Pisa University Hospital Reaches Milestone in Cochlear Implantation and Hearing Loss Treatment
For over four decades, the Otolaryngology, Audiology and Phoniatrics Operational Unit at Pisa University Hospital (AOUP) has provided comprehensive care for patients with hearing loss, from diagnosis through rehabilitation. The center recently celebrated performing its 1000th cochlear implant, marking a significant achievement in the field of auditory restoration.
A Multidisciplinary Approach to Complex Cases
The AOUP’s approach emphasizes a thorough evaluation and individualized treatment plan for each patient. As Stefano Berrettini, full professor of Otolaryngology and director of the Otolaryngology, Audiology and Phoniatrics Operational Unit, explains, the center relies on a multidisciplinary team including doctors, audiometrists, hearing aid specialists, speech therapists, radiologists and pediatric anesthetists. This collaborative approach is particularly crucial for managing complex cases.
From Single-Channel to Multi-Channel Implants: A Technological Evolution
Cochlear implant technology has advanced significantly since the first single-channel implant was performed at the Pisa ENT Clinic in 1985. These early implants provided limited sound perception without clear speech understanding. The arrival of multi-channel cochlear implants in 1998, utilizing multiple electrodes to stimulate different frequencies along the cochlea, dramatically improved sound quality and speech comprehension. This technology leverages the tonotopic organization of the cochlea, where different regions respond to different frequencies – high notes at the base, middle notes in the middle, and low notes at the apex.
Newborn Screening and Early Diagnosis: Tuscany Leads the Way
Tuscany has been at the forefront of early hearing loss detection, adopting neonatal audiological screening in 2007, several years before it became nationally mandated in 2017. This early diagnosis allows for earlier intervention. In 2010, Tuscany began covering simultaneous bilateral cochlear implants through its National Health Service (NHS), and the first such implant in a 12-month-ancient child was performed that year. Currently, diagnoses are made practically at birth, enabling prosthetic application at three months and cochlear implantation in profoundly deaf children as early as 10-12 months.
Treating a Wide Range of Conditions
The AOUP performs approximately 65-70 cochlear implant procedures annually, equally distributed between pediatric and adult patients. The center also provides ongoing care for approximately 100 patients implanted at other centers. Beyond routine cases, the AOUP has developed expertise in managing challenging conditions such as labyrinth malformations, cochlear ossifications, advanced otosclerosis, and chronic otitis media. Approximately 20% of pediatric patients operated on also have multiple disabilities, requiring a tailored approach in collaboration with the Stella Maris Institute.
Addressing Rare Diseases and Cytomegalovirus
The center also monitors and treats hearing loss resulting from rare diseases like Pendred syndrome, otoferlin mutation, and renal tubular acidosis. Particular attention is given to cytomegalovirus (CMV), a leading cause of congenital deafness. Pisa was among the first globally to integrate CMV testing into newborn screening for infants who fail their initial hearing test, recognizing the risk of progressive hearing loss and the need for early antiviral intervention.
National Guidelines, Research, and International Collaboration
The AOUP has contributed to the development of national guidelines for cochlear implantation. Stefano Berrettini coordinated the first Italian HTA guidelines on cochlear implantation in 2011. More recently, Francesca Forli, associate professor of Audiology at the University of Pisa, co-coordinated updated Italian guidelines published by the Istituto Superiore di Sanità. The center also collaborates with the Cochlear Implant Center of the Karolinska Institutet in Stockholm and maintains an OtoLabil temporal bone dissection laboratory for research and surgical training.
Patient-Centered Care
Since 1998, the Cochlear Implants Group has supported patients throughout the pre- and post-operative process. The center emphasizes a truly multidisciplinary approach to patient care, with ongoing management led by Francesca Forli and Ramona Nicastro, coordinator of speech therapists, alongside a team of doctors including Luca Bruschini, Andrea De Vito, and Francesco Lazzerini, as well as audiometrists and speech therapists. Advances in technology have also reduced the rehabilitation burden, with many children now requiring only periodic check-ups after the initial years of therapy.