesofauditoryperformance(CAP)7.Shehadrecentlycomplainedofbackpainandunderwenta1.5TlumbarspineMRIwithoutaheadcompressionbandageandconsultingENTspecialistatanotherhospital.WhileundergoingMRI,shesuddenlycomplainedofpainanddiscomfortoflefttemporalarea.MRIscanstoppedimmediately.Shefeltabuttonlikematerialverticallyagainstskullandpresseditherself.Afterthen,theexternaldevicepushedouttotheinnerdevice.Shevisitedpromptlyinourhospital;wecouldnotfindanydisplacementofinnerdeviceandmagnetinskulllateralview.Whenwereversedexternaldevice,itcouldpullinnerdevice.However,whenexternaldevicewasreversed,soundperceptionwasdecreasedsomewhat.Wedecidedreversingtheorientationofmagnetofexternaldevicebecauseshedidn’twanttodooperationforreversingmagnetofinnerdevice.After


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reversingpolarityofexternaldevicemagnet,shecompletelyrecoveredauditoryperformance.Sheisfollowingupwithoutanyproblemovertwoyears.Results:MRIevaluationisapowerfuldiagnostictoolthatshouldbeavailableforthebenefitofCIrecipients.Manyresearchershaveinvestigatedthecompatibilityof1.5TMRIwithCI.TheirresultsreportedthatpatientswithCIcouldsafelyundergo1.5TMRIwithoutremovingtheinternalmagnet.Inmanycases,anaccuratecompressivebandagingofthetemporalbone,withoutmagnetremoval,isadequatetoperformMRIfrom0.2to1.5Twithoutsignificantrisks.However,itispossibletowitnessamagnetdisplacementevenafterproperbandaging.ForMRIsystemswithfieldstrengthabove1.5T,theremovaloftheinnermagnetwithasmallskinincisionisnecessary.Wethinkthatitismostlikelythatthemagnetsphysicallyreversedorientationandendedupbackinthepocketwhenshepressedbuttonlikematerialherself.Inthiscase,wethinkthatthepressurebandagemayhavenotbeeninitially,whichallowedthemagnetstoflipover.Althoughitisconceivablethatthepolarityofthemagnetswasreversedbythemagneticfieldofthescanner,thishasneverbeenreported,andifthisdidoccur,thestrengthofthemagnetwouldlikelybegreatlyattenuated,whichwasnotthecase.Conclusion:Thiscomplicationwaseasilymanagedbyreversingtheorientationoftheexternalmagnetintheheadcoil.IfthemagnetbecomesdisplacedordemagnetizedduringMRI,themagnetcouldbereplacedusingaproceduresimilartothatrequiredifthemagnethadbeenremovedbeforetheMRI.Thisreporthighlightstheimportanceofpressurebandagethedeviceadequatelybefore1.5TMRI.Furthermore,weneedtoremodelpocketofinnermagnetandtomaketheinnerdevicesufficientlycompatiblewithmagneticfield.AbstractID:464PosterNumber:123Title:ImprovingSpeechUnderstandinginComplexListeningEnvironmentsforPediatricCochlearImplantRecipientsAuthors:SarahNatale,MS,MichaelDorman,PhD;Speech&HearingScience,ArizonaStateUniv.,Tempe,AZ.Abstract:Introduction:Inaseriesofexperimentswehaveinvestigatedthevalueofspeechenhancementstrategiesincomplexlisteningenvironmentsforpediatriccochlearimplantusers.Methods:InExperiment1(n=7),speechunderstandingwasevaluatedusingpediatricAzBiosentencesinsteadystate(ICRA)noise(S0N±90).Threeprogramsweretested:(1)ClearVoiceandUltraZoomdeactivated(noCV/noUZ),(2)ClearVoicealoneactivated(CV/noUZ),and(3)bothClearVoiceandUltraZoomactivated(CV/UZ).InExperiment2(n=6),weevaluatedthevalueofnoise-reductiontechnologiesinenvironmentswherevisualspeechcuesarepresent.Audio-Visualspeechmaterialwaspresentedinrestaurantbackgroundnoise(S0N45-330).Visualcueswerepresentedfromamonitorplacedinfrontoftheparticipant.Threeprogramswerecreatedusingparticipants’everydayprogramonNaidaQ90processors:(1)omnidirectionalprocessormic,(2)omnidirectionalT-Mic,and(3)RogerPen(70%/30%input).Results:InExperiment1,resultsindicatethattheCV/noUZprogramprovidedasignificantbenefit(17%).TheCV/UZprogramprovidedthemostbenefit(47%)whenlisteninginmoderatenoiselevels.InExperiment2,RogerPenoutperformedtheT-Micby25percentagepointsandProcessorMicby40percentagepoints.Inthepresenceofvisualcues,themagnitudeofbenefitshrunkduetoceilingeffectsbutstillremainedsignificantwiththeRogerPenoutperformingtheT-Micby13percentagepointsand


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theProcessorMicby20percentagepoints.PerformancewithRogerPenandVisualcuesonaveragecamewithin5percentagepointsoftheProcessorMic’sperformanceinquiet.Conclusion:Currentmonauralnoisereductiontechnologiesbothwithandwithoutthepresenceofvisualcuescansignificantlyimprovespeechunderstandinginmoderatelevelsofnoise. AbstractID:468PosterNumber:51Title:CochlearImplantationinChildrenwithSensorineuralHearingLossCausedbyCongenitalCytomegalovirusInfectionAuthors:ThomasA.Babcock,M.D.,AmitWolfovitz,M.D.,MichaelE.Hoffer,M.D.,FredF.Telischi,M.D.,MEE,FACS;DepartmentofOtolaryngology-HeadandNeckSurgery,Univ.ofMiamiMillerSch.ofMed.,Miami,FL.Abstract:Introduction:Congenitalcytomegalovirus(CMV)infectionistheleadingcauseofnon-geneticcongenitalsensorineuralhearingloss(SNHL)inchildren.Althoughapproximately90percentofinfantswithcongenitalCMVinfectionareasymptomaticatbirth,10to15percentdevelophearingloss.AmonginfantswithsymptomaticCMVinfectionatbirth,65-70percentdevelophearinglossaswellasassociatedneurodevelopmentaldelayandcharacteristiccentralnervoussystemabnormalities,includingintracranialcalcifications,migrationalabnormalitiessuchaspolymicrogyria,cerebralandcerebellarvolumeloss,ventriculomegaly,andwhitematterdisease.InspiteoftheprevalenceofcongenitalCMVinfection-associatedSNHL,thereisarelativepaucityofliteratureregardingcochlearimplantationinthispatientpopulationandsubsequentspeechperceptionandspeechintelligibilityoutcomes.Therefore,weaimtoreviewourinstitutionalexperiencewithcochlearimplantationinchildrenwithSNHLcausedbycongenitalCMVinfectionandexaminepreoperativeaudiometricdata,radiographicfindings,intraoperativefindings,andspeechperceptionandspeechintelligibilityoutcomes.Methods:RetrospectivechartreviewofchildrenwithSNHLcausedbycongenitalCMVinfectionthatunderwentcochlearimplantationatouracademictertiarycarefacilitybetween2010and2016.Preoperativeaudiologicevaluationandpatternofhearingloss,radiographicfindings,intraoperativefindingsandsurgicaltechnique,andspeechperceptionandspeechintelligibilityoutcomeswereassessed.Variablesimpactingresultswereexplored,includingconcomitantneurodevelopmentaldelayandcharacteristicintracranialradiographicfindingsaswellasunilateralversusbilateralcochlearimplantation.Results:PreliminaryfindingssuggestchildrenwithSNHLcausedbycongenitalCMVinfectionderivebenefitfromcochlearimplantation,albeitvariable.VariabilityinspeechperceptionandspeechintelligibilityoutcomesfollowingcochlearimplantationinchildrenwithcongenitalCMVinfection-associatedSNHLislikelyinpartduetoheterogeneityincomorbidneurodevelopmentaldelayandcentralnervoussystemabnormalities.Conclusion:CochlearimplantationhasthepotentialtoimprovehearingandspeechinchildrenwithSNHLcausedbycongenitalCMVinfection.Parentsshouldbecounseledextensivelyregardingthewiderangeinperformanceandpost-implantationindividualized,multidisciplinaryrehabilitationshouldbestronglyemphasized.FurtherstudiesareneededtoelucidatespecificfactorsassociatedwithcongenitalCMVinfectionthatmayinfluenceoutcomes. AbstractID:471PosterNumber:40


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Title:NasalResonanceCharacteristicsinMandarinSpeakingChildrenwithCochlearImplantsAuthors:YajingWang,PHDDepartmentofOtolaryngology,HeadandNeckSurgery,SunYat-senMem.Hosp.,Guangzhou,China.Abstract:Introduction:Thepresentstudyevaluatedtheeffectofcochlearimplantation(CI)andimplantageonspeechnasalresonanceinaprelinguallydeafgroupofChinesechildrenMethods:ThisstudyexaminedfiftyprelinguallydeafchildrenwithCIandfiftyage-matchedchildrenwithnormalhearing(NH).TheCIchildrenweredividedintotwogroupsbasedonimplantage.Twenty-ninechildrenreceivedimplantsbeforeoruponreaching4yearsofage,whiletwenty-onechildrenreceivedimplantsaftertheageof4.ThesubjectswereaskedtorecitetwoChinesephrasesandthreeChinesesentencesthatincludedoral,nasaoralandnasaltext.ANasameterII(Model6450;KayPentax)wasusedtoobtainnasalancevaluesofdifferentstimuli.Results:FortheoraltextandChinesephrase/baba/stimuli,theCIgroupdidnotdiffersignificantlyfromtheNHgroup(p=0.397,p=0.950).Forthenasaoraltext,nasaltextandmama/stimuli,theCIgroupshowedsignificantlylowernasalancescoresthantheNHgroup(p<0.05).Forthenasaltextstimuli,thenasalancescoresofthegroupreceivingimplantsbeforeoruponreaching4yearsofageweresignificantlyhigherthanthescoresofthegroupreceivingimplantsafterreaching4yearsofage(p<0.05).Conclusion:ThepresentstudyshowsthathyponasalitycreatesspeechproblemsamongMandarin-speakingchildrenwithCI,suggestingthatinadequatecontrolovernasal-oralbalancelevelspersistingafterchildrenreceiveCIrequiresattentionduringspeechtherapy. AbstractID:474PosterNumber:8Title:CochlearImplantEvaluationinPatientswithSingleSidedDeafnessAuthors:RaquelA.Lauria,BachelorofMedicine.Otolaryngologist,MarianaToro,BachelorofMedicine.Otolaryngologist.,LuizHenriqueChequim,BachelorofMedicine.Otolaryngologist,VagnerRodrigues,BachelorofMedicine.Otolaryngologist.Otologist,WalterBianchini,MD,ArthurCastilho,MD,AgricioCrespo,MD;DepartmentofOtolaryngology,HeadandNeck.UniversityofCampinas(UNICAMP),UNICAMP,Campinas,Brazil.Abstract:Introduction:Severeandprofoundunilateralhearinglosscancausedifficultiestohear,especiallywithtinnitusandinenvironmentswithbackgroundnoise.Thebestperformanceintermsofsoundlocationinpatientswithbinauralhearingdependsontheheadshadoweffect,the"squelch"effectandthebinauralsummation.Recentevidencesuggeststhatcochlearimplantsinsinglesideddeafness(SSD)canrestorebinauralhearing,improvetheabilitytolocatesoundsandalsoreducestheintensityoftinnitus.Thepuporseofthestudyistoperformcochlearimplantsurgeryinpatientswithunilateralsevereorprofoundsensorineuralhearingloss,whodidnotbenefitfromhearingaids.Methods:Methods:Theprocedureswereperformedin4differentpatients,whousedtheCROS("contralateralroutingofoffsidesignals")hearingaidsystemfourweekspriortothesurgery.Thecochlearimplantactivationwasperformedonemonthaftertheprocedure.Speechintelligibilitytest(HearinginNoiseTest-HINT),tinnitusevaluationandsoundlocalizationtestswereperformedbeforesurgery(withoutrehabilitationandwiththeCROSsystem)andalsointhefirst,third,sixth,ninthmonthandoneyearaftersurgery.Results:Results:Thepatientssubmittedtothecochlearimplantpresentedbetterresultsinrelationtohearinginnoisyenvironments,audiometricthresholdsandsoundlocalization,comparedtoCROSand


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non-rehabilitation.Therewasnocomplicationrelatedtosurgery.Onlytwopatientshadtinnitus,withimprovementoftheTinnitusHandicapInventoryaftersurgery,howeverwithoutstatisticalrelevance.Conclusion:Conclusion:CochlearimplantforpatientswithSSDisagoodoptionforhearingrehabilitationandcanimprovehearinginnoisyenvironments,audiometricthresholdsandsoundlocalization.Furtherinvestigationisnecessaryforproperassessmentoftinnitus. AbstractID:475PosterNumber:98Title:RadiographicPredictorsofSuccessfulCochlearImplantationforPediatricPatientswithSymptomaticCytomegalovirusAuthors:RounakB.Rawal,MD,HollyF.Teagle,AuD,CarltonJ.Zdanski,MD;Univ.ofNorthCarolinaHosp.,ChapelHill,NC.Abstract:Introduction:Multipleradiographicfindingshavebeenreportedforpediatricpatientswithsensorineuralhearingloss(SNHL)secondarytosymptomaticcytomegalovirus(CMV).Herewepresentoutcomesfromthelargestretrospectivecaseseriesofpatientsinthispopulationundergoingcochlearimplantation,andcorrelatethemwithpre-operativeradiographicfindings.Methods:Retrospectivesingle-institutionchartreviewattertiaryacademiccenter.Allpediatricpatientsundergoingimplantationattheauthors’institutionwithknowncongenitalCMVwhounderwentpre-operativeimaging(MRIorCT)wereincluded.Results:Between1993-2016,59patientsfitcriteria.Meanageatimplantationwas3.7years(range:9mos-19.3years).CerebralMRIlesionsandanomalieswerenotedin35/51patients(81.3%);innerearpathologywasnotedin8/59patients(13.6%).Oneintraoperativecomplicationwasencountered(1.7%),andnopatientsrequiredrevision.NeithercerebralMRIlesionsnorinnerearpathologysignificantlypredictedcomplications(p=0.69,p=0.99).Avarietyofspeechperceptionscoresarepresentedandcorrelatedwithradiographicanomalies.Conclusion:Pre-operativeradiographicimagingmaybemorehelpfulinpredictingpost-operativespeechreceptionscoresthaninpredictingintra-operativecomplications.However,speechperceptionscoresmustbeweighedwithpre-existingdevelopmentaldelayorneurologicimpairment.CochlearimplantationshouldbeconsideredinallpatientswithCMVandsevereSNHL. AbstractID:480PosterNumber:17Title:CochlearImplantationinCasesofUnilateralHearingLoss(UHL):TherapyImplicationsforChildrenAuthors:MaeganK.Evans,PhD,HollyTeagle,AuD,SandraHancock,MS,HaroldPillsbury,MD;UNC,UNCChapelHill,Durham,NC.Abstract:Introduction:PreviousresearchonadultswithUHLhasshownanimprovementinspeechperception,localization,and/orqualityoflifewithacochlearimplantascomparedtoanunaidedlisteningcondition.Withthepotentialofneuralplasticityintheirfavor,itisofinteresthowchildrenwithUHLcouldbenefitfromcochlearimplantstodevelopauditoryskills.AcasestudyreportbyGreaver,EskridgeandTeagle(2016)revealedthatfivechildrenwithUHLconsistentlyweartheirdevicesandhaveshownimprovedoutcomesinspeechrecognitionwhentheimplantedearisisolated.Underaninvestigationaldeviceexemption(IDE),inacurrentclinicaltrial,20childrenwithUHLwillreceiveacochlearimplant.Duringthefirstyearpost-implant,eachchildwillreceiveatotalof21auditory-verbalbasedtherapysessions.Thispresentationwillshowamodelfortherapy,basedonanaural


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rehabilitationprotocoldevelopedforadultswithUHL,whichwillbeusedduringthesesessionswiththechildrenincludedinthetrial.Methods:AtoolwasdevelopedtoguidetherapyforchildrenwithUHLandtotrackimprovementsinauditoryskillswiththeirimplant.Results:ResultsshowthatalladultswithUHLshowoverallimprovedoutcomesintheirauditoryskillspostimplantation.PreliminarydataonperformanceofchildrenwithUHLwhoreceiveacochlearimplantduringauditory-verbalbasedtherapysessionsovertimewillbediscussed.Conclusion:TherapyforchildrenwithaUHLisanewareatobeexplored.Continuedresearchonthetypeoftherapy,frequencyoftherapy,andefficacyisneeded. AbstractID:481PosterNumber:87Title:CochlearImplants:InsertionAssessmentbyComputedTomographyAuthors:RaquelA.Lauria,BachelorofMedicine.Otolaryngologist,VagnerRodrigues,BachelorofMedicine.Otolaryngologist,AlexandreC.Guimarães,MD,WalterBianchini,MD,ArthurCastilho,MD,AgricioCrespo,MD;DepartmentofOtolaryngology,HeadandNeck.UniversityofCampinas(UNICAMP),UNICAMP,campinas,Brazil.Abstract:Introduction:Cochlearimplants(CIs)functionallyrestorehearinginindividualswithprofoundhearingimpairment.ImagingexamsplayakeyroleinCIswithregardtobothplanningimplantationbeforesurgeryandqualitycontrolaftersurgery.Selectingtheoptimalinsertiondepthshouldbepatient-specificbymeansofdeterminingcorrespondingresidualhearing.Thedevelopmentofatoolformeasuringtheinsertiondepthwouldbevaluableinclinicalpractice.Theaimofthisstudywastoassessatechniqueformeasuringtheinsertiondepthofcochlearimplants(CIs)basedoncomputedtomography(CT).Methods:Fiveformaldehyde-preservedhumantemporalboneswereimplantedwithtwodifferenttypesofelectrodesthroughtheroundwindowmembrane:Themodiolarresearcharray(MRA)andTheContourAdvancedevice.ThehumantemporalboneswerefirstimplantedwithMRAelectrodesandthenimagedbyCT.Theseelectrodeswerethenremoved,andContourAdvanceelectrodeswereimplantedinthesametemporalbonesandimagedbyCT.LinearandangularmeasurementsofCIswereassessedbyCT.WecomprehensivelycharacterizedtwoCImodelswhileobviatingpossiblechangesthatcanbecausedbydifferentcochleasizesbyusingthesamehumantemporalbonestoevaluatetheimplantmodels.Results:Weobservedsignificantdifferencesbetweenbothinsertionmeasurementsforthetwoevaluatedelectrodearraysbecauseoftheirdifferentdesignandconstructioncharacteristics(p<0.05).Conclusion:ThepresentstudydemonstratesapracticalandusefultoolforevaluatingCIelectrodesinclinicalpractice.Furtherstudiesshouldmeasurepreoperativeandpostoperativebenefitsintermsofspeechrecognitionandevaluatethepreservationofresidualhearingintheimplantedear.Suchstudiescanalsodeterminecorrelationsbetweensurgicalfactors,electrodepositions,andperformance.Inadditiontorefinesurgicaltechniques,thepreciseevaluationofcochlearlengthandcorrectchoiceofCIcharacteristicscanplayanimportantroleinpostoperativeoutcomes. AbstractID:482PosterNumber:15


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Title:LanguageOutcomesFollowingCochlearImplantationinPediatricPatientswithCochlearNerveDeficiencyAuthors:ElizabethEricksonO'Neill,Au.D.1,AshleighLewkowitz,Au.D.1,AmandaGriffin,Au.D.,Ph.D.1,JenniferHarris,Au.D.1,DeniseFournierEng,M.A.2,JenniferJohnston,Ed.D.2,NicoleSalamy,M.S.2,AmySzarkowski,Ph.D.3,GregLicameli,M.D.4;1CIProgram,BostonChildren'sHosp.,Waltham,MA,2CIProgram/DeafandHardofHearingProgram,BostonChildren'sHosp.,Waltham,MA,3CIProgram/DeafandHardofHearingProgram/HarvardMedicalSchool,BostonChildren'sHosp.,Waltham,MA,4CIProgram/HarvardMedicalSchool,BostonChildren'sHosp.,Boston,MA.Abstract:Introduction:Cochlearnervedeficiency(CND)isdefinedasasmallorabsentcochlearnerve,diagnosedviaMRIand/orCTscan.Owingtotheabnormalauditorynerve,thesechildrenarenotconsideredtypicalcandidatesforcochlearimplantation(CI),asbenefitishighlyvariable.Audiologicaloutcomesinthispopulationarewelldocumentedintheliterature;however,investigationoflanguageoutcomesislimited.ThisstudywillexaminehowcochlearimplantationaffectedlanguageacquisitionforpediatricpatientswithCND,secondarytonon-syndromichearingloss.Methods:Retrospectivereviewof703medicalrecordsofchildrenwhoreceivedCIsatatertiarycarepediatrichospitalbetween1995-2016identifiedsixchildrenwithadiagnosisofCND.Audiological,speech-languageandpsychologicalchartnoteswerereviewedtodetermineaccesstosoundpre-andpost-cochlearimplantation,thetypeandqualityofearlylanguageopportunities,andlaterdevelopmentoflanguageabilities.Results:Consistentwiththeexistingliterature,audiologicaloutcomesvariedacrossthecohort.AllpatientsachievedsoundawarenessthroughtheirCI(s),withCIdetectionthresholdsrangingfrom20to75dBHL.Ofthechildrenwhowereoldenoughtomeasurespeechunderstanding(n=4),abilitiesrangedfrombasicpatternperceptiontoopen-setwordunderstanding.Forthisgroupofchildren,boththeearlylanguageexposureandthepost-implantationofchildrenthelanguageoutcomeswerehighlyvariable.Twoofthechildrenarecompetentusersoflanguage;onechild(whosehearinglosswasprogressive)isbilingualinEnglishandahomelanguageandtheotherisfluentinASL.Forthesetwoindividuals,wasearlyaccesstoanaturallanguage(spokenorsigned)seemedtobeasignificantfactorintheirlateruseoflanguage.Theotherfourchildrenhavesignificantdelaysinreceptiveandexpressivelanguage.Conclusion:Languageoutcomesforthissmallgroupvariedconsiderablyandmostofthechildrendonotmeettheexpectationsforspokenlanguageoutcomesweholdforthemajorityofchildrenwhoreceivecochlearimplant(s).Thus,cochlearimplantteamsareencouragedtothinkmorebroadlyregardingbothcochlearimplantcandidacyandparentalcounseling,pre-andpost-operatively.Pre-implantationconsultationsshouldminimallyincludeotologic,audiologic,speech-language,andpsychologicalevaluations.Weadvocateforin-depthdiscussionwithfamiliespriortoimplantationregarding:expectedauditoryoutcomes,appropriateaudiologicandspeech-languageinterventionpost-operatively,anticipatedchangesinqualityoflife,theneedforaccesstoanaturallanguage-spokenorsigned-tosupportdevelopmentofcommunication,languageandthinking,andpotentialimplicationsforcommunicationmodality/opportunities. AbstractID:483PosterNumber:107Title:AgeofUsherSyndromeTypeIDiagnosisinCochlearImplantees:OneTeam'sExperienceIncludingAgeofIndependentWalkingAuthors:NWendellTodd,MDMPH1,JolieC.Fainberg,MA2;


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1Emory,Atlanta,GA,2AtlantaSpeechSch.andEmoryUniv.,Atlanta,GA.Abstract:Introduction:OutsidethesmallcircleofthosewellinformedaboutUshersyndrometypeI,easilyidentifiablemotormilestonesalertingonetoconsiderforthesyndromearelargelyunknown.Ophthalmologicdiagnosticelements(opticalcoherencetomography,electroretinography,andatthegrossstageretinitispigmentosa)continuetoevolve.Genetictestingisoftennotcoveredbyinsurance.Methods:Datareviewofonecochlearimplantteam’s(asurgeon,anaudiologist)personalexperienceof22yearsand507childrenimplanted.Results:Eightpatients,ofwhomsixrepresentedthreesetsofsiblings,walkedindependentlyatamedianageof22.5months(range16-36months).Theagesof1stearimplantationrangedfrom6to33months,median.ThemedianagefordiagnosisofUsherIwas11years(range5-22).PriortothediagnosisofUshertypeI,twosetsofsiblings(i.e.,fourpatients)hadgeneticist-placeddiagnosesofWaardenburgsyndrome(onesetofsiblings)andconnexin26(anothersetofsiblings).Eachpatientisacomfortablelistening-speakingcommunicator.Conclusion:Forthechildwithcongenitalbilateralprofoundhearingimpairmentandwithimage-normaltemporalbones,notwalkingindependentlybyage18monthsshouldbeanalerttothepotentialdiagnosisofUshersyndromeI. AbstractID:484PosterNumber:29Title:EffectofPhonologicalErrorsonSpeechIntelligibilityinEarlyandLaterImplantedPediatricCochlearImplantUsersAuthors:OlgaPeskova,MS1,NirmalSrinivasan,PhD2,AnnGeers,PhD3,EmilyTobey,PhD3,PeterAssmann,PhD1;1BehavioralandBrainSciences,UTDallas,Richardson,TX,2Audiology,Speech-LanguagePathology,andDeafStudies,TowsonUniv.,Towson,MD,3BehavioralandBrainSciences,TheUniv.ofTexasatDallas,Richardson,TX.Abstract:Introduction:Cochlearimplants(CI)allowchildrenwithhearingloss(HL)toachievespeechperceptionandproductionoutcomestomaketheirspeechunderstandabletonormalhearing(NH)adultlisteners.Thiscapabilityisaccompaniedbyawidevariabilityofscores.Inordertounderstandthefactorsthatcontributetothisvariability,weinvestigatedtheeffectsofphonologicalerrors,ageofimplantationanddurationofCIuseonspeechintelligibilityofearlierandlaterimplantedCIusers.Methods:Laterimplantedparticipantsincludedthegroupof107childrenimplantedbetweentheagesof2and4testedat8yearsofage.Earlyimplantedparticipantsincludedthegroupof60childrenimplantedbetweentheages1and3(±2months)testedat8yearsofage.SpeechintelligibilityperformanceandnumberofphonologicalerrorswereevaluatedusingMcGarrsentences(McGarr,1983),whichvariedinlengthfrom3to5to7syllablesandweredefinedaslowandhighcontextsentences.ThreeNHlistenersindependentlyheardonesentencefromonechildandwrotedownthewordstheyunderstood.Theaveragescorewascalculatedforintelligibility.SentencesproducedbyCIusersweretranscribedbyfourspeechlanguagepathologists.BroadtranscriptionswereanalyzedusingtheComputerAidedSpeechandLanguageAnalyses(CASALA)software(Serryetal.,1997)todeterminethepercentcorrectforeachconsonantandcalculatepercentofomissionsandsubstitutions.Results:Significantnegativecorrelationsbetweenspeechintelligibilityscoresandphonologicalerrorsforbothgroupswereevident.Theearlierimplantedgrouphadsignificantlyfeweromissionandsubstitutionerrorscomparedtothelaterimplantedgroup.


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Conclusion:Thesignificantreductioninthenumberoferrorsfortheearlierimplantedgroupindicateadvantagesofearlyimplantation,longerdurationofCIuseandnewerspeechprocessingstrategiesrelativetolaterimplantedgroup. AbstractID:486PosterNumber:89Title:DiameterofNerveforPredictingOutcomeofCochlearImplantinChildrenwithSevereCochlearNerveDeficiencyAuthors:YongxinLi,professorOtolaryngology,BeijingTongrenHosp.,Beijing,China.Abstract:Introduction:Cochlearnervedeficiency(CND)isoftenassociatedwithpoorcochlearimplant(CI)outcomes,andpatientswithcochlearnerveabsentmaybeconsideredasrelativecontraindicationforCI.Thepurposeofthisstudywastoreporttheoutcomeof21CIpatientswhohaveonlyonenerveininternalauditorycanal(IAC)andtherelationshipbetweendiameterofthisnervewithpostoperativeperformance.Methods:Wepresent21childrendiagnosedascochlearnerveabsentwithonlyonenerveinIACwhoreceivedcochlearimplantsurgeriesinourcenterduringJanuary2009toJanuary2016.ThesepatientsallunderwentHRCTtodeterminethemalformationofcochlearandMRItomeasurethediameterofthepointinobliquesagittalplanescan.PostoperativeperformanceoftheCIchildrenwasassessedbyAuditoryPerformance(CAP),SpeechIntelligibilityRating(SIR),MeaningfulUseofSpeechScale(MUSS)andmeaningfulauditoryintegrationscale/infant-toddlermeaningfulauditoryintegrationscale(MAIS/IT-MAIS)1yearaftersurgery.Results:20of21patientsgotanimprovementonauditoryperformancecomparingwithpre-operation(p<0.05),including6patientswithcochlearmalformation(IP-Iandcommoncavity).Theaveragenervediameteris0.99±0.79mm.ThereissignificantrelationbetweennervediameterandSIR,MUSSandMAIT/IT-MAIS(p<0.05).Andthenervediametersbetweenpatientswithmalformation(0.75±0.43mm)andnon-malformation(1.08±0.82mm)groupsaresignificantdifferent(p<0.05).Buttheperformancesarenodifferences.Conclusion:Patientswithservecochlearnervedeficiencycouldbenefitfromcochlearimplant.AndthenervediametersinIAConMRImaybeamoderatepredictorofpostoperativeoutcomeforCIpatientswithonlyonenerveinIAC. AbstractID:487PosterNumber:162Title:IntraoperativeElectrocochleography(ECochG)inResponsetoAcousticStimulusUsingtheCochlearImplantElectrodeArrayandPost-activationSpeechOutcomesAuthors:RobertT.Dwyer,AuD1,JourdanHolder,AuD1,BrendanP.O'Connell,MD2,GeorgeB.Wanna,MD2,MarcL.Bennett,MD2,AlejandroRivas,MD2,DavidS.Haynes,MD1,RenéHGifford,PhD1,RobertF.Labadie,MD2;1HearingandSpeech,Vanderbilt,Nashville,TN,2Vanderbilt,Nashville,TN.Abstract:Introduction:Evenwithimprovementsincochlearimplant(CI)technology,largevariabilityinspeechunderstandingoutcomesexists.DurationofdeafnesshasconsistentlybeenmostshowntobetheprimaryvariableaffectingoutcomesinCIlisteners—primarilydrivenbytheextremeendsofthefunction.Fitzpatricketal.(2014)recentlyshowedhighpredictivevalueofelectrocochleography(ECoG)


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onCNCwordrecognitioninadultCIusers.TheprimarypurposeofthisstudywastodeterminethefeasibilityofmeasuringintraoperativeECochGinresponsetoacousticstimulususingtheelectrodearrayandsecondly,tocorrelatethiswithpost-activationoutcomes.Methods:28adultpatientswithnormalcochlearanatomyundergoingcochlearimplantationwithanAdvancedBionicsMid-Scaladevicewerestudied.Acoustictonebursts(125Hz,250Hz,500Hz,1000Hz,and2000Hz)werepresentedtotheoperativeearviafoaminsertearphoneafterelectrodeinsertion.ECochGresponseswererecordedusingtheimplantelectrodearray.Results:ECochGresponsesweresuccessfullymeasuredin27/29(93%)earsusingtheelectrodearray.Therangeofthetotalresponse(TR)measuredwas55dB.NosignificantcorrelationbetweenthemagnitudeoftheTRandpost-operativeCNCwasobservedfor11earsreachingthe3-monthtimepointatthetimeofabstractpreparation(p>0.05).FurtherwefoundnocorrelationwithCNCwordscoreanddurationofhearingloss,ageatimplantation,pre-CIsentencerecognition,norcognitivestatus(MMSE).Conclusion:ECochGcanreliablybemeasuredinmostCIpatients.Responsestoacousticstimuliweresuccessfullymeasuredin27/29(93%)ofdeviceinsertions.Lossoflockononedeviceandakinkedstimulusdeliverytuberesultedinlostdatafortheremaining2cases.PreliminaryfindingssuggestthatECoGmagnitudeobtainedintraoperativelyfollowingelectrodeinsertionisnotcorrelatedwithwordrecognition;however,the11patientshadnotyetreachedexpectedperformanceasymptoteatthetimeofabstractpreparation.Wewillcontinuelongitudinalassessmentwithadditionalanalyses. AbstractID:490PosterNumber:154Title:TimingofImplantationinPediatricProgressiveSNHL:AreWeWaitingTooLong?Authors:MauraCosetti,MD,JillianLevine,AuD,GeorgeWanna,MD;Otolaryngology,NewYorkEyeandEarInfirmaryofMountSinai,NewYork,NY.Abstract:Introduction:Ageatimplantationisawell-knownpredictorofoutcomeforchildrenwithcongenital,profoundsensorineuralhearingloss(SNHL),withdatasuggestingearlierimplantationmaximizespost-operativespeechunderstanding.Incontrast,optimaltimingofCIinpediatricpatientswithprogressiveSNHLremainscontroversial.TheobjectiveofthisstudyistounderstandtheimpactofageatCIonspeechunderstandinginchildrenwithprogressiveSNHL.Methods:AretrospectivechartreviewwasperformedofallpediatricpatientswithadiagnosisofprogressiveSNHLwhounderwentcochlearimplantation(CI).VariablesaffectingCIcandidacy,includingpure-toneaverage,hearing-aidfitting,etiologyofprogressivehearingloss,ageatimplantation,closedandopen-setspeechperception,andeducationalenvironmentwerecollectedandtrendstowardimplantationdecision-makingwereanalyzedResults:Children(n=12)withprogressiveSNHLwhoultimatelyunderwentCIwereidentified.AgeatCIrangedfrom13months-16years(mean5years)withaveragefollow-upof12months.Post-operatively,allpatientsdemonstratedimprovedspeechperception,includingpatientswithaccesstoopen-setspeechshortlyfollowingimplantation.Overall,youngerageatimplantationwasanindependentpredictorofpost-operativespeechunderstandingConclusion:CIcandidacydecisionsinpediatricpatientswithprogressiveSNHLwhoreceivesomebenefitfrombinauralamplificationareoftenchallengingandmulti-factorial.Althoughidealtimingremainscontroversial,ageatimplantationappearstoplayasignificantroleinpost-operativespeechunderstandingandshouldbeanimportantfactorintimingofimplantation.


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AbstractID:491PosterNumber:70Title:CorrelationsofIntracochlearandExtracochlearElectrocochleographyduringCochlearImplantationinChildrenandAdultsAuthors:ChristopherK.Giardina,B.S.1,TatyanaE.Fontenot,M.D.1,StephenPulver,M.S.1,CraigA.Buchman,M.D.2,OliverF.Adunka,M.D.3,KevinD.Brown,M.D.,Ph.D.1,HaroldC.Pillsbury,M.D.1,DouglasC.Fitzpatrick,Ph.D.1;1UNCChapelHill,ChapelHill,NC,2WashingtonUniv.atSt.Louis,St.Louis,MO,3TheOhioStateUniv.,Columbus,OH.Abstract:Introduction:Preservationofcochlearintegritythroughoutcochlearimplant(CI)insertionisparamountinmaximizingspeechandhearingoutcomesforbothchildrenandadults.However,intraoperativefeedbacktosurgeonsregardingCIpositioningandbasilarmembranetraumaarelimited.Electrocochleography(ECochG)duringCIinsertionhasbeenusedbutapproachesvarybyrecordinglocation,ateitherintra-orextracochlearsites.Specifically,groupshavereportedasteadyincreaseinintracochlearresponseandastableextracochlearresponseasindicatorsofhearingpreservation.Thepurposeofthisstudywastocharacterizeintra-andextracochlearECochGresponsesduringCIinsertionsforabroadrangeofCIsubjectsandarraytypes.Ourhypotheseswerethatintracochlearresponseswouldbelargerandgrowduringinsertion,whereasextracochlearsignalswouldbesmallerbutbetterabletodetectcochleartrauma.Methods:In74CIrecipients(29childrenand45adults),ECochGwasperformedattheroundwindow(RW)beforeCIinsertionandatanextracochlear(n=53)orintracochlear(n=21)sitethroughoutCIinsertion.ToneburstswerepresentedtotheipsilateralearusingaNatusBio-LogicAEPPro.ThefrequencywhichelicitedthelargestRWresponseat90dBnHL(typically500Hz)wasusedasthestimulusfrequencyduringCIinsertion.Theextracochlearelectrodewasacustom-builtcopperprobewhichremainedfixedonthepromontoryviaaretractor-clampedmount.Forintracochlearrecordings,manufacturer-providedtelemetrysoftwareallowedforadigitalshorttobecreatedbetweentheapicalcontactandthereferencecontact,whichwethenconnectedourrecordingdeviceto.Results:IntracochlearresponsesatthebeginningofCIinsertionwereonaverage10.7dBlargerthanextracochlearresponses,andwerenotdifferentbetweenchildrenandadults(p>0.81,t-test).ThroughoutCIinsertion,intracochlearresponsescouldgrowatleast5dBinmagnitude(38%),remainsteadywithin5dB(48%)orevendeclineinmagnitude(14%).Therewerealsodifferencesintypicalresponsepatternsbetweenmodiolarandlateralwallarrays,withmodiolararraysincreasinginmagnitude13-foldmoreonaveragethanthelateralwallarrays.Forextracochlearrecordings,responsestendedtoremainsteady(within5dB)inmostcases(72%),withoccasionalcaseshavinglarger(5dB)drops(28%).Interestingly,inbothintra-andextracochlearrecordings,responsescoulddropbymorethan5dBandhavepartialorcompleterecoverybytheendofCIinsertion(25%extracochlear,24%intracochlear).Conclusion:Intracochlearresponsestotonesaregenerallylargerthanextracochlearsignals,butgrowthduringCIinsertionwasnotcommonandwasmorelikelyinmodiolarthanlateralwallarrays.ResponsepatternsduringCIinsertionarearray-specificandasimpledropinmagnitudeateitherintra-orextracochlearsitemaynotbeanabsolutemetricfortrauma. AbstractID:493PosterNumber:90


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Title:PredictingAuditoryOutcomesfromRadiologicalImagesandElectrodeTypesinCochlearImplantPatientswithIncompletePartitionMalformationAuthors:YongxinLi,professorOtolaryngology,BeijingTongrenHosp.,Beijing,China.Abstract:Introduction:Thepurposeofthisstudywastoevaluatetheradiologyandhearing-speechrehabilitationininnerearanomalieswithIncompletePartitionforcochlearimplant(CI)usersusingdifferentelectrodetypes.Methods:Thesubjectswere40patientswithprofoundcongenitalbilateralsensorineuralhearinglossforCI.Thesepatientswereretrospectivelyselectedfromourelectronicdatabaseinwhichallinnerearmalformationswithincompletepartitionutilizingadifferentelectrodestyles(shortelectrode,FLEX24,FLEX28)between2013and2015.Thepatientsweregroupedbydifferentelectrodetypes.Computedtomography(CT)dataandmagneticresonance(MR)imageswerereviewedbytworadiologists.CategoriesofAuditoryPerformance(CAP),SpeechIntelligibilityRating(SIR),Infant-ToddlerMeaningfulAuditoryIntegrationScaleorMeaningfulAuditoryIntegrationScale(IT-MAISorMAIS),MeaningfulUseofSpeechScale(MUSS)werecollectedpre-andpostoperativelyat24monthsandwereanalyzedbyanaudiologist.Results:Theaveragebasalturnlengthofthecochleais9.02±0.76mm.Theaveragebasalturnheightofthecochleais2.49±1.60mm.ThereisasignificantcorrelationbetweenelectrodetypesandSIRscores(r=0.656,p<0.05).Amongthethreegroups,thebasalturnheightofthecochleaandSIRandMUSSaresignificantlydifferent(p<0.05).ButtherewerenodifferenceofCAPandMAIS.Conclusion:ThespeechabilityrehabilitationofinnerearanomalieswithIncompletePartitionwithCIissignificantlydifferentinthreeelectrodetypesgroups.Theshortertheelectrode,theworsethespeechperformance. AbstractID:500PosterNumber:216Title:RevisionCochlearImplantation:ARetrospectiveReviewofYoungAdultsWhoReceivedTheirFirstImplantDuringChildhood.Authors:JenniferWoodard,AuD,AndreaBucker,AuD,MargaretDillon,AuD,EnglishKing,AuD,EllenDeres,AuD,HaroldC.Pillsbury,MD,KevinD.Brown,MD;Otolaryngology,Univ.ofNorthCarolina-ChapelHill,Durham,NC.Abstract:Revisioncochlearimplantation:ARetrospectiveReviewofYoungAdultsWhoReceivedTheirOriginalImplantDuringChildhood.JenniferWoodard,AuD,AndreaBucker,AuD,MargaretDillon,AuD,English,King,AuD,EllenDeres,AuD,KevinD.Brown,MDandHaroldC.Pillsbury,MDIntroductionMultichannelcochlearimplants(CI)haveprovidedaccesstosoundforprofoundlydeafindividualsforoverthirtyyears.Whileallmanufacturers’devicescarryaten-yearwarranty,ahighpercentageofdevicesareknowntolastwellbeyondtheiroriginalwarranty.Still,manyusershaveencounteredproblemswiththeircochlearimplantsthatcannotberectifiedthroughmappingandorreplacementoftheirexternalCIsoundprocessorsthusrequiringrevisionoftheirinternaldevice.Thepurposeofthisstudyistoexaminetrendsinspeechperceptionperformanceprevs.post-revision,inapopulationofrecipientswhoreceivedtheirfirstimplantsatayoungage,andthenunderwentrevisionsurgeryaftermorethan10yearsofdeviceuseMethods


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AretrospectivereviewwascompletedofCIrecipientswhoreceivedtheirfirstdevicesatayoungageandwerefollowedforover15yearsuntilundergoingsurgicalrevision.Transitiontoanothermanufactureroccurredinhalfoftherecipients;thosewhostayedwiththesamemanufacturerreceivedanewergenerationofdevice.Speechperceptionperformanceresultsovertimewereanalyzed.ResultsRevisioncochlearimplantationwaspursuedprimarilyduetosoft-failure(painanddeclineinperformance)andinonecase,tomatchtechnologyusedinthecontralateralear.Theaverageageatoriginalimplantationwas5yearswitharangeof2-9years.Theaveragelengthofdeviceusepriortorevisionwas16years.Averageageatrevisionwas24years.Recipientswereabletoachievespeechperceptionscorescomparabletotheirpre-revision“best”performancescoreswithin3-6monthspost-activation.ConclusionPositiveoutcomeswereseenforlong-termimplantuserswhowererevisedasadults.Furtheranalysisofthispopulationiswarrantedtoexaminepreferredmapparametersasthiscohorthasgonefromusing“vintage”technologytocurrentstate-of-the-artdevicesthatincludemanyprocessingfeaturesthatwerenotavailableatthetimeoftheiroriginalactivation. AbstractID:501PosterNumber:217Title:LongTermElectricChargeRequirementsforChildrenEnrolledintheChildhoodDevelopmentAfterCochlearImplant(CDACI)StudyAuthors:TeresaZwolan,Ph.D.1,CarolineArnedt,AuD1,Nae-YuhWang,Ph.D.2,ChristineMitchell,ScM2,SamanthaZwolan,B.A.1,CdaciInvestigative,Team1;1Otolaryngology,Univ.ofMichigan,AnnArbor,MI,2Otolaryngology,JohnsHopkins,Baltimore,MD.Abstract:Introduction:TheChildhoodDevelopmentafterCochlearImplantation(CDaCI)studyisalongitudinalmulticenter,nationalcohortstudytosystematicallyevaluatecochlearimplant(CI)outcomesinchildren.In2008wereportedonthemappingcharacteristicsof188childrenenrolledinthisimportantstudy.DataincludedexaminationandcomparisonofmeanComfort(C/MLevel)measures(inchargeperphase)obtained6,12,and24monthspost-activation.Wefoundthatallthreedevices(AdvancedBionics,Cochlear,andMedEl)demonstratedsignificantincreasesinC/Mlevelsbetweendeviceactivationandthe24monthappointment.SignificantdifferencesinmeanC/Mlevelswerenotedbetweendevices.Additionally,childrenwithcochlearanomaliesdemonstratedsignificantlygreaterC/Mlevelsthanchildrenwithnormalcochleae.Methods:Inthisstudy,weperformedalongitudinalevaluationofmappingdatafor188childrenenrolledintheCDACIstudy.Allsubjectswere5yearsoldoryoungeratthetimetheyreceivedtheirinitialcochlearimplant.Thisisanextensionofourpreviousstudywherewenowincludemappingdataobtained60and96monthspost-activation,resultinginacomprehensivelongitudinalpictureofmappingcharacteristicsofchildrenfollowing8yearsofdeviceuse.Unlikeourpreviousstudy,wenowhavespeechrecognitionandspeech/languagedatasincethechildrenareolder,andweareabletoexaminetherelationshipbetweenchargelevelandvariousoutcomemeasures.Results:Dataforchargelevelsobtainedatdeviceactivationand12,24,60,and96monthspost-activationwerecompared.Weevaluatedandcompareddifferencesovertimeforallthreedevices,andreportondifferencesbetweendevicesatthevariousintervals.Weexamineddifferencesinchargelevelasafunctionofimplantcenter(sixdifferentcenterscontinuetoparticipateinthisstudy)andcomparedthechargelevelsofchildrenwithandwithoutcochlearanomalies.Lastly,weexaminedtherelationship


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betweenchargelevelandoutcomeasmeasuredbyvariousspeechperceptionandspeech/languagemeasures.Conclusion:TheCDACIstudyhasenabledustoevaluatethelongitudinalmappingcharacteristicsofpediatricpatientswhouse3differentdevicesandwereimplantedatavarietyofimplantcenters.Analysisofsuchdataenablesustobetterunderstandthelongtermmappingcharacteristicsofchildrenwithcochlearimplants,andprovidesuswithanimprovedunderstandingoftherelationshipbetweenCIchargelevelsandoutcomeswithaCIasmeasuredwithvariousspeechperceptionandspeech/languagemeasures. AbstractID:502PosterNumber:67Title:Rapid,Cost-freeMethodtoPreciselyAlignPositionofBilateralCochlearImplantsAuthors:JohnGermiller,M.D.,Ph.D.1,N.WendellTodd,M.D.2,StacyG.Justus,RN3,KaraPrickett,M.D.2;1Otolaryngology,Children'sHosp.ofPhiladelphia,Philadelphia,PA,2Otolaryngology,EmoryUniv.,Atlanta,GA,3Surgery,EmoryUniv.,Atlanta,GA.Abstract:Introduction:Precisepositioninghasimportantaestheticimplicationsforpatientsundergoingbilateralcochlearimplantsurgery.Afewmillimetersasymmetrybetweenthetwomagnetpositionscanbenoticeabletothepatientandothers,andcancreatedissatisfaction,eventheperceptionthatasurgeonhassloppytechnique.Cochlearimplantsurgeonsarewellawarehowdifficultitistocreateperfectsymmetrywhenpositioningtwodevicesinseparatesurgicalfields.Preciselymarkingbothimplantpositionspreoperatively,e.g.withmethylenebluedyemarksontheskullsurface,cangreatlyhelpalignment.However,measuringandmarkingalocationononeside,thentransferringthatreliablytotheoppositeside,canbedifficultandtimeconsuming.Wepresentarapid,easymethodtoaccuratelyandreliablymarkbothsidesofapatient’sscalpinexactlythesamelocation,usingcommonpackagingmaterialsnormallydiscardedduringsurgery.Methods:AuthorS.G.J.conceivedtheconcept,whichhassubsequentlybeenusedbytheotherauthorsattheirinstitutions.Afterthesurgeonmarksthedesiredlocationofthedeviceonthefirstside,apieceoftransparentplastic(e.g.discardedpackaging)isusedtotracetheoutlineoftheauricle,twootherfixedlandmarks(lateralcanthusandnasalspine),andadotatthepositionoftheCImagnet,allusingfelt-tippen.Theheadisthenturned,thetransparentplasticissimplyflippedupsidedown.Theexistingmarkingsarealignedontotheauricleandlandmarksonthesecondear.Thescalpisthenmarkedpreciselyattheproperpositionforthesecondmagnet.Results:SinceJanuary2014,thetechniquehasbeenusedin36bilateralcases(20sequential,and16simultaneousbilateral).Precisealignmentwassuccessfulinallcases,asdemonstratedbybothinspectionandpostoperativexrays.Thetechniquetookapproximately30seconds.Conclusion:Achievingaestheticsymmetryofbilateralcochlearimplantscanbedonepreciselyandreliablyusingthismethod,withverylittletimeandeffort,andnocost. AbstractID:503PosterNumber:215Title:AnalysisofFactorsPredictingImprovedSpeechandLanguageOutcomesAfterCochlearImplantationforPost-meningiticSensoryHearingLossAuthors:ChristopherM.Welch,MD,PhD1,LisaPark,AudD2,KevinBrown,MD,PhD1;


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1Otolaryngology/HeadandNeckSurgery,Univ.ofNorthCarolinaatChapelHill,ChapelHill,NC,2TheChildren'sCochlearImplantCtr.atUNC,Durham,NC.Abstract:Title:AnalysisofFactorsPredictingImprovedSpeechandLanguageOutcomesAfterCochlearImplantationforPost-meningiticSensoryHearingLossIntroduction:Meningitisisthemostcommoncauseofpostnatallyacquiredsensorineuralhearingloss.Promptinterventionisrecommendedinthesettingofpost-meningitichearinglossasthecochleacanossifywithinweeks.Outcomesafterimplantationformeningitis,however,aremixed.Thepurposeofthisstudyistoidentifyfactorsthatpredictimprovedspeechandlanguageoutcomesaftercochlearimplantationforpost-meningitichearingloss.Methods:Thisstudyisaretrospectivereviewofpatientsundergoingcochlearimplantationafteradiagnosisofmeningitistodeterminefactorsassociatedwithspeechoutcomes.Patientswereevaluatedfortimingofcochlearimplantation,degreeofcochlearabnormalityencounteredduringimplantation,andpost-operativespeechandlanguagemeasures.Speechoutcomeswererepresentedbythespeechrecognitionindexinquiet(SRI-Q).IntraoperativefindingswereclassifiedaccordingtotheSmullenandBalkanyscale.Findingswereappropriatelyadjustedforageorinabilitytocompletefullaudiometrictestingduetocomorbidities.LinearregressionanalysisandKruskal-Wallistestingwereusedtodeterminewhetherthesefactorsweresignificantlycorrelatedwithimprovedhearingoutcomes.Results:Analysisof62pediatricpatientswithadiagnosisofmeningitissubsequentlyreceivingcochlearimplantationrevealedanaverageageatimplantationof5.1years.Theaveragetimeelapsedbetweendiagnosisofhearinglossandcochlearimplantationwas2.5yearswithamedianof1.3years.LinearregressionanalysisoftimefromdiagnosisofhearinglosssecondarytomeningitistocochlearimplantationversustospeechoutcomesasmeasuredbySRI-Qrevealedasignificantcorrelation(Rsquare0.108,p=0.024).32of36patientswithinformationavailableoncochlearabnormalitiesatthetimeofimplantationdemonstratedsomedegreeofcochlearfibrosis.Kruskal-WallisanalysisdemonstratedasignificantcorrelationbetweencochlearabnormalitiesandspeechoutcomesasmeasuredbySRI-Q(p<0.05).Conclusions:Patientsundergoingcochlearimplantationforpost-meningitichearinglosshaveimprovedspeechoutcomeswithashortertimefromdiagnosisofhearinglosstocochlearimplantationandfewercochlearabnormalitiesatthetimeofimplantation.Itisthereforeciriticaltointervenebycochlearimplantationasearlyaspossiblefollowingsensoryhearinglossinthesettingofpost-meningitichearingloss. AbstractID:505PosterNumber:199Title:TheEffectofWirelessMicrophoneTechnologyonFamiliarWordRecognitioninToddlerswithCochlearImplantsAuthors:SusieRobertson,Ph.D.SpeechandHearingScience1,PattiM.Johnstone,Ph.D.SpeechandHearingScience1,KristenE.T.Mills,M.S.1,KarenMartin,M.S.1,KellyR.Yeager,Au.D.1,ElizabethL.Humphrey,Au.D.1,SmitaAgrawal,Ph.D.CommunicationDisorders2;1AudiologyandSpeechPathology,Univ.ofTennesseeHlth.Sci.Ctr.,Knoxville,TN,2AdvancedBionics,LLC,SanFrancisco,CA.


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Abstract:TheEffectofWirelessMicrophoneTechnologyonFamiliarWordRecognitioninToddlerswithCochlearImplantsIntroduction:Researchhasshownthatyoungchildrenwhohearmorespeechdailyarefasterandmoreaccurateatwordprocessingthandothosewhohearlessspeech.Muchofatoddler’sspeechandlanguageexposuretakesplaceatadistancefromthetalkerathome,inautomobiles,anddaycarecenters.Toddlerswithhearingimpairment(HI)areatadisadvantage.ResearchhasshownthatchildrenwithHIarelessabletounderstandspeechthanpeerswithnormalhearing(NH).Amplificationdevices,suchascochlearimplants(CI),canexploitwirelessadaptivedigitalmodulation(ADM)systemstoimproveaudibilityofspeechoverdistance.ADMshavebeenshowntoimprovespeechperceptionabilitiesinolderchildrenandadults.ThepurposeofthisstudyistoassessADMtechnologyonafamiliarwordrecognitiontaskintoddlersaged18-42monthswhouseCIsandcomparetheirperformancetothatoftoddlerswithNH.Methods:Tentoddlers(ages18-42months)withsensorineuralhearingloss(CIusers)and2groupsoftoddlerswithNH(10matchedforhearing-age;10matchedforchronologicalage)willparticipate.Usingalooking-while-listeningexperimentparadigm,thesubjectsarepresentedauditorystimulusat65dbSPLsimultaneouslywith2picturesoffamiliarwordsonascreen.Thechild’sgazeisvideotaped.Twomeasures,accuracyandprocessingspeed,areassessedforwordrecognition.TheHIgroupparticipatesin2experimentsondifferentdaysusingtwodifferentmicrophoneconfigurations(NoADMandADM),counterbalancedacrosssubjects.ToddlerswithNHparticipateinoneexperimentwithnoADM.Productivevocabularyisassessedwithastandardizedvocabularymeasure.Results:Thesubjects’looktimetotheimagesisusedtoassesswordprocessing.Twomeasureswillbeobtained:Accuracy,basedontheproportionoflooktimetothecorrecttargetduringeachtrial,andprocessingspeed,basedonthelatencytoorienttothetargetfromthedistractoraftertargetwordonset.Preliminaryresults(HIgroup,n=3;NHgroup,n=3)showgreateraccuracyandfasterprocessingspeedintheADMconditionthanintheNoADMcondition.Furthermore,theHIgroupADMconditionresultsweresimilarinaccuracyandprocessingspeedtotheNHgroup,indicatingthatADMtechnologymayprovidetoddlerswithHIimprovementsinwordrecognitiontothelevelofperformanceofnormalhearingpeers.Conclusion:TheseresultsdemonstratetheadvantageofwirelessADMintoddlerswithHIwhouseCIs.Theresultswillbediscussedinthecontextofcurrenttheoriesofearlylexicalacquisitionandthedetrimentaleffectsofdegradedspeechonwordprocessing.TheseresultswillprovidecrucialinformationregardingthepotentialofADMtechnologyonearlywordprocessingintoddlers.ThefindingsprovideevidencethatmaybeusefulforpediatricaudiologistsandearlyinterventionistswhosepriorityispromotingearlylanguagedevelopmentinyoungchildrenwithHI. AbstractID:506PosterNumber:71Title:Intra-andExtracochlearElectrocochleographywithImpedanceMeasuresduringArrayInsertionPredictAnatomicTraumatotheMongolianGerbilCochleaAuthors:ChristopherK.Giardina,B.S.,KendallA.Hutson,Ph.D.,StephenPulver,M.S.,DouglasC.Fitzpatrick,Ph.D.;UNCChapelHill,ChapelHill,NC.Abstract:Introduction:Cochlearimplant(CI)arrayswhichremaincompletelywithinthescalatympanifacilitatebetterspeechandhearingoutcomes.ThoughCIpositioninggreatlyaffectsCIperformance,feedbacktothesurgeonduringimplantationislimited.Tworapidly-assessedmetricsduringCIinsertion


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areelectrocochleography(ECochG)andimpedancemeasurements.ECochGhasbeenshowntopredictbasilarmembrane(BM)trauma,butmethodologicalapproachesvarybyrecordinglocation(intracochlearorextracochlear).Additionally,intracochlearimpedancehasshowntovarywithCIinsertiondepthandproximitytomodiolarstructures.ThepurposeofthisstudywastocharacterizechangesinintracochlearECochG,extracochlearECochG,andintracochlearimpedancethroughoutCIinsertion.ThegoalwastodeterminewhichapproachismostsensitivetoBMtraumainanormalhearinggerbilmodel.Ourhypotheseswerethatintracochlearsignalswouldbelargerandmorevariablethanextracochlearsignals,thatextracochlearmagnitudedropswouldbemoreindicativeoftraumathanintracochlearresponsechanges,andthatchangesinimpedancewouldprecedechangesinECochGresponse.Methods:In10Mongoliangerbils,anextracochlearelectrodewasplacedonthepromontorywhileanintracochlearelectrodewasplacedthroughtheroundwindow(RW)andadvancedin200umsteps.Ateachstep,simultaneousintra-andextra-cochlearECochGwasperformedto500Hzand4kHztoneburstsat40and80dBnHL.Impedanceoftheintracochlearelectrodewasalsoperformedateachstep,usingabiphasiccurrentpulse(180us,88uA).TheextracochlearelectrodewasaNeurosignFacialNerveprobewhiletheintracochlearelectrodewasaflexibleAgelectrodeplacedonahydraulicmicromanipulator.Insertioncontinueduntiltheintracochlearelectrodehitanendocochlearstructure.Thecochleaewerethenremoved,fixed,decalcified,anddissectedtoappreciatethelocationandqualityoftrauma.Results:Intheanatomicallyundamagedcochlea,perioperativerecordingsshowednochangeinECochGorimpedancelevelswithinsertiondepth.Inallothercochlea,grosstraumatotheBMwasassociatedwithdrasticfluctuationsintheECochGmagnitudesandimpedancemeasures.IntracochlearECochGmagnitudecouldincrease(n=3),remainsteady(n=3),ordecrease(n=3)beforealargedropoccurred,indicatingBMtrauma.ExtracochlearECochGcoulddipandreturn(n=1)orremainsteadybeforealargedrop(n=8),andimpedancecouldincrease(n=2)ordecrease(n=7)beforeBMtrauma.ImpedancechangesoftenprecededalossinECochG(n=6).Conclusion:Simultaneousintra-andextra-cochlearECochGwithruntimeimpedancemeasuresrevealpatternsofresponsechangesindicativeofbothatraumaticandtraumaticCIinsertions.Intra-andextra-cochlearECochGprovidedistinctinformation,andruntimeimpedancemaybeanimportantmetricforassessingCIpositionandminimizingBMtrauma. AbstractID:507PosterNumber:178Title:ElectricalStapedialReflexThresholdMeasurementinChildrenwithUnilateralCochlearImplants:DifferencesbetweenImplantedEarandNon-implantedEarAuthors:G.Bhavani,MA1,SrinivasGanji,MPhil1,SrikanthIndlamuri,MA1,E.c.VinayaKumar,MS2,RambabuKoka,MS2,JaswinderSinghSaluja,MS2,YvvssVinayKumar,MS2,KmAjimsha,PhD3,AniketSaoji,PhD4,KanthaiahKoka,PhD4;1Audiology,ApolloCochlearImplantClinic,Hyderabad,India,2ENT,ApolloCochlearImplantClinic,Hyderabad,India,3AdvancedBionicsIndiaPvtLtd,Bangalore,India,4ResearchandTechnology,AdvancedBionicsLLC,Valencia,CA.Abstract:Introduction:Researchsuggestsastrongcorrelationbetweenelectricalstapedialreflexthreshold(ESRT)andmostcomfortablelevel(Mlevel)usedforelectricalstimulation.However,theinpediatricpopulation,multipleattemptsareoftennecessaryforsuccessfulESRTmeasurement.Inaddition,incidenceofthesuccessfulESRTmeasurementsisreportedtobeloweriftheprobeisplacedin


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theimplantedear.Inadults,theinstanceofsuccessfulESRTmeasurementmaybeincreasedifhigher(above226Hz)probefrequenciesareutilizedtodetectthestapediusreflex(Wolfeetal,2016).Inthepresentstudy,effectofprobefrequencies(226,678,and1000Hz)anddifferencesbetweenimplantedandnon-implantedearwerestudiedinpediatricpopulation.Methods:TwentyunilateralAdvancedBionicscochlearimplantrecipientsparticipatedinthestudy(meanage=6.7years,SD=3.7)attheApollocenter.Tympanogramswereperformedtoseethestatusofmiddleear.ESRTsweremeasuredasafunctionofprobefrequencyintheipsilateralandthecontralateralears.Results:IpsilateralESRTs(implantedear)couldbemeasuredacross8,9,and10subjectsoutof20subjectsforprobetones226Hz,678Hz,and1000Hzrespectively.Incontrast,contralateralESRTs(nonimplantedear)wereabletobemeasuredacross18subjectsoutof21subjects(with17,18,and18forprobetones226Hz,678Hzand1000Hz).Threeoutof10subjectsforwhomipsilateralreflexcouldnotbemeasuredhasatypeBtympanogram.Conclusion:Asinadults,thesuccessofmeasuringofESRTinchildrenincreaseswithincreasingprobetonefrequency,andwhenmeasuringfromthenon-implantedear.TheuseofthehigherfrequenciesmayleadtoanincreaseinobtainingclinicalESRTsandthereforebeofuseinprogrammingofpediatricrecipients.Futurestudieswillfurtherexplorethedifferencesbetweenmiddleearresonantfrequencyofimplantedandnon-implantedears. AbstractID:511PosterNumber:69Title:RapidFixationofThinCochlearImplantstotheSkullSurfaceUsingaSingleResorbableScrew(“Pericraniopexy”)Authors:JohnGermiller,M.D.,Ph.D.,LuvR.Javia,M.D.,BrianP.Dunham,M.D.,KenKazahaya,M.D.;Otolaryngology,Children'sHosp.ofPhiladelphia,Philadelphia,PA.Abstract:Introduction:Withtheadventofthinnercochlearimplants,manysurgeonsnolongerrecessthedevicebelowthesurfaceoftheskull.Whilethisreducessurgicaltimeandrisk,italsoeliminatesaprimarymeanstosecuretheimplantagainstdisplacementandmigration.Tie-downsuturefixation,asrecommendedbythemanufacturer,istimeconsuming,andespeciallydifficultunderthelimitedexposureprovidedbynewerminimalincisiontechniques.Wepresentourtechniqueforrapid,simple,securefixationtotheskullusingonlyasingleresorbablescrew.Thisisusedto“tack”theperiosteumdowntothebonejustanteriortothedevice,andincombinationwithatightperiostealpocket,itprovidesimmediate,securefixation,andprovidesadditionalinsuranceagainstanteriordevicemigration.Methods:Since2011wehaveemployedsinglescrewpericraniopexyonthin-profiledevicesfromall3manufacturers.Forthismethod,nodrillingofawell,channel,orshelfisneeded.Thedeviceisplacedintoatightsubperiostealpocketintheusualfashion.Theperiosteumisclosed,thentheanterior“shoulder”ofthedeviceislocatedbypalpation.Asinglescrewholeistapped,throughtheintactperiosteum,intotheskull,anteriortothemaindevicecable.Aresorbable1.5mmcortexscrew(3-or4-mmlength)isinserted,alongwitharesorbablewashercutfroma2-holeplate.Together,thescrewandwashersecurely“tack”theperiosteumdowntotheboneinthislocation.Results:Since2011,screwpericraniopexyhasbeenemployedsuccessfullyin42patientsreceivingthindevices(52ears).Nodevicemigrationwasreportedatfollowupexamsinclinic2-4weekspostop.Additionally,inthe30bilateralcases,noepisodesofasymmetryduetodevicemigrationeventswerereported.Anadditional64patients(70ears)alsounderwentpericraniopexyasanadjuncttoa


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traditionalbonyrecesssecuringathickerdevice(during2012-early2015).Therewerenocomplicationsineithergroup.Conclusion:Single-screwpericraniopexyisfast(1-2minutes),easytoperform,andrelativelyinexpensive.Itavoidstheneedtodrillabonywell,shelf,orchannel.Sinceitsecurestheimplantalongitsanteriorcorner,ithelpspreventthemostlikely,andmostproblematic,formofdevicemigration,i.e.,anteriordisplacementtowardthemastoid.Itusesreadilyavailableinstrumentsandstockscrewsusedcommonlyforcraniofacialprocedures,whichresorbcompletelyoverweekstomonths.Itispreciseenoughtoallowcarefulsymmetricpositioninginbilateralcases.Finally,itisbroadlyapplicableregardlessofsurgicaltechnique,evenwhenthereislimiteddeviceexposure(minimalincisionsurgery). AbstractID:513PosterNumber:160Title:BimodalEartoEarAudioStreaming:SpeechUnderstandingAdvantagesinComplexListeningSituationsAuthors:SarahDowning,M.S.,CCC-A,EmilyCardenas,Au.D.,CCC-A,SmitaAgrawal,Ph.D.;AdvancedBionics,LLC,Valencia,CA.Abstract:Introduction:Theabilitytostreamfull-bandaudiosignalsbetweentwoearleveldevices(e.g.,betweentwoHearingAids(HA)ortwoCochlearImplant(CI)soundprocessorsorbetweenaCIsoundprocessorandanHA)inrealtimeoffersopportunitiesforsignalenhancementinseveralinterestingways.Oneapplication(StereoZoom)allowscreationofafour-microphonearrayviatwo-waycommunicationbetweenthedual-microphonesystemsoneachofthetwohearingdevices.Theresultingthird-orderdirectionalsystemcreatesanarrowerfixedtargetbeamascomparedtodual-microphonesystems.Thiscouldallowuserstofocusonasinglespeakerdirectlyinfrontoftheminverynoisyenvironments.Inasecondapplication(ZoomControl),audioinputatoneearisstreamedsimultaneouslytobothears,thusreducingthesignaldeficitatthecontralateralearduetoheadshadow.ThedirectmicrophoneinputatthecontralateralearisattenuatedtofurtherenhancetheSNR.Thiscouldimprovespeechunderstandinginnoiseinsituationswherethespeakerisnotinfrontofthelistener,suchaswhentalkingonthephoneordrivingacar.Theobjectiveofthisstudywastoassessthebenefitoftheabovetwoapplicationsofear-to-earaudiostreaming(StereoZoomandZoomControl)inadultbimodallisteners(cochlearimplantinoneearandahearingaidinthecontralateralear).Atthetimeofthestudy,thesewereexperimentalapplications.Theyarenowavailableforclinicaluse.Methods:19adultbimodalparticipants(13males,6females,meanage61years)withaNaidaCIQ90processorinoneearandaNaidaLinkhearingaidinthecontralateralearparticipatedinthestudy.SpeechunderstandingwasevaluatedusingAzBiosentences(60dBC)incafeterianoise.SNRwasbasedonthenoiselevelforeachparticipantwheretheirbimodalscoreinnoisewasapproximatelyhalftheirscoreinquiet.AnS0N±60,±90,180speakerconfigurationwasusedforassessingtheeffectivenessofStereoZoom.ZoomControlwasassessedwithspeechontheHAsideandnoisefromtheCIside(SHANCI).Bimodalbenefitwasalsomeasuredinbothstudyset-upsbyswitchingofftheHA.Easeoflisteningratingswereobtainedineachconditionona5-pointscalerangingfromverydifficulttoveryeasy.Results:ActivationofStereoZoomledtoamean21%improvementinspeechscoresinnoise(p<0.0001).ZoomControluseimprovedspeechscoresby28%(p<0.0001).Additionally,significantbimodalbenefitwasmeasuredinbothtestset-ups(21%and33%respectively,p<0.0001).Easeoflisteningratingswerecommensuratewiththesentencescores.


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Conclusion:Ear-to-earaudiostreamingcanallowbimodallistenerstotakeadvantageofenhanceddirectionalcapabilityandfocusedlistening,therebyimprovingspeechunderstandingandeaseoflisteninginchallenginglisteningsituations. AbstractID:516PosterNumber:143Title:PsychophysicalMeasuresandVowelIdentificationinChildrenwithCochlearImplantsAuthors:JulieG.Arenberg,Ph.D.,MishaelaDiNino,M.S.,KellyJahn,AuD;SpeechandHearingSciences,Univ.ofWashington,Seattle,WA.Abstract:Introduction:Auditoryperceptualoutcomesarehighlyvariable,eveninearlyimplantedchildren.Howtheauditorysystemdevelopswithinputfromacochlearimplantisnotwellunderstood.Thepresentstudyexaminesbasicperceptualmeasures:thresholdsobtainedwithfocusedelectrodeconfigurationsandpsychophysicaltuningcurves,andvowelidentificationasameasureofspeechperception.Methods:Sixchildrenbetweentheagesof11and17yearswhoareimplantedwiththeAdvancedBionicsdeviceparticipatedinthisstudy.Fiveofthechildrenarebilaterallyimplantedandthreeofthemperformedtestingwitheachearseparately,yieldingeightearstested.Bothmonopolarandfocusedquadrupolarstimulationwereusedtomeasurethresholdsacrossallchannelsineacheartested.Afast,sweep-procedurewasusedtoobtainthresholds(Biereretal.,2015)andpsychophysicaltuningcurves(PTCs).PTCswereobtainedusingaforwardmaskingparadigmforatleastonechannel(inthemiddleofthearray)foreachear.Tuningcurvewidthwasquantifiedusinganequivalentrectangularbandwidthcalculation.Aclosedsetof10vowelsin/hVd/context(naturally-spokenbyafemaletalker)werepresentedinthesoundfield.Results:Consistentwithpreviouslycollecteddatafromadults,focusedthresholdswerehigherandmorevariableacrossthearraythanthoseobtainedwithmonopolarstimulation.Earsthathadhigherfocusedthresholdsonaveragealsohadbroadertuning.Performanceonvowelidentificationwaspoorerforearsthatexhibitedhigherfocusedthresholdsandbroadertuning.Resultswillalsobecomparedtothoseobtainedpreviouslyinadults.Conclusion:Resultsindicatethatthesedirectstimulationpsychophysicalmeasurescanbereadilyobtainedinchildren.MostoftherelationshipsbetweenmeasuresaresimilartothoseobservedinpostlinguallydeafenedadultCIlisteners. AbstractID:517PosterNumber:101Title:CochlearImplantationinChildrenwithCochleovestibularAnomaliesAuthors:ManuelE.SevilaSalas,ENTSpecialist,Surgeon,AntonioPaz,Surgeon,SandraBermejo,Audiologist,XeneidaHernandez,Audiologist;ProgramaCubanodeimplantescocleares,LaHabana,Cuba.Abstract:Introduction:Cochlearimplantationwithcochleovestibularabnormalanatomyisarealchallengeforbothsurgeonandaudiologistandtherearepermanentquestionsaboutrisksandfuntionalresults.Wereviewedsurgicalproceduresperformedinchildrenwithcochleovestibularanomaliesfrom2007to2016describingsurgicalandauditoryoutcomes.Methods:RetrospectiveanalysisofpatientswithinnerearmalformationswhounderwentcochlearimplantationbetweenJanuary2007andOctober2016performingstandardfacialrecessapproachwas


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made.DiagnosisofcochleovestibularabnormalitiesweredefinedbyhighresolutioncomputedtomographyandMagneticResonanceImaging.Results:Cochleovestibularmalformationswerefoundin34patientsandenlargedvestibularaquaductwasthemustfrequentanomalie.CSFGusheroccurredin19casesbuttherewerenotcomplicationsandelectrodesinsertionwasachievedinallcases.Allchildrenshowedimprovedauditoryperformance.Conclusion:Despitesurgicalriskscochlearimplantationissurgicallyfeasibleinpatientswithcochleovestibularabnormalanatomy. AbstractID:520PosterNumber:6Title:CochlearImplantsandBilingualism:ARealmofPossibilitiesAuthors:MicheleBerke,PHD,LauraPetersen,MAEd,RoryOsbrink,MA;CaliforniaSch.fortheDeaf,Fremont,CA.Abstract:Introduction:p.p1{margin:0.0px0.0px0.0px0.0px;font:11.0pxHelvetica;-webkit-text-stroke:#000000}p.p2{margin:0.0px0.0px0.0px0.0px;font:11.0pxHelvetica;-webkit-text-stroke:#000000;min-height:13.0px}span.s1{font-kerning:none}Withtheconcernofsensitiveorcriticalperiodsoflanguageacquisition,mostcochlearimplantationhasequatedtoearlyinterventionservicesfocussingexclusivelyononelanguageandonemodality;Englishauditorylanguagedevelopment.Researchisfindingthatthebrainhasmoreplasticitythanoriginallythoughtandthatitprocessesbothauditoryandvisuallanguagesimilarly.Parentsareoftenadvisedthatifachildistoreceiveacochlearimplant,itisnotadvisabletolearnanotherlanguage.However,thebenefitsofbilingualismforallchildrenhavebeenresearchedextensivelyandstudiesshowthatchildrenexposedtomorethanonelanguagehavecognitiveandacademicadvantages.Thispresentationreviewsthedataoncochlearimplantsandbilingualismaswellhighlightsstudentperspectivesonthebenefitsofbeingbilingual.Methods:AreviewoftheresearchregardingthebenefitsandthepedagogyinwhichchildrenwithcochlearimplantsreceivelanguageinstructiontoacquirealanguageotherthanspokenEnglish.Wewillshareexcerptsfromourvideotapedinterviewsof12bilingualstudentswithcochlearimplantsfromavarietyofeducationalplacements.Results:WewillreviewthefindingsregardinghowbilingualismandspecificteachingmethodsincreasedacademicabilitiesincludingwrittenandspokenEnglishskills.Viavideos,studentswithcochlearimplantswillshareexamplesofhowhowtheirbilingualismpersonallybenefitsthembothacademicallyandsocially.Theinterviewsrevealedthatabilingualapproachallowedstudentstohaveadeeperunderstandingofbothlanguages.Conclusion:ChildrenwithcochlearimplantsareoftenlimitedtoinstructioninspokenEnglishbutbeingbilingualcanbenefitboththeirspokenandwrittenEnglish.Avarietyofeducationalapproachesareusedwithchildrenwithcochlearimplantshoweverabilingualapproachcanprovideabroaderlanguagefoundationinwhichtheycanfurthertheirlanguagedevelopment. AbstractID:206PosterNumber:10Title:ListentoMe:BenefitsofIntensiveEducationforParentsofChildrenwithCochlearImplantsAuthors:JulieA.Cooper,MS,CCC-SLP,LSLSCertAVT1,NikolasH.Blevins,MD2,MatthewB.Fitzgerald,PhD,CCC-A1;


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1OHNS,StanfordUniv.Med.Ctr.,PaloAlto,CA,2Otology/Neurotology,StanfordUniv.Med.Ctr.,PaloAlto,CA.Abstract:ListentoMe:BenefitsofIntensiveEducationforParentsofChildrenwithCochlearImplantsJulieACooper,MS,CCC-SLP,LSLSCertAVTNikolasH.Blevins,MDMatthewBFitzgerald,PhD,CCC-AIntroduction:Pre-linguallydeafenedchildrenwhoreceivecochlearimplants(CIs)canoftenlearntodevelopspokenlanguageandevenattendmainstreamclassrooms.Althoughthesechildrentypicallyreceiveavarietyofspecialservices,parentaleducationregardinghearinglossanditsconsequencesforlanguagedevelopmentaredeliveredinamuchlessstructuredmanner.Parentsareoftenforcedtoeducatethemselvesastohowtobestfacilitatelanguagedevelopmentintheirchildwithhearingloss.Toaddressthisissue,theListentoMe!(LTM)SummerInstitutewasdevelopedtoempowerparentstomaximizelisteningandspokenlanguageintheirchildrenwithcochlearimplants.Inthisone-weekprogram,parentsparticipateinpresentationsfromexpertsinthefield,therapyandclassobservations,asupportgroup,androle-playingtoimplementgoalsinthehome;childrenparticipateintherapyandclass.ThegoalofthisinvestigationwastodeterminetheeffectivenessofListentoMe!atimproving1)parentalknowledgeaboutdevelopingspokenlanguagewiththeirchild’scochlearimplant(s),2)parents’advocacyskills,3)lengthofCIuseperday,and4)child'sinterventionservicesuponreturninghome.Methods:Toexamineefficacyofthisprogram,twostepsweretaken.First,beforeandafterattendingLTM,parentalratingswereobtainedfrom43parentsastotheirknowledgeinareasrelatedtospokenlanguagedevelopmentinchildrenwithCIs.Second,fourmonthsaftercompletingtheprogram,35parentscompletedasurveywhichmeasuredwhetherparentshadappliedtheinformationprovidedinLTMintotheirdailylifeandeducationalsettingoftheirchild.Bothsetsofsurveyresultsweresubjectedtorepeated-measuresanalysesofvariance.Results:ResultsfromtheseANOVAsindicatedasignificantimprovementinparentalknowledgeacrossallconditions.Moreimportant,theparentsdisplayedasignificantimprovementintheimplementationofthisknowledge.AftercompletingLTM,85%ofrespondersreportedsuccessfullyadvocatingfortheirchild,60%reportedimprovingtheirchild’stechnology,100%reportedincreaseddeviceuse(ifthechildwasnotwearingthedeviceallwakinghourspriortoLTM),and63%reportedanimprovementintheirchild’sinterventionservices.Anecdotalreportssuggestthattheseimprovementsinaccesstotechnologyorservicesweremostlikelytohaveoccurredifthechild’slevelsoftechnologyand/orserviceswaslessthanidealforlanguagedevelopmentpriortoenrollinginLTM.Conclusions:Takentogether,theseresultssuggestthatanintensiveone-weekprogramcanresultinsignificantincreasesinparentalknowledge,improveparentadvocacyskills,thelengthofCIuseperday,andinterventionservices.ThebenefitsobservedheresuggestthatprofessionalsseekingtomaximizeoutcomesofchildrenwithCIsshouldprovideadditionalfocusonparenteducationandengagement. AbstractID:526PosterNumber:122Title:VisualCortexActivationDecrementfollowingCochlearImplantationinPre-LingualDeafenedChildrenAuthors:JiahaoLiu,ME,MaojinLiang,MD,YueboChen,MD,YajingWang,MD,YiqingZheng,MD;SunYat-SenMem.Hosp.,Guangzhou,China.


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Abstract:<METANAME="author"CONTENT="刘佳浩">Visualcortexactivationdecrementfollowingcochlearimplantationinpre-lingualdeafenedchildrenAbstractObjective:Visualtake-overoftheauditorycortexinpre-lingualdeafchildrenhavebeenwidelyreported.However,therewerefewstudiesonvisualcortexplasticitypostcochlearimplantation.Inthisstudyweinvestigatethehypothesiswhetherextrinsicauditorystimulationfollowingcochlearimplantinpre-lingualdeafenedchildrencaninducevisualcortexplasticity.Method:Visualevokedpotentials(VEPs)wererecordedin37cochlearimplantedchildren(4groupswithdifferentusetime)and8controlsubjects,inresponsetosoundandnonsoundstimulus.LatencyandamplitudewereanalyzedforP1,N1andP2componentsonOZelectrode.ComparisonsofVEPwereconductedbetweenthesoundandnonsoundstimulusandamongdifferentgroupsinordertoviewevidenceofvisualcortexre-organization.Results:ThelatenciesoftheP2componentwassignificantlylargerattheoccipitalsite(Oz)inCI0Mthanintheotherfourgroups.Afterexclusiontheeffectofage,asignificantnegativecorrelationwasfoundbetweenCIusageandP2latencyofnonsoundstimulus.OccipitalP1N1latencyandP1amplitudewasnotaffectedbygrouporstimuluscategory.ButN1andP2amplitudewassignificantlybeinglargerinresponsetosoundstimulusthantononsoundstimulus.Conclusion:OurfindingssuggestthatP2latencydevelopmentwiththeCIusageandmaybeabiomarkerofvisualcortexplasticity.Keywords:pre-lingualdeafness,cochlearimplant,visualevokedpotentials AbstractID:527PosterNumber:194Title:WhenisaBenefitAcontralateralHearingAidforCochlearImplantRecipientsAuthors:MaríaEugeniaPrieto,audiologist,LeopoldoCordero,Dr;CentrodeInvestigacionesOtoaudiológicas,buenosaires,Argentina.Abstract:Introduction:Introduction:Limitedaccesstobilateralsoundearlyinlifedisruptsnormalauditorydevelopmentandchallengeseducationalandbehavioralperformance(1).IndailypracticeweunderstandthedifficultyforsomepatientstousecochlearimplantassociatedwithContralateralHearingAids(CHA).Manypatientswhoreceiveacochlearimplant(CI)dohavesomeresidualhearingintheoppositeear;anywaysomeofusersdiscontinueuseoftheirhearingaidManystudiessuggesttheuseofCHAmainlytoimprovespeechperceptioninnoiseandlocalization.However,werealizethatnotallthepatientscoulduseiteffectively,thusbecomingpotentialcandidatesforasecondimplant.Methods:Objective:OurstudyaimedtoassesswhethertheauditoryresiduecouldbeacriticalfactorfortheuseofCHA.Toestablishwhetherparticipantsexperiencedmorebenefitusingbimodal(CIHA)stimulationthanacochlearimplant(CI)alone,andwhetherthisincreasewasrelatedtopatientfactors.Andtoinvestigatetheeffectofcontralateralhearingaidweartohabilitationoutcomeandwhysomestoptobeusers.Method:Weperformedretrospectivereviewof30childrenreceivingaunilateralCIwhosewhereusersofbimodalstimulationout-grid-align:none;text-autospace:none'>Thesepatients’needscompatibleandnewtechnologiesinbothsides.Alsoneedstobefittingtogether.Results:Results:22/30patientscontinuestobeusersofbimodalstimulationwithgoodperformance,speechrecognitionandsoundlocalization.4patientsgetacontralateralcochlearimplantaftertheylosediscriminationbecauseaprogressivehearinghistories.4patientsbecameunilateralCIusers.Twoofthemrefusetogetthesecondimplantbuttheyareconsideringdoingbecausetheylosespeechrecognitioninnoise.Theother2childhavehandicapsandpreferunilateralstimulation.


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Conclusion:Conclusion:-.PeriodicaudiologicevaluationandrehabilitationcontrolalongthetimewerecriticalfortheconsistinguseofCHA.-ThebenefitofwearinghearingaidoncontralateralearforCIrecipientsliedontheaverageaidedhearingthreshold.Therefore,somepatientsdecidedtouseitalsowhenthehearingdecrease.-ThepatientsthatdecidedtogetaCIcontralateralafteralong-termusingHAshowsafasterperformanceafterCI.-Theactuallyusersofbimodalstimulationaresuccessfulinnoisediscrimination,localizationandcasualdiscriminationandalsosometimesbetterthatbilateralCI.Thesepatients’needscompatibleandnewtechnologiesinbothsides.Alsoneedstobefittingtogether. AbstractID:582PosterNumber:86Title:MusicEnjoymentinSSDPatients:TheSynergisticEffectofElectricandAcousticStimulationAuthors:DavidLandsbergerOtolaryngology,NewYorkUniv.Sch.ofMed.,NewYork,NY.Abstract:Introduction:Althoughtherehavebeenmanystudiesofmusicperceptionwithacochlearimplant(CI),musicalsoundqualityhasbeendifficulttoquantify.Forexample,ratingsofmusicenjoymentonascaleof1-100bydeafCIusersaredifficulttointerpret.TheemergenceofCIuserswithnormalcontralateralhearingpresentsauniqueopportunitytoassessmusicenjoymentquantitativelyinCIusersbyreferencingittothatobtainedinanormalear,whichprovidesaknownandreadilyinterpretablebaseline.Methods:Inthepresentstudy,weinvestigatedsoundqualityofmusicinSingle-SidedDeafened(SSD)subjectswithaCIusingamodifiedversionoftheMUSHRA(MUltipleStimuliwithHiddenReferenceandAnchor)method.Listenersratedtheirenjoymentofbriefmusicalsegmentsofthesongs“RingofFire”and“RhapsodyinBlue”onascaleof0-200relativetoareferencestimulus,definedas100.Thereferencewastheunmodifiedmusicalsegmentpresentedtothenormalhearingearonly.An“anchor”stimulus(definedas0)wasalsoprovidedonlytothenormalhearingear.Theanchorwasthesamemusicalsegmentprocessedwitha6-channelnoisevocodersimulatinga6.5mmshift.Stimuliconsistedofacousticonly,electriconly,acousticandelectric,aswellasanumberofconditionswithlowpassfilteredacousticstimulitosimulatevaryingdegreesofhearinglossandbimodalstimulation.Acousticstimulationwasprovidedbyheadphonetothenormalearandelectricstimulationwasprovidedbyadirectconnectcabletothesubject’sclinicalspeechprocessor.Results:Tenoutof11subjectsratedcombinedelectricandacousticstimulationthebest,withatrimmedmeanrating“RingofFire”as133and“RhapsodyinBlue”as120.Thecombinationofacousticandelectricstimulationwassignificantlybetterthanunilateralacousticprocessingalone.Thesoundqualityofelectricstimulationalonewasmuchworsethanacousticstimulationalone.Inalltestedconditions,addingelectrichearingtoacoustichearingprovidedimprovementinsoundquality.Conclusion:Insummary,musicenjoymentfromelectricstimulationwasextremelypoorrelativetoaninterpretablenormal-hearingbaseline.Interestingly,addingtheelectricstimulationactuallyenhancedthesoundqualityofunilateralacousticstimulation.Thiseffectalsohappenedwithlowpassfiltered,acousticallypresentedmusicalsegments,suggestingthatsimilarresultsmaybefoundforbimodalCIusers. AbstractID:528PosterNumber:208Title:MusicalPerceptionandMusicalSatisfactioninAdultswithCochlearImplant


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Authors:AyseSanemSahli,PhD1,HavvaNurSackan,MSc2,ArmaganIncesulu,MD3,ErolBelgin,PhD4;1VOCATIONALSCHOOLOFHEALTHSERVICES,HEARINGANDSPEECHTRAININGCENTER,HACETTEPEUNIVERSITY,TURKEY-ANKARA,Turkey,2FONEMSPECIALEDUCATIONCENTER,TURKEY-ANKARA,Turkey,3FACULTYOFMEDICINE,DEPARTMENTOFENT,ESKISEHIROSMANGAZIUNIVERSITY,TURKEY-ESKISEHIR,Turkey,4FACULTYOFHEALTHSCIENCES,AUDIOLOGYDEPARTMENT,MEDIPOLUNIVERSITY,TURKEY-ISTANBUL,Turkey.Abstract:Introduction:Aftercochlearimplantation,theleveloflisteningofmusicandmusicsatisfactionvariesbetweenusers.Theaimofourstudyistoevaluatethemusicalperceptionandsatisfactionofpostlingualhearingimpairedadultswithcochlearimplant.Methods:Thirty-four(21male,13female)cochlearimplantuserswhohavepostlingualhearinglossandnoadditionalproblemhavebeenincludedinthestudy.CIusersaredividedintogroupsaccordingtotheirchronologicalage,ageofcochlearimplantanddurationofimplantuse.CIusersare20yearsofageorolder.Asthedatacollectiontool,'PersonalInformationForm'consistingofquestionsaboutthedemographiccharacteristicsoftheparticipantswasusedfirst.‘MusicPerformanceProfileforCochlearImplantUsers',whichwasadaptedfromthe'MusicTrainingandBackgroundQuestionaire'developedbyV.Looiandthe'ListeningToMusicWithACochlearImplantQuestionaire'formusicalperceptionandmusicappreciation,wasusedafterwards.Thequestionnaireconsistsofquestionsaboutcochlearimplant,historyoflisteningtomusicbeforehearingloss,musicstyles,instruments,musicrecognition,affectingfactorsoflisteningtomusicandmusictherapyprograms.EthicscommitteeapprovalwasobtainedfromHacettepeUniversityforthestudyandinformedconsentformwasusedforallparticipants.Results:Patientswhounderwentcochlearimplantationundertheageof40years(N:17)receivedstatisticallyhigherscoresforthesoundnatureoftheinstruments(pianoandviolin).Also,adultsusingcochlearimplantformorethan5yearswerefoundtohavehighermusicalperceptionandsatisfactionasistatistics(p<0.05).Conclusion:Themusicalperceptionandappreciationamongtheusersvariesdependingonmanyfactors.Themostimportantfactorsaffectingmusicalperceptionandsatisfactionareageofcochlearimplant,durationofCIandgender.Apartfromthese,thesoundcharacteristicsofthelisteningofmusicandthefeaturesofinstrumentarealsodecisivefactorsonthemusicalperceptionandsatisfaction. AbstractID:583PosterNumber:102Title:LearningMolecularImaging-basedNeurologicPredictorsofCochlearImplantOutcomeinPrelinguallyDeafChildrenAuthors:Jae-JinSong,MD,PhDDepartmentofOtorhinolaryngology,SeoulNatl.Univ.BundangHosp.,Korea,DemocraticPeople'sRepublicof.Abstract:Introduction:Therearenumerouspatientfactorsaffectingtheoutcomeofcochlearimplantation(CI).However,preoperativefunctionalstatusofthecerebralcortexhasonlybeeninvestigatedinsmallnumbersofpatients.Hence,thecurrentstudywasperformedtorevealfunctionalneuroimagingsignaturesofspeechoutcomeafterCIinprelinguallydeafpatientsusingresting-stateFDG-PETbig-databasedmachinelearningapproachandtosuggestaoutcomepredictionmodelbasedoncorticalpredictorsofCIoutcome.Atotalof111prelinguallydeafchildrenunderwentpre-CIresting-stateFDG-PET.ThisFDG-PETwasusedtopredictpost-CI3yearspeechoutcomewithregardtoopensetwordandsentencetestunderauditory-only(A-only)andaudiovisual(AV)conditions.FDG-PETdatawas


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preprocessedwithMarsBaRtoolboxforregionofinterest(ROI)analysis,and90cerebralcorticalROIswereusedfortheanalysis.Forstatisticalanalysis,LASSO(LeastAbsoluteShrinkageandSelectionOperator)regressionanalysisusingaverageglucosemetabolismof90ROIswithregardtopost-CI3yearopensetwordandsentencescores.InprelinguallydeafCIusers,activationsofthesupreriortemporalgyrus,supramarginalgyrus,andinferiorfrontalgyruswerepredictorsofhigherpost-CI3yearspeechoutcomeundertheA-onlycondition.Meanwhile,underA-Vcondition,anadditionalactivationoftheanteriorcingulategyruswasnecessarytoshowbetterspeechoutcome.InprelinguallydeafCIusers,activationsoftheventralattentionnetworkandprefrontaltop-downmodulatorareimportanttobetterprocesslanguageundertheA-onlycondition.UnderA-Vcondition,anadditionalactivationofthesaliencenetworkisnecessarytobetterunderstandmultimodalinformation.Takentogether,FDG-PET-basedmachinelearningusingLASSOcouldpredictCIoutcomeinprelinguallydeafsubjects,functionalneuroimaging-basedoutcomepredictionmaybeofhelpforprecisionmedicineinCIsubjects. AbstractID:274PosterNumber:198Title:EvaluationofaNovelBimodalFittingFormulainPediatricBimodalCochlearImplantRecipientsAuthors:CarisaReyes,Au.D.1,JeffreyL.Simmons,M.A.1,JacquelynL.Baudhuin,Au.D.1,SmitaAgrawal,Ph.D.2;1BoysTownNatl.Res.Hosp.,Omaha,NE,2AdvancedBionics,Valencia,CA.Abstract:Introduction:Theobjectiveofthisstudyistoevaluatethebenefitofanovelhearingaidprescriptionformulainchildrenwithacochlearimplantdeviceinoneearandahearingaidinthecontralateralear.Thisbimodalfittingformula(BFF),designedspecificallyforbimodallisteners,alignsfrequencyresponse,loudnessgrowthfunctions,andautomaticgaincontrol(AGC)characteristicsbetweenelectrichearing(viaNaídaCIsoundprocessor)andacoustichearing(viaNaidaLinkhearingaid).Asecondobjectiveofthestudyistoevaluatethecontributionoftwotypesoffrequencyloweringalgorithmstobimodalbenefitinchildren.Methods:Speechunderstandinginnoisewillbemeasuredinchildrenbetween8and18yearsofageutilizingbimodallistening.Performancewillbeevaluatedwiththechildren’sownhearingaidaswellaswiththeNaidaLinkhearingaidfittomatchDSLv5targetsversustheBFF.Subjectivefeedbackwillalsobeobtainedandassessed.Speechunderstandingwillbere-measuredwiththeBFFafteraonemonthlongtakehometrialtoevaluateeffectofchronicexperience.Atthissecondvisit,bimodalbenefitwillalsobemeasuredasafunctionoffrequencyloweringalgorithms.Results:Resultswillbepresentedatthemeeting.Outcomeswillbeevaluatedasafunctionofaudiometricprofiles.Theresearchaudiologists’programmingexperienceandrecommendationswillbeshared.Conclusion:AnewbimodalfittingformulaandanewhearingaidhavebeenmadeavailabletoworkspecificallywiththeNaidaCIsoundprocessor.TheintentofthisBFFistooptimizebimodalhearingwhilesimplifyingthehearingaidprogramingprocess.Thepresentstudywilllikelybethefirstpediatricstudytoevaluatetheeffectiveness(acuteandchronic)ofthisnewbimodalhearingsystem. AbstractID:530PosterNumber:116Title:UseofDeviceinCochlearImplantRecipientsinaLargeScaleCIProgram


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Authors:RanjithRajeswaran,MASLP1,LakshmiMaya,BASLP1,MohanKameswaran,MS.,FRCS.,MAMS.,DSc.,2;1MERF-InatituteofSpeechandHearing,Chennai,India,2MadrasENTRes.Fndn.(P)Ltd.,,Chennai,India.Abstract:Introduction:Cochlearimplantisabio-medicaldevicethatissurgicallyplacedinthecochleathathelpsahearingimpairedtoregainhearingsensitivity.SubjectswithseveretoprofoundsensoryneuralhearinglossacrossallagesundergoCIworldwide.Onanaverage,about360patientsundergoCIannuallyatMERF.ItisimportanttomonitortheirhearingstatusandtheirspeechoutcomesusingCIoveraperiodoftime.Thesepatientsattend1yearofhabilitationcompulsorily.Thelongtermcommunicationoutcomedependsontheconsistentuseofthedevice;hencethisstudywastakenupwiththeobjectivetoidentifythechallengesfacedbythesubjectswithCIandtheirparents.ThestudyfocusesonassessingthelongtermuseofCIbychildrenandtoexplorethefactorsthatcouldinfluencetheusageofthedeviceondailybasis.Methods:ChildrenwhohaveundergoneCIduringtheperiodofJune2012-June2016weretakenup.AchartwascreatedtodocumentthedetailsofimplantandotherpossiblefactorsinfluencingtheusageofCIondailybasis.Theparametersincludedwereageofimplantation,educationalqualificationofparents,educationalplacementofchild,languageexposedathomeandattherapy,modeofcommunication,CAPandSIRscores.Thesubjectswerecategorisedinto3groupsbasedontheirusageofCI:GroupA-fulltimeusers,GroupB-parttimeusers,GroupC-Non-usersofCI.InformationfromthepatientswhowerecurrentlyattendingrehabilitationatdifferentcentresofMERFandpatientswhohadfinishedoneyearofhabilitationwerecalledtothecentre.Results:Mostoftherecipientswereconsistentusersoftheimplant,amongthenonusersthereisapositivecorrelationwitheducationlevel,annualincome.Childrenimplantedatveryyoungerageusedthedeviceconsistentlycomparedtochildrenimplantedatverylaterage.78%useddeviceirregularlyafterfirstyearofImplantation.Conclusion:LongtermsuccessoftheCIistheeffectiveuseoforalcommunication,thiscanbeinfluencedbytheuseofdeviceapartfromotherfactorssuchastrainingetc.,Fromthisstudywehaveunderstoodthatmostofrecipientuseddeviceirregularlyafterfirstyearofimplantation.Thiscouldbeduetolackofmonitoring,mentoringandmotivation.Thoughotherfactorslikeannualincome,ageatimplantation,educationallevelplaysaroleinuseofdevice,extendeddurationofmonitoringthechildrenintheCIclinicmayhelptoovercomethesefactors. AbstractID:140PosterNumber:152Title:TheDevelopmentofMusicalityinChildrenwithCochlearImplantsEvaluatedbyMusicalEarsAuthors:xueqingchen,MD,mengwang,MD,tianqiuxu,MD,yanzhong,MD,jinyeluo,MD;BeijingTongrenHosp.,CapitalMed.Univ.;BeijingInst.ofOtolaryngology,Beijing,China.Abstract:Introduction:TheaimsofthestudyweretoevaluatethemusicalityofchildrenwithcochlearimplantsbyusingthequestionnaireofMusicalEarsEvaluationFormforProfessionals,comparethedifferencesofmusicalitybetweenchildrenwithcochlearimplantsandthosewithnormalhearing,establishnormalcomparisondataofmusicalitydevelopmentforchildrenwithhearingloss.Methods:Allchildrenparticipatedinthisstudyweredividedintotwogroups,includingcochlearimplantgroup(CIgroup)andnormalhearinggroup(NHgroup)ascontrolgroup.109childreninCIgroupwerediagnosedwithprelingual,severetoprofoundhearingloss.Theywereallimplantedunilaterallybefore3yearsoldandwithin4yearsaftercochlearimplantation.Theageatimplantationrangedfrom8to36


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monthswithameanof18months.Thehearingageatevaluationrangedfrom1to46monthswithameanof15months.180childrenwithnormalhearinginNHgroupwereallunder4yearsold.Theageatevaluationrangedfrom1to47monthswithameanof15months.ThequestionnaireofMusicalEarsEvaluationFormforProfessionalswasusedtoevaluatethemusicality,includingabilitiesofsinging;recognizingsongs,tunesandtimbre;respondingtomusicandrhythm,forallchildreninthisstudy.AllstatisticalanalyseswereexecutedusingtheSPSS20statisticalsoftwarewithacriterionofstatisticalsignificancesetatP<0.05.Results:Thescoresforoverallmusicalityinchildrenbothwithcochlearimplantsandwithnormalhearingshowedsignificantimprovementovertime(P<0.05).Thescoresforthethreesubcategoriesofmusicalityinchildrenbothwithcochlearimplantsandwithnormalhearingalsoshowedsignificantimprovementovertime(P<0.05).Theregressionfunctionforpredictionofoverallmusicalityscores(y)fromage(x)wasy=1.8x-0.008x2+3.6(R2=0.874,P=0.000),theregressionfunctionforpredictionofsingingscores(y)fromage(x)wasy=0.5x-0.001x2+3.0(R2=0.831,P=0.000),theregressionfunctionforpredictionofrecognizingsongs,tunesandtimbrescores(y)fromage(x)wasy=0.6x-0.002x2+0.9(R2=0.808,P=0.000),theregressionfunctionforpredictionofrespondingtomusicandrhythmscores(y)fromage(x)wasy=0.7x-0.005x2+1.5(R2=0.848,P=0.000).ThescoreforoverallmusicalitywasnotsignificantlydifferentbetweenCIandNHgroupsinthesamehearingage(P>0.05).Thereweresignificantdifferencesbetweenthetwogroupsinthesamechronologicalage(P<0.05).Conclusion:Themusicalityinchildrenbothwithcochlearimplantsimprovedsignificantlyovertime.Themusicalityinchildrenwithcochlearimplantswasnotsignificantlydifferentfromchildrenwithnormalhearinginthesamehearingage.Themusicalityinchildrenwithcochlearimplantswassignificantlylowerthanthatofchildrenwithnormalhearinginthesamechronologicalage. AbstractID:271PosterNumber:145Title:TheImmersion360System:BringingtheOutsideWorldintotheClinicAuthors:FrancoisBergeron,Ph.D.1,KevinLeungKam,M.Sc2,WalidChafiq,M.Sc2,BastienBouchard,M.Sc3,DominiqueDemers,M,Sc.4;1Speech&languagepathology,UniversitéLaval,Québec,Canada,2Neuroprothèses,UniversitédeMontpellier,Montpellier,France,3TechnologiesImmersion,Québec,Canada,4Clinicalandbiomedicalsciences,UniversitéLaval,Québec,Canada.Abstract:Introduction:Improvementinauditoryperceptionisamajorobjectiveoftherapeuticinterventionsforthehearingimpairedchild.Numeroustestsareproposedtoguidetheseinterventionsandassesstheirbenefits.Optimally,thesetestsshouldexplorecomplexabilitiessuchasthoseencounteredbyhearingimpairedchildrenindailylife.Thus,manycontemporarytestsweredesignedonsentencerecognitionagainstaspeechspectrumnoisecomingfromfixedsources.Whilesentencesappearasarealisticdailystimulus,onecanarguethataspeechspectrumnoiseissuedfromfixedpositionswithvariableorarbitrarilypredeterminedsignaltonoiseratioscanbefarfromwhatchildrenexperienceinreallife.Yet,itispossibletocreatemorerealistictestenvironments.TheImmersion360systemproposesavirtualenvironmentthatcanreproduceanyeverydaysoundexperienceandthus,supportamorerealistictestingconditiontoassessauditoryperception.ThisprojectaimedtospecifythepsychometricsofthissystemanddefinenormsforspeechperceptionforFrenchspeakingnormal-hearingpeople.Methods:ThirtyyoungadultswithnormalhearingwereassessedinCanadaandinFrancewiththeFrenchadaptationofAzBioin9virtualenvironments(car,garage,cafeteria,restaurant,ballgameina


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gymnasium,racetraininginagymnasium,kindergarten,roadtraffic,streettraffic).Presentationandsignaltonoiselevelsweresetatthelevelsmeasuredontherecordingsites.Results:Descriptiveanalysisspecifytheaverage,varianceandconfidenceintervalsat95%foreachtestconditionoftheImmersion360system.Normativedataarederivedfromthesemetrics.Conclusion:Anewtestbasedonvirtualenvironmentsisnowavailabletoassessspeechperceptioninarealistictestingcondition.FutureworkwillfocusondefiningnormswiththeFrenchpediatricversionofAzBiopresentlyindevelopment. AbstractID:531PosterNumber:127Title:DesignaModelfortheCochlearImplantElectrodeArrayInsidetheCochleatoStudyofCurrentDistributionforDifferentDesignConfigurationsAuthors:MarawanM.M.M.Ahmed,M.Sc.1,MohamedBadawi,PhD2;1ElectricalEngineering,FacultyofEngineering,AlexandriaUniv.,Alexandria,Egypt,2MedicalEquipmentTechnology,FacultyofAlliedMed.Sci.,PharosUniv.inAlexandria,Alexandria,Egypt.Abstract:Introduction:CochlearImplants(CIs)areimplantabledevicesthatbypassthenon-functionalinnerearanddirectlystimulatetheauditorynervewithelectriccurrents,thusenablingdeafpeopletoexperiencesoundagain.Methods:Inthispaper,weaimtodesignaninnovatedcochlearimplantmodel,usingCSTSTUDIOprogramusedtocalculatetheelectricfielddistributionandcurrentdensitydistributionaroundthechannelsofthecochlearimplantelectrodearray.Results:Thiscomputermodelsisemployedtodesignageneralmodelforthecochlearimplantelectrodearrayinsidethescala-typanyofthecochleaofthepatient.Conclusion:Withthismodelweareabletomonitortheeffectortheinfluenceofdifferentdesignconfigurationontheperformanceofthecochlearimplant. AbstractID:508PosterNumber:68Title:Electrically-evokedABR(EABR)forPotentialABICandidatesviaEndoscopically-guided,DirectRoundWindowStimulationAuthors:JohnGermiller,M.D.,Ph.D.1,LuvR.Javia,M.D.1,DanielJ.Lee,M.D.2;1Otolaryngology,Children'sHosp.ofPhiladelphia,Philadelphia,PA,2Otolaryngology,MassachusettsEyeandEarInfirmary,Boston,MA.Abstract:Introduction:Electrically-evokedABR(EABR)testingcanevaluatecochlearnerveresponsestoelectricalstimulation,andcanbeusedinchildrenwithcochlearnervedeficiencytoassessnervestatuspriortoCIorABI.Historically,electricalstimulationhasbeendeliveredbyatranstympanicneedleelectrodeplacedonthecochlearpromontory.However,precisepositioningcanbesomewhatuncertain,sinceitisnotdoneunderdirectviewofthemiddleear.Alsoinprinciple,suchstimulationmightbeattenuatedbyvariationsincochlearanatomyandbonethickness.InanefforttomorecloselysimulatethedirectstimulationofcochlearfluidsprovidedbyanactualCI,wehavebegunperformingEABRviadirectstimulationoftheroundwindow(RW)membraneunderendoscopicguidance.Wereportresultsfromourfirst10patients.Methods:EABRwasperformedunilaterallyin4childrenandbilaterallyin6(total16ears;medianage24mo).Allhadapparentcochlearnerveaplasiabasedonparasagittalmagneticresonanceimaging


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(MRI)viewsoftheinternalauditorycanal.Themiddleearwasaccessedbytranscanaltympanotomy.Underendoscopicvisualization,a1-mmball-tipprobewasplaceddirectlyontheRWmembranetostimulatefluidsofthescalatympani.NerveresponsesweremeasuredbywaveVonEABR.Forcomparison,EABRsweregeneratedundertraditionalstimulationofthebonycochlearpromontory,witheitherneedleorblunttipprobes.Results:StimulationandEABRmeasurementwassuccessfulusingbothmethodsinall16ears,andtherewerenocomplications.In14ears,noresponsesweredetectablebyeithermethod,consistentwithcochlearnerveaplasia.OneofthesepatientssubsequentlyunderwentABI,duringwhichnerveaplasiawasconfirmed.Theremaining2earshadmeasurableresponsesbybothmethods.Inbothcases,responsesweredetectableatlowerthresholdsviaRWstimulationthanviapromontorystimulation(450-700vs.700-900microamperes).Conclusion:Direct,endoscopic-guidedelectricalstimulationviatheRWmembraneissafeandeffectiveforelicitingEABRresponses,andmayresultinimproveddetectionofsmallresponsesinpatientswithseverecochlearnervehypoplasia.AsABIsurgeryisinvasivewithvariableoutcomes,improvingthesensitivityofEABRtestingiscrucialtodeterminethepresenceofafunctionalcochlearnerveinthesettingofequivocalanatomyonMRI. AbstractID:533PosterNumber:83Title:SurgeryoftheBasalTurnOssificationAuthors:VladislavKuzovkov,Professor,Ph.D.,M.D.,YuriYanov,Prof.,MemberofRussianAcademyofSciences,AndreiLilenko,M.D.,SerafimaSugarovq,M.D.;SaintPetersburgENTandSpeechRes.Inst.,SaintPetersburg,RussianFederation.Abstract:Introduction:Cochlearspiralcanalossificationisoneofthemostcriticalandcomplicatedissuesincochlearimplantation(CI).Inthispaper,weproposeamethodforatraumaticdrillingofthedescendingpartofossifiedspiralcanal,whichisprimarilyaffectedinthegreatmajorityofcases.Methods:Intheexperimentalprocedureusing25cadaverictemporalbones,syntopyoftheinnerearstructureswasverified.Topographicanatomicalmeasurementsrelatedtothecochleaspiralcanalweremade.Results:Themeandistancebetweentheroundwindowmembraneandthebasalturncurvaturewas8.0mm,thewidthofthelabyrinthinecapsulewhichbordersthespiralcanalandinternalauditorycanalwas0.36mm,andthewidthbetweenspiralcanalandinternalcarotidarterywas0.77mm.Basedonthesemeasurements,thesurgicalprocedurebasedonatraumaticdrillingoutoftheossificationwastestedoncadaverictemporalbones.Drillingstartsfromtheossifiedroundwindowmembraneandproceedsuntilthebasalturncurvature.Usingcorrectirrigationallowsidentificationofthecolordifferencebetweentheoticcapsule(greyish)andossifiedtissue(whitish).Recognizingthiscolordifferenceenablesgradualdrillingoutoftheossificationalongthedescendingpartofthebasalturnwhilepreservingthemodiolus.Thecloseadjacencyoftheinternalauditorycanalandinternalcarotidarterytothelateralbasalturnwallshouldalwaysbekeptinmind.Thissurgicaltechniquewasappliedin45subjects(meanage12.4years)withanossifieddescendingpartofthebasalturnduetomeningitis.Theossificationwasdetectedbypre-operativetemporalboneCTscans.Subjects’meantimefrommeningitisuntilCIwas12months.In19subjectsthelengthoftheossifiedspiralcanalwas1-3mm,in26subjectsitwas4-6mmandproceededuntilthebasalturncurvature.Itshouldbenotedthatin7subjectstheextentofossificationwasgreaterintraoperativelythanitcouldbepredictedbasedontemporalboneCTdata.


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Conclusion:Inallthe45subjectstheproposedmethodenabledadequateapproachtothecochleaspiralcanalandfullinsertionoftheSTANDARDelectrodearray(MED-EL,Austria). AbstractID:535PosterNumber:84Title:InsertionalTraumaDependingontheHookRegionAnatomyAuthors:VladislavKuzovkov,Ph.D.,M.D.1,AndreiLilenko,M.D.1,IgorKostevich,M.D.1,AminjonAmonov,M.D.2;1SaintPetersburgENTandSpeechRes.Inst.,SaintPetersburg,RussianFederation,2RepublicanScientificCtr.ofPediatrics,Tashkent,Uzbekistan.Abstract:Introduction:Theoptimalmethodforelectrodeinsertionforcochlearimplantationisstillapointofdebateamongstclinicians,withboththeroundwindow(RW)andcochleostomyapproachescurrentlybeingused.Insubjectswithresidualhearing,itisofcrucialimportancethatthefinestructuresofthecochleaarenotdamaged.Methods:Inthisstudy,theanatomicvariationsofthe“hook”regionon35cadaverictemporalbonesareanalyzedinordertoidentifytheoptimalelectrodeinsertionroute.Basedonthedistancebetweentheedgesofovalandroundwindows,all35ofthecadaverictemporalbonesweredividedintotwogroups:“big”or“small”,basedontheclassificationmethodproposedbyF.Atturo,M.Barbara,H.Rask-Andersen(1.56:1.09-2.35).Itwasshownthatthisdistancecorrelateswiththepositionofthefollowing“hook”regionstructures:osseousspirallamina,spiralligament,basilarmembrane,cochlearaqueduct,andaccessoryaqueducthousinginferiorcochlearvein.Thefollowingfourelectrodeinsertionmethodsarecompared:(i)viatheroundwindow,(ii)withtheuseofananteriorcochleostomy,(iii)withananterior-inferiorcochleostomy,and(iv)withtheenlargedroundwindow.Results:Eachofthesefourapproacheswerecomparedacrossboth“big”and“small”cochleae,andtheleasttraumaticmethodwasidentifiedasinvolvingelectrodedeliveryviatheroundwindowmembrane.Thisapproachenabledelectrodeinsertionwithoutalteringthe“hook”regionstructures.Whenanteriorcochleostomywasperformedinboth“big”and“small”cochlea,thespiralligamentandthelateralportionoftheosseousspirallaminawereinevitablydamagedinallofthecadavers.In33%ofthecasesinvolving“big”cochlea,thebasilarmembranewasalsodamaged.Intemporalbonesfollowinganterior-inferiorcochleostomy,thespiralligamentandtheosseousspirallaminaremainedintactin66%ofthe“big”cochleaandin50%ofthe“small”cochlea.Therewasanadditionalrisk(83%),especiallyin“small”cochlea,ofdamagingthecochleaaqueductandtheaccessoryaqueduct.Fortheenlargedroundwindowapproach,damagewasobservedinthecochleaaqueduct,anditsaccessorycanal,in75%ofthe“small”cochleaandin50%ofthe“big”cochlea.Itshouldbenotedthatexcessivebackwardsfoldingoftheroundwindowmembraneleadstolargestoma,whichmaycauseproblemswiththeelectrodeinsertion,aswellasasignificant(20%)riskofalteringthespiralligament.Conclusion:Insummary,approachingthespiralcanalviatheroundwindowmembranetendstobethesafestandleasttraumaticmethodofinsertingtheactiveelectrode.AsthedistancebetweentheroundandovalwindowscanbemeasuredonatemporalboneCT,itisadvisedtopreoperativelydecideupontheoptimalapproach,particularlyforcasesoflabyrinthrotationandfacialnervedystopiawheretheroundwindownichecannotbevisualizedandreached. AbstractID:536PosterNumber:85


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Title:ANewDeviceFixationTechnique:Long-termResultsinChildrenAuthors:VladislavKuzovkov,Ph.D.,M.D.,SerafimaSugarova,M.D.,YuriYanov,Prof.,MemberofRussianAcademyofSciences;SaintPetersburgENTandSpeechRes.Inst.,SaintPetersburg,RussianFederation.Abstract:Introduction:Reliableandapprovedsurgicaltechniquescanhelpminimizepostoperativecomplicationsinpaediatriccochlearimplant(CI)surgery.TheCONCERTOPINdevicewasthefirstCIspecificallydesignedforreliableminimallyinvasivesurgery,whichisespeciallyusefulinchildrenwherethedrillingofabedandholesforsuturescancauserarebutlife-threateningcomplicationssuchasepiduralhematomas.Thismethodreducessurgicaltimeandtherebyminimizestheimpactofanaesthesiaonthepatient,whichisofparticularimportancewhenveryyoungchildrenreceiveaCI.Methods:Subjectswere116children(aged7months-16years)whowereunilaterallyimplantedwiththeCONCERTOPINdevicebetweenOctober2013andDecember2015.A5-7cmmid-size“lazyS”shapedpostauricularincisionwasusedbecause,comparedtoalargerincision,itallowsgreatercontrolofbleedingandreducesthedurationofsofttissueexposure.Weusedtheclassicmastoidectomy/posteriortympanotomysurgicalapproachandfullyinsertedtheelectrodearrayviatheroundwindowwheneverpossible.Ifroundwindowinsertionriskeddamagetoadjacentstructures,e.g.facialnerve,insertionviacochleostomywasperformed.Nobonybedwasdrilledandholesforthepinswereonlycreatedinthecorticallayeroftheflatbonejustbehindthesquamoussuture.Bonethicknesswasassessedineachsubjectusingroutinecomputedtomography.Everysurgicalstagewasestimatedandtimed.Themeanpostoperativefollowuptimewas3years.Results:Thefullinsertionofelectrodearraysofpre-selectedlengthwaspossibleinallsubjects.Roundwindowinsertionwasperformedin91.9%subjects,cochleostomyin8.1%.Themeantotalsurgicaltimewas31±8.3min.NomajorcomplicationsoccurredafterCI.Theimplantsarestableandsecurelyfixedineverypatient.Noevidenceofdevicemigrationorrotationwasobserved.Minorcomplicationsoccurredinlessthan3%ofsubjectsandincludedhematomas(serums)andonecaseofacuteotitismedia.Conclusion:UsingtheminimallyinvasivesurgicalmethoddescribedhereintoimplanttheCONCERTOPINallowedthesurgeon(s)tosecuretheCIwithoutincreasingtheriskofpostoperativecomplicationsinpediatricCIrecipients. AbstractID:509PosterNumber:159Title:EvaluationofaContralateralRoutingofSignalSystemforUnilateralCochlearImplantRecipientsAuthors:SarahDowning,M.S.,CCC-A,EmilyCardenas,Au.D.,CCC-A,JoanOexmann,Au.D.,CCC-A,SmitaAgrawal,PhD;AdvancedBionics,LLC,Valencia,CA.Abstract:Introduction:Itiswell-establishedthattwoearsarebetterthanone.Bilateralcochlearimplantationhasshownsignificantadvantagesoverunilateralimplantationinimprovingspeechunderstandingandspatialhearinginchallengingsituations.ForunilateralCIrecipientswithaidableacoustichearingintheunimplantedear,accesstobimodalhearing(hearingaidinthecontralateralear)isanadvantageousoption.Forunilateralrecipientswithnoaidablehearingandnoaccesstobilateralimplantation,contralateralroutingofsignal(CROS)fromtheunimplantedsidetotheCIsoundprocessormaybebeneficial.ThepresentstudyexaminestheeffectivenessofaPhonakCROSdeviceprogrammedtowirelesslystreamaudioinputtoaCIsoundprocessor.Byprovidingaccesstoinputfromtheunimplantedside,theCROSdeviceshouldhelpovercomethelossofinputduetoheadshadowinunilateralCIrecipientsandimprovespeechunderstandinginquietatsoftlevelsandinnoiseat


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conversationallevels.ThisexperimentalCROSconfigurationisalsocapableofbeamforming,whichcouldfurtherimprovespeechunderstandinginnoise.ThisCROSimplementationiscurrentlyisnotapprovedforcommercialuse.Methods:AdultswithatleastoneAdvancedBionicsCIIand/orHR90Kimplantwillparticipateinthestudy.TrulyunilateralCIrecipients(withnocurrentcontralateralhearingdeviceuse)willbetestedwithoutandwithawirelessCROSdevice.Speechunderstandingwillbeevaluatedinquietat50dBAfromS0,SipsiandScontrawithAzBiosentences.SpeechunderstandingwillalsobeevaluatedwithAzBiosentencesat65dBAfromS0,SipsiandScontrain20-talkerbabblepresentedfromacircular12speakerarray.Effectivenessofbeamformingwillbeevaluatedwithsignalfromfrontandnoisefromall12speakers.Speechunderstandinginbimodalandbilateralrecipientswillalsobeevaluatedtomeasurebenefitofinputatbothearsinthistestconfiguration.BimodalrecipientswillbetestedwithoutandwithNaidaLinkHA.BilateralrecipientswillbetestedunilaterallywiththefirstCIonlyandbilaterally.SubjectivefeedbackregardingeaseofuseandbenefitofCROSwillalsobeobtained.Results:WiththeCROSdeviceoff,speechscoreswerelowestwhenspeechwaspresentedfromtheunimplantedside(Scontra)andhighestwhenspeechwaspresentedfromtheimplantedside(Sipsi).PreliminaryresultsshowthelisteningwiththeCROSdeviceimprovedspeechscoresintheScontraaswellasS0conditionssuchthatscoreswerenowclosertothoseintheSipsicondition.PreliminaryresultsalsoshowthatwhenS0,beamformingwithCROSfurtherimprovesspeechscoresascomparedtobeamformingwithCIonly.Conclusion:Forunilateralrecipientswhocannotordonotwanttooptforbilateralorbimodalhearing,thewirelessCROSdevicecouldeffectivelyallowaccesstosomeofthebenefitsoflisteningwithbothears. AbstractID:328PosterNumber:88Title:FirstExperienceWithANewThinLateralElectrodeArrayAuthors:ThomasLenarz,M.D.Ph.D.,NilsPrenzler,M.D.,RolfSalcher,M.D.,AndreasBuechner,Ph.D.;DepartmentofOtorhinolaryngology,HannoverMed.Sch.,Hannover,Germany.Abstract:Introduction:Tobeviable,anewcochlearimplant(CI)electrodearraydesignmustcombine:improvedsurgicaleaseofuse,structurepreservation,particularlyimportantforpaediatricapplication,resistbackingoutofthecochleaandbalancehearingpreservationagainstaddressingsufficientcochleartissuetosupportelectrical-onlyhearing.Methods:Thenewelectrodearraywasdesignedtakingaccountofthedetailed3-dimensionalvariabilityanalysedfrom20microCTscansofhumancochleae.Itbuildsonpositiveexperiencewithamid-scalaarraybuthasonlyaslightcurvature,beingdesignedtotakealateralscalatympaniposition.Throughfourmajordesigniterations,manualandautomatedinsertionexperimentsona3-dimentionalforcemeasurementsystemalloweddifferentialstiffnesstobetunedsuchthatinsertionforcesofunder60mNwereachieved.Thefinaldesigntestedhereis23mmlong,varyingfrom0.25x0.55mmatthemostapicalcontactto0.6x0.8mmattheproximalmarkercontact.Toconfirmtheabovedesignobjectives,10arrayswereimplantedinfreshlyfrozenhumantemporalbones.Theinsertionsweremadeusingacombinationofpureandextendedroundwindowapproaches.Surgicalaccesswasrealistic,includingthefacialrecess.Tostabilizethearray,achannelwascarefullydrilledinthefacialrecesstoaccommodatetheelectrodelead.Eachimplantedbonewasvibratedtoassessresistanceagainstextrusion.BothmicroCTandhistologicalanalysiswereconducted.


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Results:Foreachboneitwaspossibletoinsertall16stimulatingelectrodecontacts,withinsertionbeingstraightforwardinallcases.Intwocasestheroundwindowwasdeliberatelyextendedtoimproveaccess.Notranslocationswerefound.Ameaninsertiondepthof405degreeswasachieved.Therewasnodifferenceineither,easeofinsertion,orinsertiondepth,forextendedorpureroundwindowapproaches.Nobackingoutwasobservedduringthebriefagitationandvibrationofeachimplantedbone.Conclusion:Thenewarrayappearswellsuitedtoclinicalapplication,particularlywhereasimpleone-handedinsertiontechniqueisdesired.Itssmalldimensionsallowflexibilityforcochleostomy,aswellasextendedorpureroundwindowapproaches.Theinsertiondepthachievedissufficienttosupportelectricalonlyhearing,withaslightlydeeperinsertionlikelyinclinicalpractice.Withminimaltraumaobservedinthisseries,ourintentionisnexttostudyhearingpreservationwiththisarray. AbstractID:338PosterNumber:110Title:CriticalReviewofSuprameatalApproachforCochlearImplantationAuthors:VedatTopsakal,MDPhDUniversitairZiekenhuisAntwerpen,Antwerp,Belgium.Abstract:Introduction:MastoidectomywithFacialRecessApproach(MFRA)isconsideredthereferencestandardforcochlearimplantation.TheSupraMeatalApproach(SMA)wasdevelopedmorerecentlyanddoesnotrequiremastoidectomy.Weaimtoidentifytheoptimaloperativeapproachforcochlearimplantationbasedonpostoperativecomplicationsandhearingpreservationinchildrenandadultswithasystematicliteraturereviewandaretrospectivecohortstudyforpaediatriccochlearimplantation.Methods:StudiescomparingMFRAandSMAinchildrenandadultswereeligibleforinclusionforthereview.Originalreportswithmoderaterelevanceandvaliditywereincluded.Relevanceandvaliditywereassessedusingaself-modifiedCriticalAppraisalTool.ThisreviewconcordswithPRISMAguidelines.Secondlyweassessedcochlearimplantcomplicationsinchildrenimplantedbetween1996and2014beforetheageof5yearsintheUMCUtrecht.Theseverityofcomplications(minorormajor)wasdocumentedusingHoffmanandCohencriteria.Complicationswerereportedtooccurintraoperative,earlypostoperativeorlatepostoperatively.Intraoperativesurgicalchallengeswerecorrelatedtocomplicationoccurrence.Results:Onlyretrospective,non-randomizedstudieswereidentified(Level-IIIevidence)and294citationswereretrieved.Sixarticleswereselectedforfull-textinclusionand4articleswereselectedfordataextraction.NoarticlefoundasignificantdifferencebetweenMFRAandSMAwithrespecttopostoperativecomplicationsinchildrenandadults.Onestudyfoundasignificantly(p<.023)higherpediatricMFRAmastoiditisrate,however,meta-analysisdidnotindicateanoveralleffect.Analysesofourowndatashowedanaverageage-at-implantationof2.13years(SD:1.14).SMApatientsweresignificantly(p<.001)younger(1.04years(0.55-4.2)).Mostcomplicationswereminor(MFRA:64.0%;SMA:73.1%)andoccurredearlypostoperatively(MFRA:61.5%;SMA:76.9%).MorecomplicationsoccurredinSMAcomparedtoMFRApatients(61.5%vs.20.6%;p<.001)andofteninyoungSMAcohorts(6-12and18-24months;p<.008andp=.016).EspeciallymoreinfectiouscomplicationsoccurredinSMApatients(p<.05).Logisticregressionshowedthatthesurgicaltechniqueandnottheage-at-implantationcausedinfectiouscomplicationoccurrence.Conclusion:NoevidencewasidentifiedinexistingliteratureforlowercomplicationratesbetweentheMFRAorSMAforcochleairimplantationinchildrenandadults.Pediatricdatawereonlyavailablefor


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childrenimplantedabovetheageof24months.ThereisaneedforLevelIevidencetoresolvethearoundpostoperativeoutcomesofSMA.Significantlymore(infectious)complicationsoccurredinyoungcochlearimplantpatientswhenowndatawereanalysed.Becauseyoungchildrenarepronetodevelopacuteandserousotitismediamastoidectomy(MFRA)couldhaveaprotectiveeffectinthispopulation. AbstractID:538PosterNumber:95Title:Step-by-StepSurgicalTiminginSubperiostealPocketTechniqueofCIAuthors:KadirSerkanOrhan,MD,MehmetÇelik,MD,BeldanPolat,MD,LeventAydemir,MD,ErkanÖztürk,MD,YahyaGüldiken,MD;IstanbulUniv.,İstanbul,Turkey.Abstract:Introduction:Cochlearimplants(CI)areasurgically-implantedelectronicdevicesthatrestorehearingtopeoplewithprofoundorseverehearinglosswhofoundnobenefitusingconventionalsoundamplificationdevices.TheroutinesurgicalprocedureforCIisthemastoidectomywithfacialrecessapproachThesubperiostealpockettechnique(SPT)canbesafelyandeffectivelyusedinCI.Inthisstudy,weaimedtodetermineareasonabletimebymeasuringthesurgicalduration(SD)ofSPTwithstep-by-step.Methods:Thisstudyisaretrospectiveanalysisconductedonagroupof40pediatricCIrecipientswhounderwentsurgerybythesameright-handedseniorauthor(Y.G)betweenMarch2009andAugust2016.Patientswhohadanyanatomicvariantorpathologyoftemporalbonestructureswereexcludedfromthestudy.Operationsthathadextendedsurgicaltimerelatedwithanesthesiaorotherabnormalsurgicalprogresssuchassurgicaldevicefailurewerealsoexcluded.Patientswererandomlydividedinto2groups,rightside(n=20)andleftside(n=20).TheSDswerecalculatedusingsurgicalvideorecordingsorintraoperativeobserving.Thesurgicaltime(Second)wascalculatedastheintervalfromskinincisiontoskinclosuresuture.Surgicalstagesweredeterminedrespectively,asfollowsin8steps:1-Retroauricularincisionwithelevationanterior-basedPalvaflap(PF).2-Subperiostealpocket(SP)creation.3-CorticalMastoidectomy(CM)withposteriorcanalwalltinning.4-Posteriortympanotomy.5-RemovingRoundwindowniche(RWN).6-PlacementofthedeviceinthepocketandsuturingtailofPFincision.7-Electrodearrayinsertion.8-SuturingPFandskinclosure.Results:Themeanageofthetotal40CIrecipientsatthetimeofsurgerywas3.2±2years(range,1-11years;meanageofleft-sidegroupwas2.3±1.3yearsandright-sidegroup3.4±2.2years).Thirteenpatientsweremaleandseventeenwerefemale.Prelingualhearinglosswasobservedin35ofthepatients,andonly5patientswerediagnosedashavingpost-lingualhearingloss.Implantmodelsofthreedifferentcompanieswereused.Twenty-threerecipientswereimplantedwithaNucleusdevices(CochlearLtd.,LaneCove,Australia),5receivedClariondevices(AdvancedBionicsCorp.,Valencia,CA,USA)and12wereimplantedMed-eldevices.TheaveragedurationsinSPTstageswasrespectivelyasfollows:266,2±40,73,5±22;316,8±57;429,7±164;81,8±45;204,3±43;72,7±35;808±22.TheaveragetotalSDwas2820±348second.Conclusion:Inourstudy,wedescribed8stepsrespectivelyinSPT.Themosttime-consumingstepsaresuturingPFandskinclosure,posteriortympanotomy,CMandposteriorcanalwallthinning,retroauricularincisionandPFelevation,respectively.TheseresultscanbeusedinCIcenterswithresidencyprograms,whichshouldbeforareasonabletime,withgoodlearningperiodsforjuniorsurgeons.


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AbstractID:584PosterNumber:114Title:RoboticCochlearImplantation:FirstClinicalResultsAuthors:WilhelmWimmer-ArtificalHearingResearchARTORGCenterforBiomedicalEngineering,Univ.ofBern,Bern,Switzerland.Abstract:Introduction:RoboticcochlearimplantationisanewminimallyinvasiveapproachforCIsurgery.TheprocedureiscurrentlyevaluatedinaclinicaltrialattheInselspitalinBern,Switzerland.Theaimofthispresentationistoreportpreliminaryclinicalresultsofthefirstcasesofroboticcochlearimplantation.Methods:TheclinicalstudywasapprovedbythelocalIRBandregulatorybody.PreoperativeassessmentsincludedmorphologicalevaluationusingCT,tasteexaminationandfacialnerveneurography.Duringsurgery,fourbonefiducialscrewswereinsertedbehindtheearandCT(0.2mmresolution)wasperformedtoplanadrilltrajectoryfromthemastoidsurface,passingthroughthefacialrecesstothecenteroftheroundwindow.Accesstothemiddleearwasdrilledusingapreviouslydevelopedtaskspecificimage-guidedroboticsystem.SufficientclearanceofthedrilltrajectoryfromthefacialnervewasconfirmedusingintraoperativeconebeamCTimaging.Uponcompletionofdrillingandscrewremoval,atympanomeatalflapwascreatedandtheroundwindowmembranewasexposed.Animplantbedwaspreparedandtheelectrodearraywasmanuallyinsertedusingaspecificallymanufacturedinsertiontube.CorrectplacementandnominalfunctionoftheimplantwasverifiedbytelemetryandpostoperativeCTimaging.Postoperativefacialnerveneurographyandtasteexaminationtookplacetwoweekspostoperatively.Audiologicalassessmentwasperformedaspartofroutineclinicalcare.Results:Roboticmiddleearaccesswascompletedin4patients,withsuccessfulelectrodeinsertionaccordingtothepreoperativelydefinedplan.Audiologicalresultsforallpatientsarecurrentlybeingcollected.Conclusion:Wehavedemonstratedin4patientsthataCIelectrodecanbesuccessfullyinsertedintothecochleathrougha1.8mmkeyholeaccesscreatedbyasurgicalrobot.Theworkflowwiththeroboticsetuprequiresadditionalsetuptimeandextensiveteamwork. AbstractID:204PosterNumber:224Title:X-linkedMalformationDeafness,aNewSyndrome?Authors:HenrikSmeds,MD,PhD1,EvaKarltorp,MD,PhD1,Britt-MarieAnderlid,MD,PhD2,CeciliaHenricson,PhD3,FilipAsp,PhD4,LenaAnmyr,PhD5,JeremyWales,MD,PhD1,UlrikaLöfkvist,PhD6;1Otolaryngology,KarolinskaUniv.Hosp.,Stockholm,Sweden,2DepartmentofClinicalGenetics,KarolinskaUniv.Hosp.,Stockholm,Sweden,3DepartmentofBehavioralSciencesandLearning,Univ.ofLinköping,Linköping,Sweden,4DepartmentofClinicalScience,InterventionandTechnology,KarolinskaInst.t,Stockholm,Sweden,5DepartmentofSocialWorkinHealth,KarolinskaUniv.Hosp.,Stockholm,Sweden,6DepartmentofSpecialNeedsEducation,Univ.ofOslo,Oslo,Norway.Abstract:Introduction:X-linkedmalformationdeafnessisararehereditarycauseofcongenitalorrapidprogressivehearingloss.Ofallhereditaryhearingloss,mutationsontheX-chromosomearerare,andmaycausesyndromicaswellasnon-syndromicdeafness.Fournon-syndromichearinglosslocihavebeenmappedtotheX-chromosome,DFNX1-4.Amongnon-syndromicx-linkedhearingloss,DFNX2isthemostcommon(around50%)anditscausativegenehasbeenidentifiedasPOU3F4.DFNX2iscausedbyavarietyofmutationswithinthePOU3F4geneoritsregulatoryelements.Theaffectedchildren


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presentwithasevere-profoundmixedhearinglossandtemporalboneimagingshowsatypicalinnerearmalformationclassifiedasIncompletePartitiontype3(IP3).Cochlearimplantation(CI)isoneoptionofhearingrestorationinseverecases.InthisstudyweevaluatethisgroupofpediatricCIrecipients,comparedwithacontrolgroup,anddiscusspossiblelinkstoneurodevelopmentalsymptoms.Methods:Tenchildrenwithx-linkeddeafnessandcochlearimplants(firstimplantedage0.9-2.8years)wereevaluatedwitharetrospectivechartreviewincombinationwithadditionaltestingbyamultidisciplinaryteam.Hearing,language,cognitiveresultsandmentalhealthwerecomparedwithacontrolgroupofchildrenwithnon-syndromichearingloss(GJB2,Connexin26)withCI(n=10).MutationanalysisofthePOU3F4genewasperformedandthegenotypewascomparedwithoutcome.Results:MutationsinPOU3F4werefoundinnineofthetenchildrenwithIPIIImalformation.Childrenwithx-linkeddeafnessshowedlowlevelofspeechrecognition,especiallyinnoise,delayedorimpairedspokenlanguageabilitiesandexecutivefunctioningdeficitswhichcorrelatedwithmentalill-healthissues.Bycontrast,controlsrevealedmoreage-appropriateresultsinthesedomains.Childrenwithx-linkeddeafnessalsodisplayedhyperactivityandpoorconcentrationability.However,eightoftenchildrenexpressedhighnon-verbalcognitiveabilitydespitetheirotherhearing-andcognitive-relatedissues.Conclusion:ThechildrenwithX-linkeddeafnessinthepresentstudydisplayedpoorerperformanceonmeasuresofexecutivefunctionsaswellasspokenlanguageskillsincomparisontothecontrolgroupwithConnexin26deafness.ThefindingsofthepresentstudysuggestalinkbetweenPOU3F4deafnessandneurodevelopmentalanomalies.This“POU3F4syndrome”presentswithmixedsevere-profoundhearinglossandbehavioraldisturbances,suchasattentiondeficithyperactivityorautismspectrumdisorders.AlthoughCIisafeasiblealternativeforchildrenwithx-linkedmalformationdeafness,thechildrenneedextensivesupport.Oralcommunicationaloneispossiblebutthemajorityofchildreninthepresentstudyexhibitedlanguageandcognitivedifficulties.

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