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Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs).Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability.The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost-effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost-effective.Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.
Getting a decent (but sparse) signal to the brain for users of cochlear implants. - Hearing research
The challenge in getting a decent signal to the brain for users of cochlear implants (CIs) is described. A breakthrough occurred in 1989 that later enabled most users to understand conversational speech with their restored hearing alone. Subsequent developments included stimulation in addition to that provided with a unilateral CI, either with electrical stimulation on both sides or with acoustic stimulation in combination with a unilateral CI, the latter for persons with residual hearing at low frequencies in either or both ears. Both types of adjunctive stimulation produced further improvements in performance for substantial fractions of patients. Today, the CI and related hearing prostheses are the standard of care for profoundly deaf persons and ever-increasing indications are now allowing persons with less severe losses to benefit from these marvelous technologies. The steps in achieving the present levels of performance are traced, and some possibilities for further improvements are mentioned. This article is part of a Special Issue entitled
.Copyright Â© 2014 The Author. Published by Elsevier B.V. All rights reserved.
Mexican rice borer (Lepidoptera: Crambidae) injury to corn greater than to sorghum and sugarcane under field conditions. - Journal of economic entomology
The Mexican rice borer, Eoreuma loftini (Dyar) (Lepidoptera: Crambidae), is the key pest of sugarcane (Saccharum spp.) in Texas; it can attack several grassy crop and noncrop host plants and has spread into Louisiana. Through small-plot, commercial field, and pheromone trap experiments, this study demonstrates that the pest uses corn, Zea mays L., more than sugarcane and sorghum, Sorghum bicolor (L.) Moench, but when corn is harvested in late summer, injury to nearby sugarcane strongly increases during the next approximately equal to 2 mo to harvest. Corn was more infested than sugarcane and sorghum in commercial fields regardless of whether sampling occurred on field edges or farther into field interiors. Differences in numbers of infested stalks and in numbers of larval entry holes between field edges and interiors were not detected. We found that Mexican rice borer infestation of corn can cause loss of ears, and lodging, shattering, and complete destruction of maturing stalks. The larger quantities of adult Mexican rice borers captured in pheromone-based traps placed at corn field edges compared with sorghum and sugarcane field edges further indicates that corn is preferred to sugarcane and sorghum. The basis for the pest's attraction to corn and implications to potential range expansion to other U.S. sugarcane-growing regions are discussed.
Cochlear implants matching the prosthesis to the brain and facilitating desired plastic changes in brain function. - Progress in brain research
The cochlear implant (CI) is one of the great success stories of modern medicine. A high level of function is provided for most patients. However, some patients still do not achieve excellent or even good results using the present-day devices. Accumulating evidence is pointing to differences in the processing abilities of the "auditory brain" among patients as a principal contributor to this remaining and still large variability in outcomes. In this chapter, we describe a new approach to the design of CIs that takes these differences into account and thereby may improve outcomes for patients with compromised auditory brains.Copyright Â© 2011 Elsevier B.V. All rights reserved.
Remote programming of cochlear implants: a telecommunications model. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
Evaluate the effectiveness of remote programming for cochlear implants.Retrospective review of the cochlear implant performance for patients who had undergone mapping and programming of their cochlear implant via remote connection through the Internet.Postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for 7 patients who had undergone remote mapping and programming of their cochlear implant were compared with the mean scores of 7 patients who had been programmed by the same audiologist over a 12-month period. Times required for remote and direct programming were also compared. The quality of the Internet connection was assessed using standardized measures. Remote programming was performed via a virtual private network with a separate software program used for video and audio linkage.All 7 patients were programmed successfully via remote connectivity. No untoward patient experiences were encountered. No statistically significant differences could be found in comparing postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for patients who had undergone remote programming versus a similar group of patients who had their cochlear implant programmed directly. Remote programming did not require a significantly longer programming time for the audiologist with these 7 patients.Remote programming of a cochlear implant can be performed safely without any deterioration in the quality of the programming. This ability to remotely program cochlear implant patients gives the potential to extend cochlear implantation to underserved areas in the United States and elsewhere.
An attempt to improve bilateral cochlear implants by increasing the distance between electrodes and providing complementary information to the two ears. - Journal of the American Academy of Audiology
The purpose of this investigation was to determine if adult bilateral cochlear implant recipients could benefit from using a speech processing strategy in which the input spectrum was interleaved among electrodes across the two implants.Two separate experiments were conducted. In both experiments, subjects were tested using a control speech processing strategy and a strategy in which the full input spectrum was filtered so that only the output of half of the filters was audible to one implant, while the output of the alternative filters was audible to the other implant. The filters were interleaved in a way that created alternate frequency "holes" between the two cochlear implants.In experiment one, four subjects were tested on consonant recognition. Results indicated that one of the four subjects performed better with the interleaved strategy, one subject received a binaural advantage with the interleaved strategy that they did not receive with the control strategy, and two subjects showed no decrement in performance when using the interleaved strategy. In the second experiment, 11 subjects were tested on word recognition, sentences in noise, and localization (it should be noted that not all subjects participated in all tests). Results showed that for speech perception testing one subject achieved significantly better scores with the interleaved strategy on all tests, and seven subjects showed a significant improvement with the interleaved strategy on at least one test. Only one subject showed a decrement in performance on all speech perception tests with the interleaved strategy. Out of nine subjects, one subject preferred the sound quality of the interleaved strategy. No one performed better on localization with the interleaved strategy.Data from this study indicate that some adult bilateral cochlear implant recipients can benefit from using a speech processing strategy in which the input spectrum is interleaved among electrodes across the two implants. It is possible that the subjects in this study who showed a significant improvement with the interleaved strategy did so because of less channel interaction; however, this hypothesis was not directly tested.
A summary of the literature on global hearing impairment: current status and priorities for action. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
Hearing loss (HL) and deafness are global issues that affect at least 278 million people worldwide. Two thirds of the people who have HL worldwide live in developing countries. Importantly, it is estimated that 50% of this HL can be prevented. In developing countries, funding for prevention, early detection, and rehabilitative programs is severely limited, and therefore, agencies must compete against priorities to treat life-threatening, pandemic diseases such as human immunodeficiency virus, malaria, and tuberculosis. Delays in diagnosis are common, and social attitudes, local customs, and cultural bias are contributing factors.The purpose of this review is to gain an understanding of the prevalence of HL in the developing world and to focus attention on the growing need for both prevention and effective treatment programs. A second goal is to use this information to suggest priorities and approaches to address these problems worldwide.The data were compiled from a review of the literature on the global impacts of hearing impairment and recently published reports on the prevalence and cause of hearing impairment in developing nations.The high prevalence of HL in the developing world is due to a variety of factors, including lack of widespread comprehensive immunization programs and other medical care, and inadequate funds for intervention once HL is identified. International organizations, governments, and nongovernment organizations have many opportunities to prevent and treat HL through cost-effective means.
Partial deafness cochlear implantation (PDCI) and electric-acoustic stimulation (EAS). - Cochlear implants international
The purposes of this paper are to (1) review briefly the experience to date with combined EAS for patients with some residual, low-frequency hearing; and (2) describe the further results that have been obtained with this combination for patients with higher levels of residual hearing at low frequencies, termed 'PDCI'. In broad terms, PDCI and combined EAS have produced large improvements in the speech reception abilities of the treated patients, compared with preoperative scores or with postoperative scores for electric stimulation only or acoustic stimulation only. The benefits have been especially large for recognition of speech presented in competition with interfering sounds such as speech-spectrum noise. Although PDCI and combined EAS have been established as highly effective procedures, questions remain about optimal combinations of electric and acoustic stimuli; the ideal depth of insertion for the electrode array; whether the ideal depth may vary from patient to patient; and whether the reliability of hearing preservation in an implanted cochlea can be increased beyond the present high levels. The answers to these questions could lead to even better treatments for persons with little or no hearing at high frequencies and at least some remaining hearing at low frequencies.
Cochlear implants: current designs and future possibilities. - Journal of rehabilitation research and development
The cochlear implant is the most successful of all neural prostheses developed to date. It is the most effective prosthesis in terms of restoration of function, and the people who have received a cochlear implant outnumber the recipients of other types of neural prostheses by orders of magnitude. The primary purpose of this article is to provide an overview of contemporary cochlear implants from the perspective of two designers of implant systems. That perspective includes the anatomical situation presented by the deaf cochlea and how the different parts of an implant system (including the user's brain) must work together to produce the best results. In particular, we present the design considerations just mentioned and then describe in detail how the current levels of performance have been achieved. We also describe two recent advances in implant design and performance. In concluding sections, we first present strengths and limitations of present systems and then offer some possibilities for further improvements in this technology. In all, remarkable progress has been made in the development of cochlear implants but much room still remains for improvements, especially for patients presently at the low end of the performance spectrum.
Cochlear implants: a remarkable past and a brilliant future. - Hearing research
The aims of this paper are to (i) provide a brief history of cochlear implants; (ii) present a status report on the current state of implant engineering and the levels of speech understanding enabled by that engineering; (iii) describe limitations of current signal processing strategies; and (iv) suggest new directions for research. With current technology the "average" implant patient, when listening to predictable conversations in quiet, is able to communicate with relative ease. However, in an environment typical of a workplace the average patient has a great deal of difficulty. Patients who are "above average" in terms of speech understanding, can achieve 100% correct scores on the most difficult tests of speech understanding in quiet but also have significant difficulty when signals are presented in noise. The major factors in these outcomes appear to be (i) a loss of low-frequency, fine structure information possibly due to the envelope extraction algorithms common to cochlear implant signal processing; (ii) a limitation in the number of effective channels of stimulation due to overlap in electric fields from electrodes; and (iii) central processing deficits, especially for patients with poor speech understanding. Two recent developments, bilateral implants and combined electric and acoustic stimulation, have promise to remediate some of the difficulties experienced by patients in noise and to reinstate low-frequency fine structure information. If other possibilities are realized, e.g., electrodes that emit drugs to inhibit cell death following trauma and to induce the growth of neurites toward electrodes, then the future is very bright indeed.
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