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      Facial nerve stimulation after cochlear implantation: our experience Translated title: La stimolazione del nervo facciale dopo la procedura di impianto cocleare: la nostra esperienza

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          SUMMARY

          Post-implantation facial nerve stimulation is one of the best known and most frequent complications of the cochlear implant procedure. Some conditions, such as otosclerosis and cochlear malformations, as well as high stimulation levels that may be necessary in patients with long auditory deprivation, expose patients to a higher risk of developing post-implant facial nerve stimulation. Facial nerve stimulation can frequently be resolved with minimal changes in speech processor fitting but, in some cases, this can lead to a reduction in the outcome. A retrospective review has been made of the clinical features of 11 patients (out of 119 patients consecutively implanted, from 1999 to 2007, at the ENT Clinic of the University of Pisa) who developed post-implantation facial nerve stimulation.

          RIASSUNTO

          La stimolazione del nervo facciale è una delle complicanze più comuni e meglio conosciute della procedura di impianto cocleare. Alcune condizioni come l'otosclerosi, le malformazioni cocleari ma anche gli elevati livelli di stimolazione, che possono essere necessari in pazienti con lunga deprivazione uditiva, sottopongono i pazienti ad un maggior rischio di sviluppare la stimolazione del nervo facciale. Questa può essere trattata mediante minime modifiche nel fitting post-operatorio con talvolta una riduzione delle performance uditive. In questo articolo abbiamo analizzato retrospettivamente le caratteristiche cliniche di 11 pazienti (su un gruppo di 119 impiantati dal 1999 al 2007 presso la Clinica ORL dell'Università di Pisa) che hanno sviluppato la stimolazione del nervo facciale.

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          Cochlear implantation in children with anomalous cochleovestibular anatomy.

          To evaluate outcomes after cochlear implantation in children with anomalous cochleovestibular anatomy, a review of radiological classification, surgical implantation, and outcome of 103 children with such anomalies was performed. The hypothesis was that children with anomalous cochleovestibular anatomy would have poorer outcomes and therefore be poorer candidates as a result of their diminished ability to interpolate and use auditory information delivered through a cochlear implant. A series of studies was carried out to review the cochleovestibular anomalies among 298 children implanted over the decade ending in January 2002. Children were grouped based on cochleovestibular anatomy as follows: normal (n = 195), common cavity deformity (n = 8), hypoplastic cochlea (n = 16), incomplete partition (n = 42), and vestibular aqueduct enlargement (n = 37). Concomitant anomalies of the posterior labyrinth (n = 26) and internal auditory canal/cochlear canal (n = 11) were also identified. Findings at surgery, postoperative speech perception outcomes, and speech processor programmability were examined as a function of cochleovestibular anatomy. A database containing demographics (age at implant, duration of implant use), audiological characteristics, pure-tone average, surgical findings (cerebrospinal fluid leak/perilymph leak, abnormal facial nerve anatomy), speech perception data (from two closed-set and three open-set tests), and data relating to speech processor programmability were used for analysis. Electrically evoked auditory brainstem response was measured in 94 of the children (2 cases of common cavity deformity, 7 of hypoplastic cochlea; 10 of incomplete partition; and 12 of vestibular aqueduct enlargement). Response morphological findings were assessed by visual inspection of the waveforms. Data were analyzed using analyses of variance with post hoc testing using the Bonferroni multiple-comparisons test. To further assess differences in outcomes between different categories of cochleovestibular anomalies, linear regression analyses were performed. The significance level was set at P < .05. The use of high-resolution imaging techniques resulted in the detection of a cochleovestibular anomaly in 35% of implanted ears. Implantation was more challenging in 24% of the children as a result of abnormal middle ear anatomy (17.5%) or cerebrospinal fluid leak/perilymph leak (6.7%). There was no significant difference in speech perception scores in children with anomalous cochleae compared with children with normal cochleovestibular anatomy. Children with narrowing of the internal auditory canal/cochlear canal performed more poorly than all other groups. Children with common cavity deformity and hypoplastic cochlea had reduced dynamic range and increased incidence of facial simulation and were judged to be more difficult to program despite the fact that no fewer electrodes were inserted. Children with common cavity deformity and hypoplastic cochlea tended to require wider pulse widths more often than children in other groups, and these requirements were associated with abnormal morphological findings on evoked auditory brainstem response testing. The authors have been continuing to assess the candidacy of each child applying for cochlear implantation individually, and the results of present study have suggested that the presence of anomalous cochleovestibular anatomy, with the exception of narrowing of the internal auditory canal/cochlear canal, should not play a significant role in candidacy assessment. Children with narrow internal auditory canal/cochlear canal should be carefully and individually considered. In children with anomalous cochleovestibular anatomy, the potentially increased difficulty in the establishment of optimal stimulation levels and the higher potential for surgical difficulty must be weighed in candidacy decisions but do not universally preclude successful implantation and a good outcome.
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            Cochlear implant soft failures consensus development conference statement.

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              Complications of cochlear implant surgery.

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                Author and article information

                Journal
                Acta Otorhinolaryngol Ital
                Pacini
                Acta Otorhinolaryngologica Italica
                Pacini Editore SpA
                0392-100X
                1827-675X
                February 2011
                : 31
                : 1
                : 11-16
                Affiliations
                Otology and Cochlear Implant Unit, University-Hospital of Pisa, Cisanello, Italy
                Author notes
                Address for correspondence: Prof. S. Berrettini, Divisione di Otorinolaringoiatria, Audiologia e Foniatria, Università di Pisa, Cisanello, Via Paradisa 2, 56124 Pisa, Italy. Fax: +39 050 997500. E-mail: s.berrettini@ 123456med.unipi.it
                Article
                Pacini
                3146332
                21808458
                dee8262f-2b50-40fd-8b37-4f759eac0878
                © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

                History
                : 07 December 2010
                : 07 January 2011
                Categories
                Otology

                Otolaryngology
                facial nerve,cochlear implants,otosclerosis
                Otolaryngology
                facial nerve, cochlear implants, otosclerosis

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