Cochlear implantation in the twenty-first century.

C~rrentlY' co~hlear impla~tation is a very excitIng, expandIng, and rapIdly changing field of otology. My opinion and earnest hope is that several new developments will take place in the early twenty-first century. In this article, I focus on the shortversus long-electrode controversy in some detail as it relates to implantation for deafness and then briefly discuss our thoughts and current efforts related to cochlear implantation for the electrical suppression of tinnitus. Let me start with my conclusion, which commonly is viewed as heresy among the orthodox: Patients with single-channel implants can achieve significant open-set speech discrimination. Momentarily, we will discuss the theory and data that support this concept. Clearly, multichannel devices also work. However, as we shall see, they do so at a significant cost to the patient and by that I mean not merely financial. Through the International Center for Otologic Training and my interest in implants, I have developed a close relationship with Bill House. He has an infectious personality and is an ingenious humanitarian who still espouses the single-channel implant theory despite current orthodoxy. I repeatedly read Bill's three monographs [1-3] on the subject, and increasingly they made sense to me. His theory was plausible but, for me, the proof demanded data. So, I committed four trips to Los Angeles to review and study his data but, more importantly, to interview and videotape his patients. Now I briefly will review his theory and supportive data and then will show you videotapes of my interviews with these patients. At the conclusion of this presentation I hope that you will begin to evolve your position on this controversy.