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The efficiency of patient's rehabilitation after bilateral cochlear implantation
Goykhburg M. , Bakhshinyan V. , Chugunova T. , Zherenkova V. , Tavartkiladze G.
National Research Centre for Audiology and Hearing Rehabilitation, Moscow, Russian Federation
Aim: To evaluate the efficiency of rehabilitation process after bilateral cochlear implantation (CI).
Methods: The subject pool contained 33 patients who were implanted in the Center in 2011-2013. 9 patients
were bilaterally implanted simultaneously, 5 of them were after reimplantation of the 1st ear and implantation of
the 2 one. 24 patients were after sequential bilateral CI, the period between 2 surgeries was less than 1 year in
14 patients and more than 1 year in 10 patients. At the time of cochlear implantation 23 patients were in the age
from 1 to 3 years, 8 - from 4 to 16 years. 2 patients were adults. In our assessment we used the free field (FF)
tonal audiometry and the FF speech audiometry. Patients were also tested by speech therapist.
Results: During the switch-on of the speech processor after the 1st surgery all patients were able to hear
sounds of musical toys at the distance of about 3 m according to the speech therapist's examination. During the
switch-on of the 2nd speech processor (after the 2nd surgery) they were also able to hear conversational speech
in addition to sounds of musical toys both at the distance of 5 m. After 7 months of using 2 speech processors
those patients who had sequential CI during the period of less than 1 year had good speech and whisper
recognition at the distance of 6 m. Those patients who were implanted after 1 year from the 1 surgery achieved
the similar results only after 1 year of using 2 speech processors. During the switch-on of the speech processors
after the simultaneous CI all patients had perceptions of the sound of the musical toys at the distance of 3 m and
right after 3 months had good speech recognition in situation of limited choice. It should be noted that during the
switch-on of the speech processors in the patients, who underwent simultaneous reimplantation of the 1 ear
and implantation of the 2 ear, the reactions in the reimplanted ear were better than in newly implanted ear.
Speech and whisper recognition had appeared after 3 months of using CI-system. The FF tonal audiometry was
performed in all patients, and all of them were classified as patients with the mild hearing loss (26-40dB).The FF
sound perception thresholds in bilaterally implanted patients with 2 active speech processors were significantly
better than those who used 1 active speech processor. Binaural summation was found in all cases. The FF
speech audiometry was performed in adult patients. Their Speech Discrimination Scores (SDS) at the
presentation level of 45-55 dB was about 100%. At the level of 25 dB SDS deteriorated abruptly.
Conclusions: The decreasing of the time frame between the 2 surgeries provides the reduction of the hearing
perception differences between 2 ears and improved sound localization. According to the FF tonal audiometry
the binaural summation was confirmed. The results were better in the earlier implanted ear despite of the lack of
auditory nerve stimulation in case of reimplantations.