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  • 1.
    Lundin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Experiences from Cochlear Implantation and Auditory Brainstem Implantation in Adults and Children: Electrophysiological Measurements, Hearing Outcomes and Patient Satisfaction2016Doctoral thesis, comprehensive summary (Other academic)
    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.

    List of papers
    1. Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
    Open this publication in new window or tab >>Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness
    2014 (English)In: Audiology & Neurotology Extra, ISSN 1664-5537, Vol. 4, no 2, p. 46-55Article in journal (Refereed) 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.

    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-248579 (URN)DOI:10.1159/000365274 (DOI)
    Available from: 2015-04-01 Created: 2015-04-01 Last updated: 2016-03-22Bibliographically approved
    2. Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
    Open this publication in new window or tab >>Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation
    2015 (English)In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 16, no 5, p. 254-261Article in journal (Refereed) 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.

    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-272679 (URN)10.1179/1754762815Y.0000000005 (DOI)
    Available from: 2016-01-15 Created: 2016-01-15 Last updated: 2019-12-18Bibliographically approved
    3. Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
    Open this publication in new window or tab >>Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden
    Show others...
    2014 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, no 10, p. 1052-1061Article in journal (Refereed) 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.

    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-233250 (URN)10.3109/00016489.2014.909051 (DOI)000342204900011 ()24881643 (PubMedID)
    Note

    De två första författarna delar förstaförfattarskapet.

    Available from: 2014-10-01 Created: 2014-10-01 Last updated: 2017-12-05Bibliographically approved
    4. Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
    Open this publication in new window or tab >>Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)
    2016 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 1, p. 62-67Article in journal (Refereed) 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.

    Keywords
    Auditory brainstem implants; QoL; benefit; NF2
    National Category
    Otorhinolaryngology
    Identifiers
    urn:nbn:se:uu:diva-265777 (URN)10.3109/00016489.2015.1079925 (DOI)000365678800011 ()26426855 (PubMedID)
    Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
    5. Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
    Open this publication in new window or tab >>Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients
    2016 (English)In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628Article in journal (Refereed) Epub ahead of print
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:uu:diva-275226 (URN)
    Available from: 2016-02-01 Created: 2016-02-01 Last updated: 2017-11-30Bibliographically approved
  • 2.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Behr, Robert
    Univ Marburg, Acad Hosp, Klinikum Fulda gAG, Fulda, Germany.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Re-implantation of an auditory brainstem implant (ABI) in a child: A case report2017In: Acta oto-laryngologica case reports, E-ISSN 2377-2484, Vol. 2, no 1, p. 119-124Article in journal (Refereed)
    Abstract [en]

    The study aimed at describing a case of auditory brainstem implant (ABI) paediatric re-implantation performed at the Akademiska University Hospital, Sweden. The patient was a boy with Goldenhar syndrome with absent vestibular-cochlear nerves and was first implanted with an ABI in 2009 at the age of two years. A technical device failure in 2015 led to a re-implantation at the age of nine years. The ABI was successfully re-implanted although the implant was closely attached to the surrounding tissue and difficult to remove. The intraoperative electrical auditory brainstem measures (eABRs) gave unclear responses after re-implantation. After 12 months, the patient's hearing thresholds was not as good as it was after the primary implant, but it is still developing. The child is a full-time user. ABI re-implantation is possible even after many years, although there is a risk that the implant might be fixed to the brainstem and difficult to remove.

  • 3.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Näsvall, Andreas
    Köbler, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Linde, Göran
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Cochlear implantation in the elderly2013In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 14, no 2, p. 92-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To analyse complications and outcome of cochlear implant (CI) treatment in seniors receiving CIs during a 10-year period.

    METHODS:

    A total of 28 patients, 79 years or older (mean age 81.6 years), were evaluated and compared with a younger group of 76 patients, 20-60 years old (mean age 48.9 years). A retrospective study of the patients' records was performed. Data on per- and post-operative complications, pre- and post-operative speech perception, estimated cognitive skills, and social situation was extracted. A subjective score was assessed and correlated with post-operative performance.

    RESULTS:

    No severe per- or post-operative surgical complications were noted. Speech perception improved significantly after surgery (P < 0.001). The younger age group showed better results post-operatively for monosyllabic words (P < 0.01) compared with the older group with no difference seen for bi-syllabic words. In both the groups, there were no significant differences between patients living with or without social support.

    DISCUSSION:

    CI surgery for patients 79 years or older was well tolerated. Patients benefited greatly from the device with improved hearing. CI should not be denied older individuals who are otherwise in good health. Non-use in the elderly was associated with post-operative vertigo and tinnitus, severe disease and limited social support.

  • 4.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Stillesjö, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Nyberg, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Experiences from Auditory Brainstem Implantation (ABI) in four Paediatric Patients2016In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628Article in journal (Refereed)
  • 5.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Stillesjö, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Nyberg, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Self-Reported Benefit, Sound Perception, and Quality-of-Life in Patients with Auditory Brainstem Implants (ABIs)2016In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 1, p. 62-67Article in journal (Refereed)
    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.

  • 6.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Stillesjö, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Experiences and Results from Cochlear Implantation in Patients with Long Duration of Deafness2014In: Audiology & Neurotology Extra, ISSN 1664-5537, Vol. 4, no 2, p. 46-55Article in journal (Refereed)
    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.

  • 7.
    Lundin, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Stillesjö, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Prognostic Value of Electrically Evoked Auditory Brainstem Responses in Cochlear Implantation2015In: Cochlear Implants International, ISSN 1467-0100, E-ISSN 1754-7628, Vol. 16, no 5, p. 254-261Article in journal (Refereed)
    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.

  • 8. Siegbahn, Malin
    et al.
    Lundin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Olsson, Gun-Britt
    Stillesjö, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Kinnefors, Anders
    Rask-Andersen, Helge
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Nyberg, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Auditory Brainstem Implants (ABIs): 20 Years of Clinical Experience in Uppsala, Sweden2014In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 134, no 10, p. 1052-1061Article in journal (Refereed)
    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.

1 - 8 of 8
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