Methods of Partial Deafness Treatment

Henryk Skarżyński, Piotr H. Skarżyński, Henryk Skarzynski, Piotr H. Skarzynski, Henryk Skarżyński, Piotr H. Skarżyński, Henryk Skarzynski, Piotr H. Skarzynski

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367759605
• eBook ISBN: 9781000399004
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

This book presents the revolutionary approach to the treatment of hearing loss proposed by Professor Henryk Skar?y?ski and developed in collaboration with the group of internationally recognized experts on clinical and experimental otolaryngology, otosurgery, and audiology. The authors present an in-depth look at different aspects of this comprehensive concept of treatment of partial and total deafness with hearing implants, and discuss the approaches to diagnostics and patient selection, results in different groups of patients, the surgical technique, and procedures. This book also covers audiological aspects, auditory training, patient's performance, and psychology.

This book is a comprehensive review of the method of partial and total deafness treatment developed and introduced into clinical practice by Professor Henryk Skar?y?ski. The publication is noteworthy for presenting a multifaceted approach to the subject from related science experts' and clinicians' point of view.

Chapter 1 The strategy of preservation of preoperative hearing and inner ear structures in hearing implant surgery

Henryk Skarżyński

Institute of Physiology and Pathology of Hearing

DOI: 10.1201/9781003164876-1

CONTENTS

1. Introduction
2. Otosurgical method used in the strategy of preserving the preoperative hearing and inner ear structures
3. Conclusions

INTRODUCTION

For a long time, better and better results obtained in the treatment of profound hearing loss and deafness with cochlear implants, especially in younger and younger children, have been an incentive for scientists and clinicians to steadily expand cochlear implantation indications (Blamey et al. 2012). The research was conducted independently in Europe, the USA, and Australia. Initially, it was focused on electric stimulation of one ear with an implant, while the other ear, with slightly better hearing, was aided with a hearing aid. Less often, researchers studied the possibilities of ipsilaterally combined acoustic and electric stimulation (Skarżyński et al. 1997b, 2003, Ilberg Ch. et al. 1999, Gantz et al. 2004).

In 1997, the principles of the minimally invasive surgical technique developed for preserving the preoperative residual hearing in low frequencies were presented at a conference in New York, USA (5th International Cochlear Implant Conference) (Skarżyński et al. 1997b). In 2000, results of the first group of 67 children whose preoperatively nonfunctional residual hearing and inner ear structures have been preserved during implantation were presented at the European ESPCI congress in Antwerp, Belgium (Skarżyński et al. 2000). All these patients had in the same ear acoustic stimulation through a hearing aid in low frequencies and electric stimulation through a cochlear implant in the rest of the frequency range. In 2 to 3 years of follow-up, these children have shown improved and faster development of auditory skills, which confirmed this approach’s utility. In 2000, results of the same application of cochlear implants with preservation of the residual hearing in the first group of adults were presented at the EUFOS congress in Berlin (Lorens et al. 2000).

Subsequently, several-year-long observations of implanted patients with a better and better residual hearing before implantation demonstrated the validity of broadening the accepted cochlear implantation indications to include the electric complementation of hearing entirely normal in frequencies up to 500 Hz (Skarżyński et al. 2002). Electric complementation of normal low-frequency hearing was used for the first time by H. Skarżyński in an adult in 2002 and a child in 2004 (Skarżyński et al. 2003, 2004a).

Extension of cochlear implant indications was based on reported effects of hearing preservation and surgical procedure proposed by Skarżyński et al. (2006). It involves the approach to the tympanic duct through the round window as the most physiological way to insert an electrode into the inner ear and comprises six surgical steps (Skarżyński et al. 2010, 2012b). Longitudinal observation of the growing group of patients, which initially numbered hundreds and presently has overpassed six thousand, indicates the validity of extending indications for cochlear implantation in partial deafness. It has been corroborated by the numerous subsequent reports and presentations of the research material on all continental and global congresses and conferences dedicated to the hearing implants, audiology, and otology organized in recent years. It aimed to systematically present new target groups of patients and preservation of the preoperative hearing in a longer and longer time of follow-up. In recent years, it also involved presenting new technologies regarding the length and flexibility of cochlear implant electrodes and presenting the Polish school in that field of science and medicine.

During the 9th European Symposium on Pediatric Cochlear Implantation ESPCI in Warsaw in 2009, H. Skarżyński presented the new concept of partial deafness treatment that included the surgical procedure, length of electrodes, combination of acoustic and electric stimulation, and preservation of the preoperative hearing and inner ear structures (Skarżyński & Lorens 2010b) (Table 1.1 and Figure 1.1). In 2013, H. Skarżyński and 43 invited experts from all over the world had developed the first classification for the assessment of the results of preservation of preoperative hearing (Skarżyński et al. 2013).

Table 1.1 The newest concept of applying the acoustic and electric stimulation in the treatment of different hearing impairments and partial deafness, according to Skarżyński et al. (2014b)

No.	Groups of patients with partial deafness
1.	Acoustic amplification of hearing with a hearing aid, bone conduction device, or middle ear implant [PDT – acoustic stimulation (PDT-AS)].
2.	Combined natural-electric stimulation: amplification of the preserved efficient hearing up to 1.5 kHz through electric stimulation [PDT – electro-natural stimulation (PDT-ENS)].
3.	Electric complementation of existing good hearing in low frequencies up to 0.5 kHz [PDT – electric complementation (PDT-EC)].
4.	Combined acoustic-electric stimulation with acoustic amplification of the preserved residual hearing in low and mid-frequencies with a hearing aid or a duet/hybrid system, and electric stimulation of the remaining part of the same ear [PDT – electric-acoustic stimulation (PDT-EAS)].
5.	Only electric stimulation in the case of an existing but nonfunctional residual hearing on different frequencies with preservation of inner ear structures [PDT – electric stimulation (PDT-ES)].

Figure 1.1 Comparison of stimulation ranges: acoustic (hearing aid or middle ear/bone conduction implant), electric (cochlear implant), and natural hearing, according to Skarżyński et al. (2010).

The results of more than six thousand operated patients corroborate the strategy of preservation of preoperative hearing. All implantations with different cochlear implants were performed using the six-step procedure to preserve the existing structure of the inner ear (Skarżyński et al. 2003, 2010, 2012b). Alongside the development of the surgical method and steady extension of indications for cochlear implantation in a larger and larger group of patients, the subsequent milestones were related to the impact of these actions on the development of new technologies, such as very flexible cochlear implant electrodes of different length (Skarżyński & Podskarbi-Fayette 2010, Skarżyński et al. 2012b, 2014a, Skarżyński P.H. et al. 2019). A new element of the development of that strategy was a modification of a limited electric stimulation with the electrodes of the length between 19–20 mm and 24, 25, and 28 mm as the complementation of a typical hearing preserved at 0.25, 0.5, 0.75, 1, and 1.5 kHz (Skarżyński et al. 2011, Skarżyński P.H. et al. 2019).

The crucially important step in developing the concept of partial deafness treatment was elaborating the previously mentioned, first in the world classification of partial deafness, according to Skarżyński et al. (2010). It is essential for continued study of the results of homogenous groups of patients with different levels of preserved preoperative hearing after cochlear implantation. The results obtained in various homogenous groups of patients presented by different authors and involving applying different technological solutions should be followed and form the basis for further extension of indications and popularization of the partial deafness treatment method. It has a significant effect on the development and application of new technologies in managing postoperative care, e.g., the creation of telemedical networks and the application of telefitting in everyday patient service. The satisfaction of patients and their families with the results of treatment of partial deafness in the World Hearing Center of the Institute of Physiology and Pathology of Hearing (WHC) and the subsequent growing interest in that method had the decided impact on the decision to expand the infrastructure of the WHC.

In recapitulation, it should be underlined that modern therapy can be developed to use acoustic stimulation with a middle ear implant or a bone conduction implant in many such situations. It is possible in some patients in the whole frequency range, but there are groups of patients where it is not because a small part of the ear, e.g., above 3 or 4 kHz, is deaf. For that reason, the PDT-AS (partial deafness treatment – acoustic stimulation) group has been included in the whole concept of treatment of different levels of partial deafness, but only with the application of acoustic stimulation. Indeed, continued longitudinal observation of good preservation of preoperative hearing up to 1.5 kHz should enable a further extension of cochlear implantation criteria, with hearing preserved in a broader range. It may be crucial to eliminate or reduce tinnitus’s sensation caused by hearing loss over 2 and 3 kHz.

Twenty-three years has passed since the first surgeries of patients with preserved preoperative hearing in 1997. Since that time, the PDT strategy has been used in more than 5 thousand patients from 9 months to 84 years of age. In that group, children and youths up to 18 years constituted 37.2% and adults 62.8%. In children older than 5 years and adults, the preoperative hearing threshold was determined with audiometry. In younger children, the preoperative hearing threshold was tested with the ABR (auditory brainstem response) performed for 0.5, 1, 2, and 4 kHz. It should be underlined that the two most important groups were patients with normal or fully socially efficient hearing up to 500 Hz, 750 kHz, or 1,500 Hz – PDT-EC⁵⁰⁰, PDT-EC⁷⁵⁰, and PDT-ENS. These three groups of patients who need only electric complementation of the existing hearing are the most challenging for the surgeon. Still, at the same time, they are apt to obtain the best and fastest effects in posto...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Editors
• Contributors
• 1 The strategy of preservation of preoperative hearing and inner ear structures in hearing implant surgery
• 2 Audiological aspects of the partial deafness cochlear implantation with hearing preservation
• 3 Intraoperative monitoring of hearing preservation with ECochG in treatment of partial deafness
• 4 Genetic biomarkers of neuroplasticity in the treatment of children with prelingual deafness with cochlear implantation
• 5 Otosurgical techniques in the application of various auditory implants
• 6 Hearing preservation classification according to Skarżyński et al. (2013)
• 7 Review of clinical material presented during demonstration surgeries
• 8 Role of the pharmacology (glucocorticoids) in hearing preservation in the partial deafness treatment (PDT)
• 9 Otoneurological aspects of cochlear implantation in partial and total deafness
• 10 The utility of the functional magnetic resonance imaging for assessment of brain functions in patients with partial deafness
• 11 Audiological rehabilitation in the partial deafness treatment program strategy – eliminating participation limitations
• 12 Auditory development and speech perception in children after partial deafness cochlear implantation
• 13 Understanding the partial deafness – different perspectives: subjective, auditory perception and communication, psychological, and social
• 14 Evaluation of partial deafness patients by means of auditory evoked potentials, otoacoustic emissions, and wideband tympanometry
• 15 Auditory cortex, partial hearing loss, and cochlear implants: selected observations and comments
• Bibliography
• Index