[Cochlear implant--current questions].

Basing on the results obtained with 63 patients stimulated via the extracochlear or intracochlear version of the Vienna Cochlea Implant the following topics are discussed: Extracochlear versus intracochlear stimulation. Cochlea Implants in small children. Preoperative signs regarding the final result. Ideas for evaluation of results. Extracochlear or intracochlear stimulation enables speech understanding in about one-half of the postlingual deaf patients but the extent of speech recognition is greater when intracochlearly stimulated. Long-term follow-up as well as our experience with patients who had to be reimplanted demonstrate that the implantation manoevre does not create clinically relevant signs of damage. After the experiences with cochlear implants in adults their use in small children was encouraged, the more so since electric stimulation of prelingual deaf adults does not mediate speech recognition. There seems to be a chance to achieve speech comprehension if electric stimulation starts very early. The age limit in our group is the end of the third year. Final results cannot be presented but it is very clear that acoustic orientation and verbalisation are created and enhanced by electric stimulation. With regard to the preoperative prognosis, three parameters (threshold, dynamic range and TDL) are valid, of which TDL seems to be of major importance. The evaluation of the results should follow the hierarchical organisation of the language and must consider the three main levels of speech organisation.