20 Jahre bilaterale Cochleaimplantation – eine Analyse seither implantierter erwachsener Patienten

Zusammenfassung

Binaurales Hören ist Voraussetzung für die Lokalisationsfähigkeit und verbessert das Hören im Störgeräusch. Die bilaterale Cochleaimplantation wird seit 20 Jahren zur Wiederherstellung des binauralen Hörens eingesetzt. In einer Querschnittsstudie wurden 103 der 165 in Würzburg zwischen 1995 und Juni 2014 bilateral implantierten erwachsenen Patienten bezüglich ihres Sprachverständnisses in Ruhe (Freiburger Einsilber, Hochmair-Schulz-Moser (HSM)-Satztest, jeweils bei 70 dB) und im Störgeräusch (HSM Test, Signal/Rausch-Abstand 10 dB) untersucht. Es zeigte sich, dass bei fast der Hälfte der Patienten die zweite implantierte Seite das bessere Sprachverständnis aufwies. Im Vergleich zur ersten Seite stieg das Einsilberverständnis bilateral im Mittel von 54 auf 63% und das Satzverständnis von 86 auf 96% in Ruhe. Im Störgeräusch stieg das Satzverständnis von 47 auf 65%. Das Sprachverständnis der zweiten Seite war vom Zeitintervall zwischen der Implantation beider Seiten in dem hier untersuchten postlingual ertaubten Kollektiv unabhängig. Die Querschnittsdaten unterstreichen die Bedeutung der bilateralen Cochleaimplantation für die Verbesserung des Sprachverstehens in Ruhe und mehr noch im Störschall und damit für die Verbesserung in alltäglichen Situationen. Die bilaterale Implantation sollte daher zum anerkannten Standard der Patienten-versorgung werden.

Abstract

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

Schlüsselwörter

Cochleaimplantation - bilateral - binaural - Richtungshören - Störgeräusch

Key words

cochlear implantation - spatial hearing - hearing in noise - bilateral - binaural

• Literatur

• 1 Aronoff JM, Yoon YS, Freed DJ, Vermiglio AJ, Pal I, Soli SD. The use of interaural time and level difference cues by bilateral cochlear implant users. The Journal of the Acoustical Society of America 2010; 127: EL87-EL92
• 2 Litovsky RY, Jones GL, Agrawal S, Van Hoesel R. Effect of age at onset of deafness on binaural sensitivity in electric hearing in humans. The Journal of the Acoustical Society of America 2010; 127: 400-414
• 3 Schön F, Müller J, Helms J. Speech reception thresholds obtained in a symmetrical four-loudspeaker arrangement from bilateral users of MED-EL cochlear implants. Otology & Neurotology 2002; 23: 710-714
• 4 Müller J, Schön F, Helms J. Speech understanding in quiet and noise in bilateral users of the MED-EL COMBI 40/40+ cochlear implant system. Ear and hearing 2002; 23: 198-206
• 5 Balkany T, Boggess W, Dinner B. Binaural cochlear implantation: comparison of 3 M/House and Nucleus 22 devices with evidence of sensory integration. Laryngoscope 1988; 98: 1040-1043
• 6 Johnsson LG, House WF, Linthicum FH. Bilateral cochlear implants: histological findings in a pair of temporal bones. Laryngoscope 1979; 89: 759-762
• 7 Pelizzone M, Kasper A, Hari R, Karhu J, Montandon P. Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear. Acta Otolaryngol 1991; 111: 263-268
• 8 van Hoesel RJ, Tong YC, Hollow RD, Clark GM. Psychophysical and speech perception studies: a case report on a binaural cochlear implant subject. The Journal of the Acoustical Society of America 1993; 94: 3178-3189
• 9 Blamey P, Artieres F, Baskent D, Bergeron F, Beynon A, Burke E, Dillier R, Fraysse B, Gallégo S, Govaerts PJ, Green K, Huber AM, Kleine-Punte A, Maat B, Marx M, Mawman D, Mosnier I, O‘Connor AF, O‘Lear S, Rousset A, Schauwers K, Skarzynski H, Skarzynski PH, Sterkers O, Terranti A, Truy E, Van de Heyning P, Venail F, Vincent C, Lazard DS. Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants: an update with 2251 patients. Audiol Neurootol 2013; 18: 36-47
• 10 Litovsky R, Parkinson A, Arcaroli J, Sammeth C. Simultaneous bilateral cochlear implantation in adults: a multicenter clinical study. Ear and hearing 2006; 27: 714-731
• 11 Gifford RH, Driscoll CL, Davis TJ, Fiebig P, Micco A, Dorman MF. A Within-Subject Comparison of Bimodal Hearing, Bilateral Cochlear Implantation, and Bilateral Cochlear Implantation With Bilateral Hearing Preservation: High-Performing Patients. Otology & Neurotology 2015; 36: 1331-1337
• 12 Smulders YE, van Zon A, Stegeman I, Rinia AB, Van Zanten GA, Stokroos RJ, Hendrice N, Free RH, Maat B, Frijns JH, Briaire JJ, Mylanus EA, Huinck WJ, Smith AL, Topsakal V, Tange RA, Grolman W. Comparison of Bilateral and Unilateral Cochlear Implantation in Adults: A Randomized Clinical Trial. JAMA otolaryngology–head & neck surgery 2016; DOI: 10.1001/jamaoto.2015.3305.
• 13 Litovsky RY, Parkinson A, Arcaroli J. Spatial hearing and speech intelligibility in bilateral cochlear implant users. Ear and hearing 2009; 30: 419-431
• 14 Buss E, Pillsbury HC, Buchman CA, Pillsbury CH, Clark MS, Haynes DS, Labadie RF, Amberg S, Ronald PS, Kruger P, Novak MA, Wirth JA, Black JM, Peters R, Lake J, Wackym PA, Firszt JB, Wilson BS, Lawson DT, Schatzer R, D‘Haese PS, Barco AL. Multicenter U. S. bilateral MED-EL cochlear implantation study: speech perception over the first year of use. Ear and hearing 2008; 29: 20-32
• 15 Laszig R, Aschendorff A, Stecker M, Müller-Deile J, Maune S, Dillier N, Weber B, Hey M, Begall K, Lenarz T, Battmer RD, Böhm M, Steffens T, Strutz J, Linder T, Probst R, Allum J, Westhofen M, Doering W. Benefits of bilateral electrical stimulation with the nucleus cochlear implant in adults: 6-month postoperative results. Otology & Neurotology 2004; 25: 958-968
• 16 Schnabl J, Bumann B, Rehbein M, Müller O, Seidler H, Wolf-Magele A, Sprinzl G, Windfuhr J, Weichbold V. Höranstrengung bei Cochlea-Implantaten. Einseitige versus beidseitige Versorgung. Hno 2015; 63: 546-551
• 17 Hughes KC, Galvin KL. Measuring listening effort expended by adolescents and young adults with unilateral or bilateral cochlear implants or normal hearing. Cochlear implants international 2013; 14: 121-129
• 18 Gordon KA, Papsin BC. Benefits of short interimplant delays in children receiving bilateral cochlear implants. Otology & Neurotology 2009; 30: 319-331
• 19 Graham J, Vickers D, Eyles J, Brinton J, Al Malky G, Aleksy S, Martin J, Henderson L, Mawman D, Robinson P, Midgley E, Hanvey K, Twomey T, Johnson S, Vanat Z, Broxholme C, McAnallen C, Allen A, Bray M. Bilateral sequential cochlear implantation in the congenitally deaf child: evidence to support the concept of a “critical age” after which the second ear is less likely to provide an adequate level of speech perception on its own. Cochlear implants international 2009; 10: 119-141