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From the Editor In this issue of the CNI REVIEW, our authors describe how technology, surgical expertise, intensive therapy and an understanding of the underlying causes of deafness have coalesced into the miraculous: bringing functional hearing to the deaf and preserving hearing in those who once had no hope of keeping it. Cochlear implantation has been described as a miracle of modern medicine. It represents the first time in history that surgery has restored one of the primary senses. Combining a surgically placed internal implant with an externally worn speech processor, this technology provides much more than simple awareness of sound: truly useful hearing is produced in the majority of recipients suffering significant deafness. David Kelsall describes how advances in device technology, patient selection and rehabilitation methods over the past 25 years translate to remarkable (some would say miraculous) benefit to thousands of patients. Nancy Caleffe-Schenk’s article introduces the reader to Auditory-Verbal therapy, utilized with children who are deaf or hard of hearing since the 1950’s. Now, combined with cochlear implantation, Auditory-Verbal therapy has gained broad acceptance in the medical, educational and therapeutic professions. The basic premise of the Auditory-Verbal approach is that language and speech are learned through listening. Using this intensive therapy method, children with cochlear implants can now acquire spoken language commensurate with their chronological age. Integration into the hearing world is the expected outcome. In adults, the small “benign” tumors called acoustic neuromas are a frequent cause of deafness. In the past, surgical removal or radiation treatment of the tumor nearly always resulted in a deaf ear, and often in paralysis of the face. J.D. Day describes how advancements in the treatment of these tumors have resulted in relatively high rates of hearing preservation and facial nerve function. Patients can now be offered a treatment strategy that may include bservation, microsurgical removal, or stereotactic radiosurgery (such as Gamma Knife), alone or in combination. Dr. Day’s personal series of acoustic neuroma patients managed surgically over a 5-year period is compared to current results obtained with stereotactic radiosurgery utilizing the Gamma Knife. Working together, using a rational algorithm with multiple options for treatment, doctors at the Colorado Neurologic Institute can offer significantly improved outcomes for people with this type of tumor. Joseph Hegarty elucidates one of the primary underlying causes of deafness in children. Genetically determined deafness may occur in isolation (non-syndromic deafness) or with multiple other features (syndromic deafness). A genetic defect in connexin-26, a protein present in the inner ear, is thought responsible for nearly half of cases of non-syndromic deafness. Syndromic deafness, although less common, is more often recognized because of other systemic anomalies that can be spotted early in a child’s life. Knowing the underlying cause of deafness can help physicians select the most appropriate treatment strategies. Twenty-three centuries ago, Cleanthes wrote, “…and you, Fate, wherever you have assigned me, I shall follow without hesitation; but even if I am disobedient and do not wish to, I shall follow no less surely.” There is much we still cannot change, but as we read this issue of the CNI REVIEW, fate seems to have loosened its grip a little. John H. McVicker, MD, FACS To view the articles: This issue of the CNI REVIEW is provided in Adobe Acrobat PDF format. You can right-click to download the PDF file to your computer, or click to open and read online. Or click on each title below to open a smaller PDF file containing only the article's pages.
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CNI REVIEW Library · CNI PublicationsColorado Neurological Institute (CNI),
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In
the fifth century BC, Sophocles illustrated how irrevocable Fate spurns
humanity’s attempts at self-determination by showing us a once-proud Oedipus
Rex blinded and humiliated by his own hand. The loss of one of the primary
senses has forever been a terrifying, irreversible event, separating and
insulating people from the world around them. Similarly, the gift of restored
hearing for a deaf person has never been other than a matter of miracle.
In the last decade, this miracle of preserved or restored hearing has
instead become a matter of medicine. 
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