REVIEWS   

Otorinolaringologia 2004 June;54(2):111-23

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Update on cochlear implantation. A review

Eisen M. D. ¹, Lustig L. R. ²

¹ Department of Otorhinolaryngology University of Pennsylvania Medical Center Philadelphia, Pennsylvania, USA 2 Department of Otolaryngology Johns Hopkins University Medical Center Baltimore, Maryland, USA

Current top­ics and ­issues regard­ing the coch­le­ar ­implant are ­addressed in ­this ­review. The his­to­ry of the ­implant’s ear­ly devel­op­ment is ­first sum­mar­ized. The ­basics of ­implant tech­nol­o­gy, includ­ing ­recent tech­no­log­i­cal advanc­es in the elec­trode ­array and ­speech pro­ces­sors are ­next dis­cussed. The cri­te­ria for ­implant can­di­da­cy and work­up of poten­tial ­implant recip­ients is ­then ­reviewed, includ­ing radio­log­ic eval­u­a­tion. Patients ­with cer­tain oto­log­i­cal and neu­ro­to­log­i­cal co-mor­bid­ities, includ­ing Ménière’s dis­ease and otos­cler­o­sis, chal­lenge the ­implant sur­geon, but do not pre­clude implan­ta­tion. The sur­gery for coch­le­ar implan­ta­tion ­remains pri­mar­i­ly a trans­mas­toid ­facial ­recess ­approach for inser­tion ­through a cochle­os­to­my ­into sca­la tym­pa­ni. In ­patients ­with coch­le­ar mal­for­ma­tions or ­postmen­in­gi­tis coch­le­ar ossifi­ca­tion, adjust­ments in the ­implant sur­gery may be war­rant­ed. Complications of implan­ta­tion ­remain ­rare. Assessing ­implant per­for­mance has clas­si­cal­ly ­relied on behav­ior­al test­ing meth­ods, but objec­tive meas­ure­ments ­have ­been devel­oped to eval­u­ate ­implant func­tion, espe­cial­ly in the young­est ­implant ­patients. These pri­mar­i­ly ­involve elec­tro­phys­io­log­i­cal meas­ure­ments of the electri­cal­ly-­evoked coch­le­ar ­nerve ­response, but ­also ­include func­tion­al imag­ing of cen­tral ner­vous ­system. Recent ­work has ­begun to cor­re­late ­these objec­tive meas­ure­ments ­with behav­ior­al test­ing. Outcome stud­ies of coch­le­ar ­implant ­patient per­for­mance ­with ­tests of ­speech per­cep­tion, lan­guage acqui­si­tion, and ­speech pro­duc­tion indi­cate ­that ­postlin­gual ­adults ­with a ­short peri­od of deaf­ness and the young­est prelin­gual­ly ­deaf ­patients ­have the ­best ­results ­with ­their ­implants. Furthermore, sev­er­al stud­ies indi­cate ­that implan­ta­tion is ­both ­cost-effec­tive to soci­ety and ­improves the qual­ity of ­life of ­deaf ­patients.