The surgical procedure for placement of a single-electrode cochlear implant in children is described in detail. This is essentially the same procedure that has been successfully used in adults. Medical, radiological, and surgical data are also presented. The majority of the children were deafened by meningitis. Preoperative X-rays indicated ossification of scala tympani was present in 34% of the cases and ossification of the round window in more than 50%. Surgical and postoperative complications have been minimal.

Child↗

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Otitis media in children following the cochlear implant.

Children are more prone to otitis media than adults. Therefore, although otitis media has not produced any complications in adult cochlear implant patients, concern has been expressed that it might do so in children with an implant. This study examined the frequency and severity of otitis media following cochlear implantation. Data were collected from parents and physicians by use of a questionnaire. In addition, medical records were examined for incidence and severity of otitis media or any evidence of inner ear infection. All parents and all physicians who responded to the questionnaire rated both the frequency and severity of otitis media as the same or decreased after implantation when compared to preimplant. Medical records show no evidence that incidence of otitis media is affected by the implant.

Child↗

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Long term results of electrode implantation and electronic stimulation of the cochlea in man.

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Cochlea↗

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Menière's disease and endolymphatic hydrops: clinical-histopathological correlations.

The clinical-histopathological correlation between Menière's disease and endolymphatic hydrops was done to explain, as much as possible, causes of symptoms of Menière's disease. Twenty-three temporal bones with endolymphatic hydrops from 17 patients were reviewed and clinical and histopathological findings were correlated. Histopathological examination revealed frequent, severe deformities in the labyrinthine walls and permanent changes in Reissner's membranes. Evidence of rupture was difficult to assess. Of 21 ears of patients with the clinical diagnosis of Menière's disease, 93% had endolymphatic hydrops. A statistical correlation between increased area of the cochlear duct and hearing loss was found. Some correlation was also found between frequency of vertigo and results of electronystagmography with histopathological findings. Consequently, the mechanical effect of endolymphatic hydrops seems to have greater significance in the production of symptoms of Menière's disease than the biochemical effect of ruptures. In a review of ten unusual cases from this series of 17 patients, traumatic neuromas or remnants of vestibular structures were found after an incomplete labyrinthectomy. Histopathological findings of four patients who had undergone endolymphatic subarachnoid shunt surgery are described.

Adult↗

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Status of hearing Rehabilitation Research Center Implant Program.

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Cochlear Implants↗

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Experiences with the cochlear implant in preschool children.

Years of experience with the cochlear implant in profoundly deaf adults led to a decision to attempt to extend the benefits of this device to children. As of March 15, 1983, 43 deaf children ranging in age from 2.7 to 17.5 years have been implanted. Seventeen of these are children under 6 years of age. All had worn hearing aids but demonstrated little or no benefit from them. Auditory thresholds with the implant are significantly better than those obtained unaided and with hearing aids. Although a longer period of experience is required, the preschool-aged children can eventually make the same auditory discriminations as older children and adults. Long-term impact on speech and language development remains to be determined, but there is already evidence for significant improvement in these areas.

Adolescent↗

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Cochlear implant for tinnitus. Case reports.

Various forms of electrical stimulation are effective in reducing tinnitus in some patients. Our experience with cochlear implant patients who have preimplant tinnitus demonstrated that about half experienced relief after the implant. We present five patients who underwent cochlear implant exclusively for tinnitus relief. Results are mixed with only one definite success. Electrical stimulation and our current research efforts are discussed.

Aged↗

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Neurons of the inferior medullary velum in the cerebellopontine angle.

The edge of the inferior medullary velum (tenia) is attached in part to the surface of several structures localized in the cerebellopontine angle, including the cochlear nuclear complex and the pontobulbar body. Since superficial layers of these structures contain numerous neurons, we examined the possibility that neurons are also present within the velum. On light microscopy, we found groups of neurons accumulated immediately under the pia mater covering the tenia. The number of groups in different specimens varied from one to three, and the groups were rounded or oval in shape. A bundle of fibers running from the main mass of the brain stem toward these groups was revealed with a myelin-staining technique. The majority of neurons in the groups were angular in shape. These findings may contribute to our understanding of the general and surgical anatomy of the cerebellopontine angle.

Adult↗

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Experiences with the Nucleus multichannel cochlear implant in three young children.

Clinical trials for the Nucleus multichannel cochlear implant in children 2 through 9 years of age have been ongoing for approximately 1 year. We describe three children who have used the device for at least 8 months. Based on these three cases, we discuss some factors that might affect the outcome of the Nucleus implant in young children: age at implantation, age at onset of deafness, and duration of profound deafness before implantation. Surgical and rehabilitation issues, including educational settings, are reviewed.

Auditory Threshold↗

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Surgery of the skull base: transcochlear approach to the petrous apex and clivus.

The transcochlear approach is described for resection of lesions arising anterior or medial to the internal auditory canal as well as for those arising directly from the clivus. Through an extended complete mastoidectomy the facial nerve is totally decompressed and re-routed posteriorly from the stylomastoid foramen to the internal auditory canal. The fallopian canal, promontorium, and cochlea are removed anteriorly and medially as far as the internal carotid artery, obtaining exposure to a triangular area limited by the superior petrosal sinus, inferior petrosal sinus, carotid, and internal auditory canal, giving adequate exposure to the structures of the clivus and the midline (basilar artery, vertebral arteries, and the sixth cranial nerves).

Adolescent↗

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Present status and future directions of the Ear Research Institute cochlear implant program.

Thirty-three adult subjects have been implanted with single-electrode cochlear implants at the Ear Research Institute. This paper outlines the current status of the subjects; the rehabilitation and testing program; results found with the implant; and future directions of the implant program. Results indicate that implant subjects can score significantly above chance on a variety of discrimination tests. Implant subjects also score significantly better than hearing aid subjects on these tests. Research is continuing on engineering and signal-processing improvements for the single-elecrode implant. Multiple-electrode implants and binaural implants are being considered for future research at the Ear Research Institute.

Adult↗