Digitala Vetenskapliga Arkivet

Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Experiences from Cochlear Implantation and Auditory Brainstem Implantation in Adults and Children: Electrophysiological Measurements, Hearing Outcomes and Patient Satisfaction
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Cochlear implants (CIs) and auditory brainstem implants (ABIs) are prostheses for hearing used in patients with profound hearing impairment. A CI requires an operational cochlear nerve to function in contrast to an ABI. ABIs were initially designed for adult patients with neurofibromatosis type 2 (NF2), suffering from bilateral vestibular schwannomas. Now ABIs are also used for patients, both adults and children, with congenital cochlear malformations, cochlear nerve hypoplasia/aplasia, and cochlear ossification. The aims of this thesis are to evaluate hearing outcome in patients implanted with a CI after long-term deafness. An extended period of deafness has earlier been considered as a contraindication for CI surgery. Further, we analyzed if electrically evoked auditory brainstem responses (eABRs) can predict CI outcome and pinpoint the optimal selection of treatment such as CI or ABI. We also disclose our experiences from ABI surgery in Uppsala, such as implant use, hearing outcome, complications, and satisfaction among the patients. Finally, we evaluated the results and benefits of ABIs in non-NF2 pediatric patients.

Results show that patients with an extended deafness period and durations over 20 years can achieve speech understanding and benefit from CIs. Patients with long-term deafness and limited years of hearing before deafness did not perform as well as those with shorter deafness duration and longer hearing experience did. eABR seems to have a definite role in the diagnostic armamentarium, to better consider alternative surgical strategies such as ABI. No eABR waveform predicted a poor CI outcome. There was no correlation between speech perception and eABR waveform latencies or eABR waveform quality. A majority of the ABI patients used their ABIs and benefited from them for at least some period. ABI assisted voice control in a majority of the full-time users and they reported improved understanding of speech with the implant switched on. No severe complications from ABI surgery or ABI stimulation were noted. The patients were generally satisfied, even if their hearing remained very limited. All pediatric patients but one used the implant continuously and benefited from it.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2016. , s. 104
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1183
Nyckelord [en]
cochlear implant, auditory brainstem implant, electrically evoked auditory brainstem responses, long deafness duration, neurofibromatosis type 2
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-275091ISBN: 978-91-554-9483-4 (tryckt)OAI: oai:DiVA.org:uu-275091DiVA, id: diva2:903300
Disputation
2016-04-15, Skoogsalen, ingång 78/79, Akademiska sjukhuset, Uppsala, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2016-03-22 Skapad: 2016-01-29 Senast uppdaterad: 2016-04-05
Delarbeten
1. Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
Öppna denna publikation i ny flik eller fönster >>Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
2014 (Engelska)Ingår i: Audiology & Neurotology Extra, ISSN 1664-5537, Vol. 4, nr 2, s. 46-55Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective:

The aim of the present study was to gauge factors that influence the outcome of cochlear implants (CI) in patients who have been deaf for an extended period.

Patients and Methods:

Twelve adult cases (13 ears) were operated on at the CI unit in Uppsala during the period of 2002-2013. These patients had a deafness duration ranging between 20 and 72 years in the implanted ear and severe to profound hearing loss or deafness in the other ear. Data concerning pre- and postoperative speech perception, deafness duration, hearing/deafness duration in the contralateral ear, age at implantation, intraoperative electrophysiological measurements, cause of deafness, and user status were collected.

Results:

Eleven of 12 patients (13 ears) benefitted from CI treatment.

Conclusion:

The overall hearing experience, deafness duration, and age at onset of deafness are important issues to consider prior to CI.

Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
urn:nbn:se:uu:diva-248579 (URN)DOI:10.1159/000365274 (DOI)
Tillgänglig från: 2015-04-01 Skapad: 2015-04-01 Senast uppdaterad: 2016-03-22Bibliografiskt granskad
2. Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
Öppna denna publikation i ny flik eller fönster >>Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
2015 (Engelska)Ingår i: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 16, nr 5, s. 254-261Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives

The aim of this study was to investigate whether electrical auditory brainstem responses (eABRs) obtained during cochlear implantation (CI) can predict CI outcomes. We also aimed to assess whether eABR can be used to select patients for auditory brainstem implantation (ABI).

Methods

This was a retrospective study. The latencies and quality of the eABR waveforms from adult patients implanted with CI in Uppsala from 2011 to 2013 (n = 74) and four children with severe cochlear abnormalities were analyzed. Speech perception was assessed through postoperative monosyllabic word (MS-word) recognition. A score was constructed for each patient based on wave II, III, and V patency.

Results

eABR latencies increased towards base stimulation of the cochlea. Wave V for the mid- and low-frequency regions was the most robust. Significant latency shifts occurred in wave V from the low- to high-frequency regions (**P < 0.01) and from the mid- to high-frequency regions (**P < 0.01). No correlations were found between waveform score, wave V–III interval, wave V latency, and MS-word scores. A negative eABR always predicted a negative outcome. Among the patients with negative outcomes, 75% had eABRs.

Discussion

Implant electrical stimulation and brain stem recordings can be used (eABRs wave V) to predict a negative functional outcome. Low-frequency waves V were observed in all patients with successful CI outcomes. Patients for whom eABR waveforms were completely absent had unsuccessful CI outcomes.

Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
urn:nbn:se:uu:diva-272679 (URN)10.1179/1754762815Y.0000000005 (DOI)
Tillgänglig från: 2016-01-15 Skapad: 2016-01-15 Senast uppdaterad: 2019-12-18Bibliografiskt granskad
3. Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
Öppna denna publikation i ny flik eller fönster >>Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
Visa övriga...
2014 (Engelska)Ingår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, nr 10, s. 1052-1061Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

CONCLUSIONS:

Even though sound perception may be limited after treatment with an auditory brainstem implant (ABI), it provides benefits and should be selectively offered to patients. Importantly the patients must be motivated, given reasonable expectations of outcome and offered long-term rehabilitation with a considerable 'learn to listen' period with the implant device.

OBJECTIVES:

To describe the clinical experiences and results of 24 ABI surgeries performed in Uppsala University Hospital between 1993 and 2013.

METHODS:

Most patients (n = 20) suffered from neurofibromatosis type 2 (NF2); a few patients (n = 4) were paediatric non-NF2 patients. The files were searched for information on the presurgery size of the vestibular schwannoma, whether the patient had undergone gamma knife treatment, the surgical approach, the side effects of the surgery and of the use of the implant, the electrode activation pattern and implant use, and categories of auditory performance (CAP) score.

RESULTS:

Our results show that many patients greatly benefited from an ABI, and most of the patients used their implants even though the hearing improvements usually consisted of awareness of surrounding sounds and improved lip-reading. No severe side effects were observed from implant stimulation.

Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
urn:nbn:se:uu:diva-233250 (URN)10.3109/00016489.2014.909051 (DOI)000342204900011 ()24881643 (PubMedID)
Anmärkning

De två första författarna delar förstaförfattarskapet.

Tillgänglig från: 2014-10-01 Skapad: 2014-10-01 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
4. Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
Öppna denna publikation i ny flik eller fönster >>Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
2016 (Engelska)Ingår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, nr 1, s. 62-67Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

CONCLUSION:

The majority of the patients used their auditory brainstem implants (ABIs) all the time, reporting that he/she would make the decision to receive an implant again if the decision were reconsidered. The findings support that the ABI is a valuable treatment in patients with type 2 neurofibromatosis (NF2) and in children with congenital inner ear and nerve anomalies or cochlear ossification.

OBJECTIVE:

To evaluate the patients who underwent ABI implantation in Uppsala during 1993-2013. This study analyzed patients' implant use, perception of environmental sounds, perceived benefit from the implant, and quality-of-life (QoL).

METHOD:

The NF2-patients (n = 20) comprised the majority of the patients, and there were a few non-NF2 pediatric patients (n = 4). The exclusion criteria included deceased patients (n = 4) and patients with no hearing sensations from the implant, or those with an inactivated ABI (n = 2). The data were collected from a questionnaire survey.

RESULTS:

Eleven adult patients and two pediatric patients answered the questionnaires. Eight of the adult patients used their implants 'always'. The two children always used their implants. Hearing problems had the largest negative effect on the QoL. The non-users and the users scored equally on the NFTI-QoL.

Nyckelord
Auditory brainstem implants; QoL; benefit; NF2
Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
urn:nbn:se:uu:diva-265777 (URN)10.3109/00016489.2015.1079925 (DOI)000365678800011 ()26426855 (PubMedID)
Tillgänglig från: 2015-11-03 Skapad: 2015-11-03 Senast uppdaterad: 2017-12-01Bibliografiskt granskad
5. Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
Öppna denna publikation i ny flik eller fönster >>Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
2016 (Engelska)Ingår i: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 17, nr 2, s. 109-115Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: Indications for auditory brainstem implants (ABIs) have been widened from patients with neurofibromatosis type 2 (NF2) to paediatric patients with congenital cochlear malformations, cochlear nerve hypoplasia/aplasia, or cochlear ossification after meningitis. We present four ABI surgeries performed in children at Uppsala University Hospital in Sweden since 2009.

Methods: Three children were implanted with implants from Cochlear Ltd. (Lane Cove, Australia) and one child with an implant from MedEl GMBH (Innsbruck, Austria). A boy with Goldenhar syndrome was implanted with a Cochlear Nucleus ABI24M at age 2 years (patient 1). Another boy with CHARGE syndrome was implanted with a Cochlear Nucleus ABI541 at age 2.5 years (patient 2). Another boy with post-ossification meningitis was implanted with a Cochlear Nucleus ABI24M at age 4 years (patient 3). A girl with cochlear aplasia was implanted with a MedEl Synchrony ABI at age 3 years (patient 4). In patients 1, 2, and 3, the trans-labyrinthine approach was used, and in patient 4 the retro-sigmoid approach was used.

Results: Three of the four children benefited from their ABIs and use it full time. Two of the full time users had categories of auditory performance (CAP) score of 4 at their last follow up visit (6 and 2.5 years postoperative) which means they can discriminate consistently any combination of two of Ling's sounds. One child has not been fully evaluated yet, but is a full time user and had CAP 2 (responds to speech sounds) after 3 months of ABI use. No severe side or unpleasant stimulation effects have been observed so far. There was one case of immediate electrode migration and one case of implant device failure after 6.5 years.

Conclusion: ABI should be considered as an option in the rehabilitation of children with similar diagnoses.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2016
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:uu:diva-275226 (URN)10.1080/14670100.2016.1142693 (DOI)26841821 (PubMedID)
Tillgänglig från: 2016-02-01 Skapad: 2016-02-01 Senast uppdaterad: 2023-07-12Bibliografiskt granskad

Open Access i DiVA

fulltext(1871 kB)2226 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 1871 kBChecksumma SHA-512
e820b91099e4748fb71f99fb9b2526a595e0e569b7381a0c1c9dc312ab985b278ad3d1c6423fd0e842d70d5918f7d476185786a0fbfb9401f0da76485d5ece53
Typ fulltextMimetyp application/pdf

Sök vidare i DiVA

Av författaren/redaktören
Lundin, Karin
Av organisationen
Institutionen för kirurgiska vetenskaper
Medicin och hälsovetenskap

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 2226 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

isbn
urn-nbn

Altmetricpoäng

isbn
urn-nbn
Totalt: 3091 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf