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Hearing Disorders: HELP
Articles by John Thomas Roland
Based on 33 articles published since 2009
(Why 33 articles?)
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Between 2009 and 2019, J. T. Roland wrote the following 33 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Cochlear implantation in late childhood and adolescence: is there such a thing as 'too late'? 2012

Heman-Ackah, Selena E / Roland, J Thomas / Waltzman, Susan B. · ·Expert Rev Med Devices · Pubmed #22702249.

ABSTRACT: -- No abstract --

2 Editorial Cochlear implants: an evolving technology. 2012

Roland, J Thomas / Haynes, David S. · ·Otolaryngol Clin North Am · Pubmed #22115693.

ABSTRACT: -- No abstract --

3 Review Toward hearing preservation in cochlear implant surgery. 2014

Huarte, Raquel M / Roland, John T. ·aDepartment of Otolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Navarra, Spain bDepartment of Otolaryngology-Head and Neck Surgery, New York University Cochlear Implant Center, New York University School of Medicine, New York, USA. ·Curr Opin Otolaryngol Head Neck Surg · Pubmed #25101938.

ABSTRACT: PURPOSE OF REVIEW: To summarize the recent medical literature related to the feasibility of hearing preservation after cochlear implantation and to identify variables that may influence hearing preservation in the implanted ear as well as the hearing perception outcomes. RECENT FINDINGS: The published data provide evidence that hearing preservation in the implanted ear yields significantly higher levels of speech recognition in complex listening environments than having just monaural acoustic hearing. There is ample evidence that hearing preservation is feasible and the reported rate is 50-89% in the low frequencies. This rate tends to be stable over time, except for a small percentage that diminishes around 3 months of follow-up. However, factors or variables which influence hearing preservation are yet unknown. Variables such as patient age, degree of residual hearing, insertion depth, insertion speed, duration of profound high frequency deafness and electrode design have been proposed. SUMMARY: Much attention has been focused on hearing preservation in the implanted ear. Thus, investigations into electrode array design, surgical technique and pharmacological management have been undertaken. Minimizing damage in the inner ear not only enhances the possibility for hearing preservation and better performance in complex listening scenarios but also conserves inner ear structures for future treatments.

4 Review Implanting obstructed and malformed cochleae. 2012

Coelho, Daniel H / Roland, J Thomas. ·Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University Cochlear Implant Center, Virginia Commonwealth University School of Medicine, PO Box 980146, Richmond, VA 23298-0146, USA. dcoelho@mcvh-vcu.edu ·Otolaryngol Clin North Am · Pubmed #22115684.

ABSTRACT: Implantation of the ossified and dysplastic cochlea presents many unique challenges to both the surgeon and programming team. Altered embryology and physiology of these labyrinthine dysplasias may result in forms and functions unfamiliar to those casually involved with cochlear implants. Remarkable developments in diagnosis, surgical technique, electrode design, processing strategies, and programming have all contributed to the ability to successfully implant patient populations previously excluded from this life-changing intervention.

5 Review Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria. 2012

Heman-Ackah, Selena E / Roland, J Thomas / Haynes, David S / Waltzman, Susan B. ·Department of Otolaryngology, New York University Cochlear Implant Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA. ·Otolaryngol Clin North Am · Pubmed #22115681.

ABSTRACT: Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.

6 Review Extracochlear electrode extrusion. 2011

Vaid, Neelam / Roland, J Thomas / Vaid, Sanjay. ·BIG EARS, KEM Hospital, Pune, India. vaids@vsnl.com ·Cochlear Implants Int · Pubmed #21917207.

ABSTRACT: Extracochlear electrode extrusion is a potentially under-recognized complication of cochlear implantation. As the age of implantation becomes younger, electrode extrusion is of concern due to future skull growth. Extrusion of several electrodes may compromise performance and thus require surgical reinsertion of the electrodes. Almost 60% of patients with electrode extrusion have required revision surgery. This paper presents a case report and literature review which discusses factors which contribute to electrode extrusion and emphasizes the need for a high degree of suspicion in certain situations. Surgical steps such as electrode fixation techniques are highlighted in order to attempt to reduce the occurrence of this complication.

7 Review Cochlear implantation in the very young child: issues unique to the under-1 population. 2010

Cosetti, Maura / Roland, J Thomas. ·New York University, New York, NY, USA. ·Trends Amplif · Pubmed #20483813.

ABSTRACT: Since the advent of cochlear implantation, candidacy criteria have slowly broadened to include increasingly younger patients. Spurred by evidence demonstrating both perioperative safety and significantly increased speech and language benefit with early auditory intervention, children younger than 12 months of age are now being successfully implanted at many centers. This review highlights the unique challenges involved in cochlear implantation in the very young child, specifically diagnosis and certainty of testing, anesthetic risk, surgical technique, intraoperative testing and postoperative programming, long-term safety, development of receptive and expressive language, and outcomes of speech perception. Overall, the current body of literature indicates that cochlear implantation prior to 1 year of age is both safe and efficacious.

8 Article Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss. 2018

Roland, J Thomas / Gantz, Bruce J / Waltzman, Susan B / Parkinson, Aaron J. ·Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York. · Department of Otolaryngology-Head and Neck Surgery, the University of Iowa, Iowa City, Iowa. · Cochlear Americas, Centennial, Colorado, U.S.A. ·Laryngoscope · Pubmed #29330858.

ABSTRACT: OBJECTIVE: To demonstrate the long-term benefits of implantation in patients with high-frequency sensorineural hearing loss, this report provides 5-year follow-up on a group of implant recipients who were subjects of the Cochlear™ Nucleus METHODS: The results of three related clinical studies were compiled to provide outcome data after 1, 3, and 5 years of implant use in a group of subjects who presented with preoperative high-frequency hearing loss and were implanted with a Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant. A subset of the 50 adult subjects (N = 32) who participated in the Hybrid L24 pivotal Investigational Device Exemption (IDE) completed comprehensive evaluations at 12 months postactivation, 3 years postactivation, and then as part of a postapproval study at 5 years postactivation. Testing included audiometric, speech perception, and subjective satisfaction measures. RESULTS: Mean unilateral speech perception performance was significantly improved at all postoperative intervals compared to preoperative best-aided results and has remained stable to 5 years postactivation. Ninety-four percent of subjects had measurable hearing, and 72% continued to use electric-acoustic stimulation in the implanted ear after 5 years of implant use. Subjective satisfaction results support objective performance improvements. CONCLUSION: Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation. Benefits include speech perception abilities significantly better than those in the preoperative best-aided condition, with additional benefit in those using electric-acoustic stimulation in the implanted ear. LEVEL OF EVIDENCE: 2b. Laryngoscope, 1939-1945, 2018.

9 Article Cochlear implantation under conscious sedation with local anesthesia; Safety, Efficacy, Costs, and Satisfaction. 2017

Shabashev, Samion / Fouad, Yasser / Huncke, T Kate / Roland, J Thomas. ·a NYU Department of Anesthesiology, Perioperative Care, and Pain Medicine , NYU Langone Medical Center , New York , NY , USA. · b Otlaryngology Department, Faculty of Medicine , Zagazig University , Zagazig , Egypt. · c Department of Otolaryngology-Head and Neck Surgery , NYU Langone Medical Center , New York , NY , USA. ·Cochlear Implants Int · Pubmed #28934019.

ABSTRACT: OBJECTIVE: To evaluate the safety, efficiency, cost effectiveness, and satisfaction of patients undergoing cochlear implantation under conscious sedation versus general anesthesia. STUDY DESIGN: Retrospective case review of 20 patients who underwent cochlear implantation under conscious sedation which was compared to 20 age-matched patients where surgery was performed under general anesthesia. METHODS: Perioperative times, length of stay, anesthesia drug costs, postoperative complications, and patient satisfaction were compared between the two groups. RESULTS: Conscious sedation was associated with decreased drug costs, surgery time, and anesthesia time. Length of stay was significantly longer for patients undergoing general anesthesia. Patient satisfaction was superior with conscious sedation. Perioperative morbidity was not significantly different between the two groups. CONCLUSION: Conscious sedation for cochlear implantation is a safe, efficient, and cost-effective alternative to general anesthesia. The efficacy of conscious sedation for cochlear implant surgery may expand the treatment of profound hearing loss to the elderly who are deemed too sick for general anesthesia or are fearful of the cognitive or medical consequences of general anesthesia.

10 Article Performance Plateau in Prelingually and Postlingually Deafened Adult Cochlear Implant Recipients. 2017

Cusumano, Cristen / Friedmann, David R / Fang, Yixin / Wang, Binhuan / Roland, J Thomas / Waltzman, Susan B. ·*Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx †Department of Otolaryngology-Head and Neck Surgery ‡Department of Population Health, NYU School of Medicine, New York, New York. ·Otol Neurotol · Pubmed #28166183.

ABSTRACT: OBJECTIVE: To characterize the performance plateau after unilateral cochlear implantation (CI) in prelingually and postlingually deafened adults and to compare their relative progress. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Prelingually and postlingually deaf adults who received a unilateral CI and completed a minimum of 2 years of follow-up at our center. INTERVENTION: Unilateral CI. MAIN OUTCOME MEASURES: Standard speech perception testing (consonant-nucleus-consonant [CNC] monosyllabic word test and hearing in noise test [HINT] or AzBio sentence test) were performed preoperatively and 3 and 12 months postoperatively, and annually thereafter. RESULTS: In postlingually deaf patients (n = 102), there was a significant improvement in word scores for 3 years postimplantation (p < 0.01). Beyond the 3 years postoperative time point, word scores continued to improve, albeit at a flatter rate. In prelingually deaf patients (n = 16) word scores improved significantly for 5 years postimplantation (p = 0.03). CONCLUSIONS: Adults with postlingual deafness undergoing unilateral CI show significant improvement in speech perception for 3 years postimplantation, at which point their performance continues to improve, albeit at a flatter rate. The performance of adults with prelingual deafness improves significantly as late as 5 years postimplantation. These time intervals reflect a change to the currently reported 6 to 12 months period and should impact on counseling, especially in the prelingual CI candidate.

11 Article A physiological and behavioral system for hearing restoration with cochlear implants. 2016

King, Julia / Shehu, Ina / Roland, J Thomas / Svirsky, Mario A / Froemke, Robert C. ·Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York; · Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Biology, Hunter College, New York, New York; and. · Department of Otolaryngology, New York University School of Medicine, New York, New York; · Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York; Center for Neural Science, New York University, New York, New York. *, co-senior authors. · Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, New York; Neuroscience Institute, New York University School of Medicine, New York, New York; Department of Otolaryngology, New York University School of Medicine, New York, New York; Department of Neuroscience and Physiology, New York University School of Medicine, New York, New York; Center for Neural Science, New York University, New York, New York. *, co-senior authors. Robert.Froemke@med.nyu.edu. ·J Neurophysiol · Pubmed #27281743.

ABSTRACT: Cochlear implants are neuroprosthetic devices that provide hearing to deaf patients, although outcomes are highly variable even with prolonged training and use. The central auditory system must process cochlear implant signals, but it is unclear how neural circuits adapt-or fail to adapt-to such inputs. The knowledge of these mechanisms is required for development of next-generation neuroprosthetics that interface with existing neural circuits and enable synaptic plasticity to improve perceptual outcomes. Here, we describe a new system for cochlear implant insertion, stimulation, and behavioral training in rats. Animals were first ensured to have significant hearing loss via physiological and behavioral criteria. We developed a surgical approach for multichannel (2- or 8-channel) array insertion, comparable with implantation procedures and depth in humans. Peripheral and cortical responses to stimulation were used to program the implant objectively. Animals fitted with implants learned to use them for an auditory-dependent task that assesses frequency detection and recognition in a background of environmentally and self-generated noise and ceased responding appropriately to sounds when the implant was temporarily inactivated. This physiologically calibrated and behaviorally validated system provides a powerful opportunity to study the neural basis of neuroprosthetic device use and plasticity.

12 Article Neurocognitive testing and cochlear implantation: insights into performance in older adults. 2016

Cosetti, Maura K / Pinkston, James B / Flores, Jose M / Friedmann, David R / Jones, Callie B / Roland, J Thomas / Waltzman, Susan B. ·Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA; Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA. · Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA. · Department of Otolaryngology, New York University School of Medicine, New York, NY, USA. · Department of Otolaryngology, New York University School of Medicine, New York, NY, USA; Department of Neurosurgery, New York University School of Medicine, New York, NY, USA. ·Clin Interv Aging · Pubmed #27274210.

ABSTRACT: OBJECTIVE: The aim of this case series was to assess the impact of auditory rehabilitation with cochlear implantation on the cognitive function of elderly patients over time. DESIGN: This is a longitudinal case series of prospective data assessing neurocognitive function and speech perception in an elderly cohort pre- and post-implantation. SETTING: University cochlear implant center. PARTICIPANTS: The patients were post-lingually deafened elderly female (mean, 73.6 years; SD, 5.82; range, 67-81 years) cochlear implant recipients (n=7). MEASUREMENTS: A neurocognitive battery of 20 tests assessing intellectual function, learning, short- and long-term memory, verbal fluency, attention, mental flexibility, and processing speed was performed prior to and 2-4.1 years (mean, 3.7) after cochlear implant (CI). Speech perception testing using Consonant-Nucleus-Consonant words was performed prior to implantation and at regular intervals postoperatively. Individual and aggregate differences in cognitive function pre- and post-CI were estimated. Logistic regression with cluster adjustment was used to estimate the association (%improvement or %decline) between speech understanding and years from implantation at 1 year, 2 years, and 3 years post-CI. RESULTS: Improvements after CI were observed in 14 (70%) of all subtests administered. Declines occurred in five (25%) subtests. In 55 individual tests (43%), post-CI performance improved compared to a patient's own performance before implantation. Of these, nine (45%) showed moderate or pronounced improvement. Overall, improvements were largest in the verbal and memory domains. Logistic regression demonstrated a significant relationship between speech perception and cognitive function over time. Five neurocognitive tests were predictive of improved speech perception following implantation. CONCLUSION: Comprehensive neurocognitive testing of elderly women demonstrated areas of improvement in cognitive function and auditory perception following cochlear implantation. Multiple neurocognitive tests were strongly associated with current speech perception measures. While these data shed light on the complex relationship between hearing and cognition by showing that CI may slow the expected age-related cognitive decline, further research is needed to examine the impact of hearing rehabilitation on cognitive decline.

13 Article Single-sided Deafness Cochlear Implantation: Candidacy, Evaluation, and Outcomes in Children and Adults. 2016

Friedmann, David R / Ahmed, Omar H / McMenomey, Sean O / Shapiro, William H / Waltzman, Susan B / Roland, J Thomas. ·Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, NY, U.S.A. ·Otol Neurotol · Pubmed #26756150.

ABSTRACT: OBJECTIVES: Although there are various available treatment options for unilateral severe-to-profound hearing loss, these options do not provide the benefits of binaural hearing since sound is directed from the poorer ear to the better ear. The purpose of this investigation was to review our center's experience with cochlear implantation in such patients in providing improved auditory benefits and useful binaural hearing. STUDY DESIGN: Retrospective chart review. METHODS: Twelve adult patients and four pediatric patients with unilateral severe-to-profound hearing loss received an implant in the poorer ear. Outcome measures performed preoperatively on each ear and binaurally included consonant-nucleus-consonant (CNC) monosyllabic words and sentences in noise. The mean pure-tune average in the better ear was within normal range. RESULTS: Test scores revealed a significant improvement in CNC and sentence in noise test scores from the preoperative to most recent postoperative evaluation in the isolated implant ear. All adult subjects use the device full-time. CONCLUSIONS: The data reveal significant improvement in speech perception performance in quiet and in noise in patients with single-sided deafness after implantation. Performance might depend on factors including length of hearing loss, age at implantation, and device usage.

14 Article United States multicenter clinical trial of the cochlear nucleus hybrid implant system. 2016

Roland, J Thomas / Gantz, Bruce J / Waltzman, Susan B / Parkinson, Aaron J / Anonymous4370835. ·Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York. · Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa. · University of Washington Medical Center, Seattle, Washington, U.S.A. ·Laryngoscope · Pubmed #26152811.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the safety and efficacy of acoustic and electric sound processing for individuals with significant residual low-frequency hearing and severe-to-profound high-frequency sensorineural hearing loss. STUDY DESIGN: Prospective, single-arm repeated measures, single-subject design. METHODS: Fifty individuals, ≥ 18 years old, with low-frequency hearing and severe high-frequency loss were implanted with the Cochlear Nucleus Hybrid L24 implant at 10 investigational sites. Preoperatively, subjects demonstrated consonant-nucleus-consonant word scores of 10% through 60% in the ear to be implanted. Subjects were assessed prospectively, preoperatively, and postoperatively on coprimary endpoints of consonant-nucleus-consonant words, AzBio sentences in noise, and self-assessment measures. RESULTS: Significant mean improvements were observed for coprimary endpoints: consonant-nucleus-consonant words (35.8 percentage points) and AzBio sentences in noise (32.0 percentage points), both at P < 0.001. Ninety-six percent of subjects performed equal or better on speech in quiet and 90% in noise. Eighty-two percent of subjects showed improved performance on speech in quiet and 74% in noise. Self-assessments were positive, corroborating speech perception results. CONCLUSION: The Nucleus Hybrid System provides significant improvements in speech intelligibility in quiet and noise for individuals with severe high-frequency loss and some low-frequency hearing. This device expands indications to hearing-impaired individuals who perform poorly with amplification due to bilateral high-frequency hearing loss and who previously were not implant candidates.

15 Article Recurrent cochlear implant infection treated with exteriorization and partial mastoid obliteration. 2016

Tawfik, Kareem O / Golub, Justin S / Roland, J Thomas / Samy, Ravi N. · ·Cochlear Implants Int · Pubmed #25955509.

ABSTRACT: OBJECTIVE AND IMPORTANCE: Preoperative chronic otitis media (COM) is a risk factor for postoperative infection after cochlear implantation (CI), but its management varies by surgeon. Our case highlights a strategy for implant preservation in a patient with a history of recurrent cochlear implant infection. CLINICAL PRESENTATION: A 70-year-old woman with a history of chronic lymphocytic leukemia presented in 2005 with bilateral COM and sensorineural hearing loss meeting CI candidacy. Four months after left mastoid obliteration with abdominal fat graft and external auditory canal closure, a left CI was placed. Subsequent postauricular cellulitis resolved with oral antibiotics. A similar two-stage CI was performed on the right without complication. During the following year, numerous left-sided infections and fluid collections developed but were treated unsuccessfully with intravenous (IV) antibiotics and operative debridement. With concern for biofilm colonization, the implant was explanted and the electrode left in the cochlea. After reimplantation in 2010, infections resumed despite long-term IV antibiotics and incision and drainage. Intervention and technique In 2012, the left mastoid cavity was exteriorized and converted to standard canal wall-down anatomy. Bone pâté was placed over the electrode, followed by cadaveric acellular dermis and a split-thickness skin graft. After more than 2 years, her better-performing CI remains infection-free. CONCLUSION: After 6 years of postoperative infections unresponsive to aggressive medical management, surgical interventions, and period of device removal, our patient's infections resolved after mastoid exteriorization and multilayered protection of the electrode. This strategy may enable implant preservation in patients with recurrent post-CI infection in an obliterated cavity.

16 Article A case report: the first successful cochlear implant in Uganda. 2015

Byaruhanga, Richard / Roland, J Thomas / Buname, Gustav / Kakande, Emily / Awubwa, Michael / Ndorelire, Chris / Namwagala, Justine. ·Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. · Department of Otolaryngology, Professor and Chair, New York University School of Medicine. ·Afr Health Sci · Pubmed #26958040.

ABSTRACT: Hearing impairment is a significant disability. According to the World Health Organization (WHO), more than 80% of the world's approximately 120 million people with hearing impairment live in developing countries. Cochlear implant is the only therapeutic intervention for those with severe-profound sensorineural hearing loss. We are reporting an interesting case of the very first cochlear implant operation carried out in Uganda. The patient was a 23 year old male whose presenting complaint was inability to hear in the left ear for three and a half years and in the right ear for one year. He had been treated for TB(Tuberculosis) mastoiditis. After the 8 months of treatment, the otorrhea persisted and he underwent a tympanomastoidectomy on the same ear. He reported no familial history of hearing loss. On examination, ENT examination revealed a small pars flaccida retration pocket of the right tympanic membrane with cholesteatoma. The left ear had an intact tympanic membrane. Pure tone audiometry revealed profound sensorineural hearing loss in both ears (see attached PTA results), CT scan of the temporal bone showed normal inner ear anatomy bilaterally and mild sclerotic changes in both mastoid bones. He then had surgery on his right ear which included cochlear implantation. The cochlear implant (CI) was activated on the first postoperative day remotely via internet with the help of the cochlear implant team at New York University Cochlear Implant Center and the patient was immediately able to appreciate some sounds. He received a pneumococcal vaccine on the first postoperative day and was discharged the following day.

17 Article Surgical techniques and outcomes of cochlear implantation in patients with radiographic findings consistent with X-linked deafness. 2015

Cosetti, Maura K / Friedmann, David R / Heman-Ackah, Selena E / Perez, Ronen / Waltzman, Susan B / Roland, J Thomas. ·Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Louisiana State University, Shreveport, LA, USA. Electronic address: mcoset@lsuhsc.edu. · Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA. · Division of Otolaryngology, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA. · Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel. ·Int J Pediatr Otorhinolaryngol · Pubmed #26250436.

ABSTRACT: OBJECTIVES: X-linked deafness is a potential etiology of sensorineural hearing loss characterized by bulbous dilatation of the fundus of the internal auditory canal (IAC) and the absence of the bony plates separating the basal turn of the cochlea and IAC. These malformations predispose patients to IAC insertion during cochlear implantation (CI). Our objective is to describe the surgical technique, audiometric and speech performance outcomes in a group of patients with this unique cochlear malformation. METHODS: A retrospective chart review was performed of all patients at a tertiary care facility who underwent CI between January 2006 and July 2011. RESULTS: A total of five patients were identified with radiographic findings characteristic of X-linked deafness, specifically a deficient modiolous, absent lamina cribrosa and bulbous IAC. A modified cochleostomy was utilized to ensure electrode insertion within the scala tympani avoiding the IAC. In each case, fluoroscopy was utilized to visual electrode progression during insertion and complete insertion was accomplished. All patients demonstrated improved speech performance following implantation. CONCLUSIONS: Utilizing the techniques described, patients with these unique radiographic findings consistent with X-linked deafness may successfully undergo CI with excellent potential for auditory rehabilitation.

18 Article Sequential bilateral cochlear implantation in the adolescent population. 2015

Friedmann, David R / Green, Janet / Fang, Yixin / Ensor, Kelsey / Roland, J Thomas / Waltzman, Susan B. ·Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, New York, U.S.A. · Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, U.S.A. ·Laryngoscope · Pubmed #25946482.

ABSTRACT: OBJECTIVES: To examine the variables affecting outcomes for sequential bilateral cochlear implantation patients in the adolescent population. STUDY DESIGN: Retrospective chart review at tertiary care center. METHODS: Main outcome measures were open set speech recognition tests at the word (Consonant-Nucleus-Consonant/Phonetically Balanced Kindergarten List Test [CNC/PBK]) and sentence levels in noise (Hearing in Noise Test-Noise [HINT-N]) in different test conditions with respect to the age at first and sequential implantation, as well as the interval between implants. RESULTS: Despite a mean age at sequential implantation of 13.5 years, sequential bilateral implanted adolescents revealed significant improvement in the sequential cochlear implant (CI2) ear. The mean time interval between implants was 8.2 years. A wide range of performance was noted, and age at implantation and interval between first cochlear implant (CI1) and CI2 did not predict outcome. Mean CNC/PBK score with CI1 alone was 83.0%, with the CI2 alone was 56.5%, and with bilateral implants was 86.8%. Sentence scores (HINT-N) were 89.5% for CI1, 74.2% for CI2, and 94.4% for bilateral CI condition. The clinical relevance of these enhanced perception abilities requires attention to individual device use, performance with the first implant, and subjective benefits reported by patients. CONCLUSIONS: Bilateral sequential cochlear implantation leads to improved speech perception in the adolescent population and should be considered in this population, even after a long period of deafness and despite a prolonged interval between implants. Numerous factors affect the ability to predict performance, but age at implantation and interimplant interval were not correlated with performance measures. Extensive preoperative counseling and individualized evaluation are critical to ensure that patients and families understand the range of possible outcomes. LEVEL OF EVIDENCE: 4

19 Article Effects of loss of residual hearing on speech performance with the CI422 and the Hybrid-L electrode. 2015

Friedmann, David R / Peng, Robert / Fang, Yixin / McMenomey, Sean O / Roland, J Thomas / Waltzman, Susan B. · ·Cochlear Implants Int · Pubmed #25912363.

ABSTRACT: OBJECTIVE: Preservation of residual low-frequency hearing has become a priority in cochlear implantation. The purpose of this study was to compare rates of hearing preservation and effects on performance of loss of low-frequency acoustic hearing with two different length electrodes. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary Care Hospital. PATIENTS: Twelve patients were implanted with the CI422 a slim-straight electrode; the second group consisted of 10 patients implanted with the Hybrid-L, a shorter hearing preservation electrode. MAIN OUTCOME MEASURE: Audiometric thresholds and speech perception measures. RESULTS: At 1 year, 3/10 (30%) patients with the Hybrid-L and 7/12 (58%) patients with the CI422 lost residual acoustic hearing resulting in a profound hearing loss in the implanted ear. In comparing these patients in particular, mean CNC words in the implanted ear were 72% in the CI422 electrode group and 15% in the Hybrid-L electrode group at 1 year (P = 0.03). While hearing preservation rates with the Hybrid-L tended to be better, among recipients who lost residual hearing, speech perception was better in those with the longer CI422 electrode. CONCLUSIONS: With emphasis on preservation of residual hearing, patients need to be counseled regarding possible outcomes and options should loss of residual hearing occur following implantation. While shorter electrodes may have better rates of hearing preservation, the patients with the longer straight electrode in our study had significantly better speech understanding following the loss of residual hearing.

20 Article The Relationship Between Insertion Angles, Default Frequency Allocations, and Spiral Ganglion Place Pitch in Cochlear Implants. 2015

Landsberger, David M / Svrakic, Maja / Roland, J Thomas / Svirsky, Mario. ·Department of Otolaryngology, New York University School of Medicine, New York, USA. ·Ear Hear · Pubmed #25860624.

ABSTRACT: OBJECTIVES: Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hertz, but the electrode arrays are not designed to reach the most apical regions of the cochlea, which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal-hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States. DESIGN: The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from X-ray. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer's default frequency-to-electrode allocation. RESULTS: Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e., the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models. CONCLUSIONS: A mismatch was observed between the predicted frequency and the default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.

21 Article Expanded pediatric cochlear implant candidacy. 2015

Roland, J Thomas / Waltzman, Susan B. ·NYU Langone Medical Center, Otolaryngology, New York, New York, USA John.Roland@nyumc.org. · NYU Langone Medical Center, Otolaryngology, New York, New York, USA. ·Otolaryngol Head Neck Surg · Pubmed #25833926.

ABSTRACT: -- No abstract --

22 Article Reduced Cochlear Implant Performance After the Use of Growth Hormone With Regain of Function After Cessation of Growth Hormone Therapy. 2015

Lafer, Marissa P / Green, Janet E / Heman-Ackah, Selena E / Roland, J Thomas / Waltzman, Susan B. ·*NYU Cochlear Implant Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York; and †Otology, Neurotology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A. ·Otol Neurotol · Pubmed #25730449.

ABSTRACT: OBJECTIVE: To assess whether recombinant growth factor (hGH) therapy has an effect on cochlear implant (CI) performance. PATIENTS: Two pediatric CI recipients (S1, S2) who underwent treatment with hGH for short stature were identified for review. S1 has bilateral labyrinthine dysplasia and received implants at ages 10 months (right) and 4 years 3 months (left). S2 was diagnosed with severe to progressive sensorineural hearing loss bilaterally and received a CI at age 9 years 10 months (left). INTERVENTION(S): Case series. MAIN OUTCOME MEASURE(S): Cochlear implant, hGH, and speech perception data were collected. Phonetically Balanced Kindergarten (PBK) and Consonant Nucleus Consonant (CNC) word recognition scores were reviewed to assess auditory perception. Electrode impedances, threshold levels, and comfort levels were also reviewed. RESULTS: After 4 months of hGH, word recognition scores for S1 were observed to decrease from 90 to 72% (right) and were stable at 40% (left). Despite troubleshooting, performance continued to decline bilaterally to 52% (right) and 28% (left), and the decision was made to discontinue hGH. One month after cessation of hGH, word recognition scores began improving to 74% (right) and 68% (left). Word recognition scores for S2 were observed to have decreased from 92% the previous year to 82% after taking hGH for 2 months. Given both our previous experience with S1 and discussions with S2's parents, hGH was discontinued after 10 months of therapy. Two months after cessation of hGH, S2's word recognition had improved to 86% (left). CONCLUSIONS: Our case studies illustrate that implanted children undergoing treatment with hGH may experience a decrease in speech perception, which recovers after the cessation of treatment. Since hGH use has become more prevalent in recent years, it is important to inquire whether children undergoing, or who have undergone, implantation are receiving hGH so that they may be appropriately monitored.

23 Article An abnormal audiogram. 2015

Paul, Benjamin C / Roland, J Thomas. ·Department of Otolaryngology-Head and Neck Surgery, New York University Langone Medical Center, New York, New York. ·JAMA · Pubmed #25562271.

ABSTRACT: -- No abstract --

24 Article Revision cochlear implantation following internal auditory canal insertion. 2013

Heman-Ackah, Selena E / Friedmann, David R / Cosetti, Maura K / Waltzman, Susan B / Roland, J Thomas. ·Department of Otolaryngology, New York University School of Medicine, New York, New York, U.S.A. ·Laryngoscope · Pubmed #24114888.

ABSTRACT: OBJECTIVES/HYPOTHESIS: In pediatric patients with congenital malformations of the inner ear, anomalies within the anatomy may facilitate unintentional insertion of the cochlear implant electrode into the internal auditory canal. Revision procedures for removal and replacement of cochlear implant electrodes following internal auditory canal insertion are fraught with potential danger, including the theoretical risk of injury to vasculature within the internal auditory canal, repeat insertion within the internal auditory canal, and cerebrospinal fluid leak. The objective of this presentation is to describe a technique for revision cochlear implantation following internal auditory canal insertion to minimize the potential associated risks. STUDY DESIGN: Case series. METHODS: A retrospective chart review was performed on all patients at a tertiary care facility who underwent revision cochlear implantation for internal auditory canal insertion between January 1999 and July 2011. RESULTS: A total of four patients referred from outside institutions have undergone revision cochlear implantation for internal auditory canal insertion. The records from these patients were reviewed. Electrodes were safely removed in all cases without injury to the anterior inferior cerebellar artery or its branches (i.e., labyrinthine artery). Complete insertion was accomplished on reimplantation. Neural response telemetry was performed in all cases, and responses were noted. Fluoroscopy was utilized to visualize electrode progression during insertion. A detailed description of the operative technique is provided. CONCLUSIONS: This case series describes a technique for revision cochlear implantation that appears to be safe and effective in preventing potential associated complications.

25 Article The effects of residual hearing in traditional cochlear implant candidates after implantation with a conventional electrode. 2013

Cosetti, Maura K / Friedmann, David R / Zhu, Bovey Z / Heman-Ackah, Selena E / Fang, Yixin / Keller, Robert G / Shapiro, William H / Roland, J Thomas / Waltzman, Susan B. ·Department of Otolaryngology, New York University School of Medicine, New York, NY 10016, USA. ·Otol Neurotol · Pubmed #23449440.

ABSTRACT: OBJECTIVE: To analyze the effects of residual hearing on postoperative speech performance in traditional cochlear implant (CI) patients implanted with a conventional electrode. STUDY DESIGN: Retrospective review. SETTING: Academic tertiary referral center. PATIENTS: A total of 129 adults implanted by a single surgeon at a tertiary care facility between June 2005 and November 2010 with measurable preoperative pure tone thresholds at any frequency were included. INTERVENTION: Cochlear implantation with a conventional electrode via an anterior inferior cochleostomy. MAIN OUTCOME MEASURE: Speech perception using monosyllabic word scores in quiet and sentences in quiet and noise in the electric (CI-only) condition of the implanted ear. Preservation of hearing was defined as complete for postoperative thresholds within 10 dB of preimplant values and partial if greater than 11 dB. Pure tone audiometry and speech perception testing were performed preoperatively and at regular intervals postoperatively, with the 1-year evaluation being the final outcome period. RESULTS: Preservation at any frequency or level was not a factor in speech perception outcome, although preservation was more common in low frequencies. Hearing preservation was correlated with younger age at implantation, but was not related to length of hearing loss, cause of deafness, device type, sex, preoperative speech performance, or low-frequency pure-tone average. CONCLUSION: Hearing can be preserved in traditional CI patients implanted with a conventional electrode. Although preservation of hearing may have implications for future technology, it is not currently correlated with speech performance in the CI-only condition.

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