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John K. Niparko - One of the best experts on this subject based on the ideXlab platform.
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Cochlear Implantation in older adults
Medicine, 2012Co-Authors: Frank R Lin, John K. Niparko, Wade W Chien, Danisa M Clarrett, Howard W. FrancisAbstract:AbstractCochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for Cochlear Implantation (CI) is approximately 150,000 and will continue to increase with the aging of t
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Language development after Cochlear Implantation: an epigenetic model
Journal of Neurodevelopmental Disorders, 2011Co-Authors: Timothy M. Markman, John K. Niparko, Emily A Tobey, Laurie S Eisenberg, Alexandra L Quittner, Donna Thal, Nae Yuh WangAbstract:Growing evidence supports the notion that dynamic gene expression, subject to epigenetic control, organizes multiple influences to enable a child to learn to listen and to talk. Here, we review neurobiological and genetic influences on spoken language development in the context of results of a longitudinal trial of Cochlear Implantation of young children with severe to profound sensorineural hearing loss in the Childhood Development after Cochlear Implantation study. We specifically examine the results of Cochlear Implantation in participants who were congenitally deaf ( N = 116). Prior to intervention, these participants were subject to naturally imposed constraints in sensory (acoustic–phonologic) inputs during critical phases of development when spoken language skills are typically achieved rapidly. Their candidacy for a Cochlear implant was prompted by delays ( n = 20) or an essential absence of spoken language acquisition ( n = 96). Observations thus present an opportunity to evaluate the impact of factors that influence the emergence of spoken language, particularly in the context of hearing restoration in sensitive periods for language acquisition. Outcomes demonstrate considerable variation in spoken language learning, although significant advantages exist for the congenitally deaf children implanted prior to 18 months of age. While age at Implantation carries high predictive value in forecasting performance on measures of spoken language, several factors show significant association, particularly those related to parent–child interactions. Importantly, the significance of environmental variables in their predictive value for language development varies with age at Implantation. These observations are considered in the context of an epigenetic model in which dynamic genomic expression can modulate aspects of auditory learning, offering insights into factors that can influence a child’s acquisition of spoken language after Cochlear Implantation. Increased understanding of these interactions could lead to targeted interventions that interact with the epigenome to influence language outcomes with intervention, particularly in periods in which development is subject to time-sensitive experience.
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spoken language development in children following Cochlear Implantation
JAMA, 2010Co-Authors: John K. Niparko, Emily A Tobey, Donna J Thal, Laurie S Eisenberg, Nae Yuh Wang, Alexandra L Quittner, Nancy E FinkAbstract:Context Cochlear Implantation is a surgical alternative to traditional amplification (hearing aids) that can facilitate spoken language development in young children with severe to profound sensorineural hearing loss (SNHL). Objective To prospectively assess spoken language acquisition following Cochlear Implantation in young children. Design, setting, and participants Prospective, longitudinal, and multidimensional assessment of spoken language development over a 3-year period in children who underwent Cochlear Implantation before 5 years of age (n = 188) from 6 US centers and hearing children of similar ages (n = 97) from 2 preschools recruited between November 2002 and December 2004. Follow-up completed between November 2005 and May 2008. Main outcome measures Performance on measures of spoken language comprehension and expression (Reynell Developmental Language Scales). Results Children undergoing Cochlear Implantation showed greater improvement in spoken language performance (10.4; 95% confidence interval [CI], 9.6-11.2 points per year in comprehension; 8.4; 95% CI, 7.8-9.0 in expression) than would be predicted by their preImplantation baseline scores (5.4; 95% CI, 4.1-6.7, comprehension; 5.8; 95% CI, 4.6-7.0, expression), although mean scores were not restored to age-appropriate levels after 3 years. Younger age at Cochlear Implantation was associated with significantly steeper rate increases in comprehension (1.1; 95% CI, 0.5-1.7 points per year younger) and expression (1.0; 95% CI, 0.6-1.5 points per year younger). Similarly, each 1-year shorter history of hearing deficit was associated with steeper rate increases in comprehension (0.8; 95% CI, 0.2-1.2 points per year shorter) and expression (0.6; 95% CI, 0.2-1.0 points per year shorter). In multivariable analyses, greater residual hearing prior to Cochlear Implantation, higher ratings of parent-child interactions, and higher socioeconomic status were associated with greater rates of improvement in comprehension and expression. Conclusion The use of Cochlear implants in young children was associated with better spoken language learning than would be predicted from their preImplantation scores.
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Cochlear Implantation update
Pediatric Clinics of North America, 2003Co-Authors: Howard W. Francis, John K. NiparkoAbstract:Cochlear implant technology continues to revolutionize the habilitation of hearing impairment in children and the attendant delay in verbal language development. A strong consensus has been reached that Cochlear implants can produce marked gains in speech understanding in children with severe to profound hearing impairment, but rehabilitation and special education services are indispensable adjuncts needed to maximize benefit [1]. The increasing prominence of pediatric Cochlear Implantation since Food and Drug Administration (FDA) approval in 1990 [2] coincides with growing public and professional awareness of the importance of early identification and intervention of hearing loss in children. The resulting legislative mandate for newborn screening that is sweeping the United States reflects the recognition of hearing loss as one of the most prevalent disabilities of childhood and one that interrupts the normal flow of verbal-based knowledge to 90% of the deaf children who are raised by hearing families [3]. Since FDA approval, children now account for 50% of the 35,000 individuals who have received Cochlear implants in the United States. The safety of Cochlear implant surgery in young children and the demonstration of improved efficacy compared to hearing aids prompted FDA approval of the Nucleus 24 device (Cochlear Corporation) in 2000 for children aged 1 year and older. This approval, in addition to early identification by newborn screening programs, has resulted in a steady fall in the mean age at Implantation [4]. Although Cochlear Implantation is increasingly accepted by individuals in the Deaf culture—represented by the National Association of the Deaf and other organizations—as an assistive listening device for adults, the Implantation of deaf children continues to be a contentious issue [5]. Cochlear implants use implantable circuitry and systems of information processing to circumvent dysfunctional hair cell transduction and enable deafened
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Cochlear Implantation update.
Pediatric clinics of North America, 2003Co-Authors: Howard W. Francis, John K. NiparkoAbstract:Cochlear Implantation is recognized as a valuable intervention with important implications for the acquisition of speech perception and verbal language in children with severe to profound hearing impairment. Auditory rehabilitation, language intervention, and close coordination between parents, schools, and the implant center are necessary to maximize efficacy. Early identification of hearing loss, early hearing aid use and language intervention, and Cochlear Implantation by 2 years of age are positive predictors for language acquisition that can approach the levels of normal-hearing children. There are early indications that increased access to mainstream education and gains in quality of life are long-term benefits that render Cochlear Implantation a cost-effective intervention.
Howard W. Francis - One of the best experts on this subject based on the ideXlab platform.
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Cochlear Implantation in older adults
Medicine, 2012Co-Authors: Frank R Lin, John K. Niparko, Wade W Chien, Danisa M Clarrett, Howard W. FrancisAbstract:AbstractCochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for Cochlear Implantation (CI) is approximately 150,000 and will continue to increase with the aging of t
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Geriatric Cochlear Implantation
Operative Techniques in Otolaryngology-head and Neck Surgery, 2010Co-Authors: Jennifer Dobson Yeagle, Howard W. FrancisAbstract:Cochlear Implantation allows for improved communication and quality of life in elderly individuals with severe to profound sensorineural hearing loss and poor word discrimination. Medical and psychosocial factors, however, pose additional challenges that can impact desired Cochlear implant outcomes. Risks associated with Cochlear Implantation are not significantly increased with age. Special consideration should, however, be given to the peri-operative needs of this population and added risks associated with the recovery process. A thorough multidisciplinary approach to candidacy evaluation is necessary to minimize intervention risks, and develop appropriate expectations by the patient and family members. Post-operative rehabilitation including the development of strategies for better communication in real world conditions is underutilized, but is likely to increase success with a Cochlear implant.
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Cochlear Implantation update
Pediatric Clinics of North America, 2003Co-Authors: Howard W. Francis, John K. NiparkoAbstract:Cochlear implant technology continues to revolutionize the habilitation of hearing impairment in children and the attendant delay in verbal language development. A strong consensus has been reached that Cochlear implants can produce marked gains in speech understanding in children with severe to profound hearing impairment, but rehabilitation and special education services are indispensable adjuncts needed to maximize benefit [1]. The increasing prominence of pediatric Cochlear Implantation since Food and Drug Administration (FDA) approval in 1990 [2] coincides with growing public and professional awareness of the importance of early identification and intervention of hearing loss in children. The resulting legislative mandate for newborn screening that is sweeping the United States reflects the recognition of hearing loss as one of the most prevalent disabilities of childhood and one that interrupts the normal flow of verbal-based knowledge to 90% of the deaf children who are raised by hearing families [3]. Since FDA approval, children now account for 50% of the 35,000 individuals who have received Cochlear implants in the United States. The safety of Cochlear implant surgery in young children and the demonstration of improved efficacy compared to hearing aids prompted FDA approval of the Nucleus 24 device (Cochlear Corporation) in 2000 for children aged 1 year and older. This approval, in addition to early identification by newborn screening programs, has resulted in a steady fall in the mean age at Implantation [4]. Although Cochlear Implantation is increasingly accepted by individuals in the Deaf culture—represented by the National Association of the Deaf and other organizations—as an assistive listening device for adults, the Implantation of deaf children continues to be a contentious issue [5]. Cochlear implants use implantable circuitry and systems of information processing to circumvent dysfunctional hair cell transduction and enable deafened
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Cochlear Implantation update.
Pediatric clinics of North America, 2003Co-Authors: Howard W. Francis, John K. NiparkoAbstract:Cochlear Implantation is recognized as a valuable intervention with important implications for the acquisition of speech perception and verbal language in children with severe to profound hearing impairment. Auditory rehabilitation, language intervention, and close coordination between parents, schools, and the implant center are necessary to maximize efficacy. Early identification of hearing loss, early hearing aid use and language intervention, and Cochlear Implantation by 2 years of age are positive predictors for language acquisition that can approach the levels of normal-hearing children. There are early indications that increased access to mainstream education and gains in quality of life are long-term benefits that render Cochlear Implantation a cost-effective intervention.
Karen B Avraham - One of the best experts on this subject based on the ideXlab platform.
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Connexin-Associated Deafness and Speech Perception Outcome of Cochlear Implantation
Archives of Otolaryngology-head & Neck Surgery, 2006Co-Authors: Riki Taitelbaum-swead, Zippora Brownstein, Chava Muchnik, Lela Megirov, Minka Hildesheimer, Jona Kronenberg, Liat Kishon-rabin, Moshe Frydman, Karen B AvrahamAbstract:Objective To compare performance after Cochlear Implantation in children with mutations in connexin (Cx) 26 ( GJB2) or Cx30 ( GJB6 ) and children with deafness of unknown etiology. Design Genetic analysis and speech perception evaluation was performed in the children with and without Cx mutations who had undergone Cochlear Implantation. Speech perception performance was retrospectively analyzed 6, 12, 24, 36, and 48 months after Implantation. Test material was selected according to the child's age and cognitive and language abilities. Setting The study took place at speech and hearing and genetic centers of a hospital in the central part of Israel and the genetics departments of 3 additional centrally located hospitals. Patients A total of 30 children who had undergone Cochlear Implantation were selected for the study, with control patients matched according to age at Implantation, duration of implant use, and mode of communication. There was no evidence for additional disabilities or handicaps in either group. Main Outcome Measures Speech perception measurements included a questionnaire, as well as closed and open-set tests. Results Overall, the 2 groups showed significant improvement in speech perception results after Implantation. Four years after Implantation, both groups achieved mean open-set speech perception scores of approximately 60%, 75%, and 90% for monosyllabic, 2 syllables, and words in sentences tests, respectively. Conclusions There were no apparent differences in speech perception performance after Implantation between the children with Cx mutations and children with deafness of unknown etiology. These data have important implications as a prognostic indicator when counseling candidates for Cochlear Implantation.
Steven A. Telian - One of the best experts on this subject based on the ideXlab platform.
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Transcanal labyrinthectomy for intractable vertigo after unilateral Cochlear Implantation.
Otology & Neurotology, 2011Co-Authors: Katherine D. Heidenreich, Teresa A Zwolan, Hussam K. El-kashlan, Gregory J Basura, Steven A. TelianAbstract:Document the use of transcanal labyrinthectomy to treat disabling attacks of vertigo after unilateral Cochlear Implantation. A 46-year-old woman with severe-profound bilateral sensorineural hearing loss secondary to enlarged vestibular aqueducts underwent Cochlear Implantation for her right ear with a Nucleus Freedom device. The surgery was uneventful, and postoperative imaging confirmed that the electrode was positioned properly. She developed episodic vertigo 10 to 14 days after the implant surgery, which failed to improve with aggressive vestibular rehabilitation therapy. Plugging of the round window for possible perilymphatic fistula did not relieve her symptoms. Right transcanal labyrinthectomy supplemented by filling the vestibule with gentamicin-soaked Gelfoam and then a customized vestibular rehabilitation program. Comparison of vestibular symptoms and Cochlear implant performance before and after transcanal labyrinthectomy. The patient had immediate relief of symptoms, and the function of the Cochlear implant was not adversely affected. Transcanal labyrinthectomy may be an effective method to ablate the vestibular end organ after unilateral Cochlear Implantation. It can offer relief of disabling vertigo without adversely affecting the performance of the implant.
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Cochlear Implantation in chronic suppurative otitis media
Otology & Neurotology, 2002Co-Authors: Hussam K Elkashlan, H. A. Arts, Steven A. TelianAbstract:ObjectiveTo evaluate management options for Cochlear Implantation in patients with chronic suppurative otitis media.Study DesignRetrospective case review.SettingTertiary referral center with a large Cochlear implant program.PatientsTen patients with chronic suppurative otitis media who received coch
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Successful Cochlear Implantation in a patient with MELAS syndrome.
The American journal of otology, 1999Co-Authors: Eben L. Rosenthal, Paul R. Kileny, Angelique Boerst, Steven A. TelianAbstract:Objective: To describe methods of assessing Cochlear implant candidacy in patients with potentially significant peripheral and central nervous system (CNS) degeneration. Study Design: A patient with a degenerative CNS disease (MELAS syndrome) undergoing evaluation for Cochlear Implantation is described. Setting: This study took place at a tertiary care center. Patient: A patient with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) who had cortical blindness and profound sensorineural hearing loss was evaluated and rehabilitated with Cochlear Implantation. Interventions: Pure-tone audiogram, behavioral responses to promontory stimulation electrical auditory brainstem response, and electrically evoked middle-latency responses (MLRs) were used to assess eighth nerve, auditory brainstem, and cortical auditory pathways. Cochlear Implantation with Cochlear Corporation mini 22 implant was performed. Results: Repeatable electrically evoked MLRs and behavioral responses to promontory stimulation documented the presence of auditory cortical responses. Successful Implantation resulted in open set speech recognition and communication using the auditory/oral mode. Conclusion: This report describes successful Implantation in a patient with MELAS syndrome and demonstrates the ability to preoperatively confirm the integrity of brainstem and cortical auditory pathways despite significant CNS degeneration.
Blake C. Papsin - One of the best experts on this subject based on the ideXlab platform.
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Seizure activity following Cochlear Implantation: is it the implant?
International Journal of Pediatric Otorhinolaryngology, 2012Co-Authors: Tulika Shinghal, Sharon L. Cushing, Karen A. Gordon, Joelene Huber, John M. Lee, Blake C. PapsinAbstract:Abstract Objective Cochlear Implantation is a successful method of auditory rehabilitation. This procedure has been associated with facial nerve and vestibular end-organ stimulation suggesting potential for extra-Cochlear stimulation. The objectives of this study were to investigate the potential relationship between Cochlear Implantation and seizure activity in the pediatric implant population. Methods Local Research Ethics Board approval was obtained. The Hospital for Sick Children's Cochlear Implant Database from 1998 to 2011 was retrospectively reviewed. Based on a multidisciplinary team, patients who received a diagnosis of seizure disorder or had been investigated for seizure-like activity were identified and reviewed. Results Fifteen children from a group of 816 pediatric Cochlear implant users were identified as having suspected seizure-like activity. Eventually 10 children were found to have seizures based on an evaluation by a pediatric neurologist and an electroencephalogram. Of these 10, only 3 children had new onset of seizures after Cochlear Implantation and 2 of these 3 suffered from global developmental delay and other medical comorbidities. No definite temporal connection was found between Cochlear implant use and seizure activity. Conclusions Cochlear Implantation in the pediatric population continues to be a reliable and safe intervention for children. Overall the prevalence of post Implantation seizure disorders in our population (0.37%) is lower than that of the overall population (0.5–1%). The presence of new-onset seizure activity following Cochlear Implantation is unusual and while there are theoretic possibilities of how a Cochlear implant could be implicated in initiating seizures we were unable to find evidence to support this association.
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Tympanic membrane changes following paediatric Cochlear Implantation
Cochlear Implants International, 2005Co-Authors: Yvonne Chan, Paolo Campisi, Adrian L. James, Blake C. PapsinAbstract:OBJECTIVE: To investigate the effects of Cochlear Implantation on the tympanic membrane in children. DESIGN: Cross-sectional study. METHODS: Eighty-four Cochlear implant recipients were recruited at a vaccination clinic. The implanted ear was examined and the appearance of the external auditory canal and tympanic membrane documented. Demographic and clinical data such as age at Implantation, duration of Implantation, preoperative tympanic membrane appearance and preoperative middle-ear function were obtained retrospectively from hospital charts. RESULTS: Thirty-eight patients (46.9%) were found to have abnormal tympanic membrane findings. The most common abnormality was scarring of the tympanic membrane in the vicinity of the electrode array. No statistically significant association was found between the tympanic membrane findings and demographic and clinical variables. CONCLUSIONS: Cochlear Implantation may cause tympanic membrane scarring. The significance of the scarring is unclear. Dehiscence of the posterior wall of the external auditory canal should be avoided to prevent retraction pocket formation of the tympanic membrane.