Preliminary Outcomes Report for CO2 Laser Assisted Electric-Acoustic Cochlear Implantation.
Otol Neurotol 2018;
39:582-590. [PMID:
29649047 DOI:
10.1097/mao.0000000000001789]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE
Report on the safety/efficacy of a novel, carbon dioxide (CO2) laser-assisted protocol for hearing-preservation cochlear implantation (HPCI) and electric-acoustic stimulation (EAS).
STUDY DESIGN
Retrospective case review.
SETTING
Tertiary referral center.
PATIENTS
Adult patients meeting established criteria for HPCI and EAS.
INTERVENTION
Therapeutic/rehabilitative. A standardized protocol used CO2 laser to achieve meticulous hemostasis and perform cochleostomy was evaluated.
MAIN OUTCOME MEASURES
Audiometric assessments included low-tone pure tone average (LtPTA), consonant-nucleus-consonant (CNC), and AzBio scores. Primary outcomes were low-tone hearing-preservation (LtHP) and EAS usage rates. Secondary outcomes included change in LtPTA, outcomes durability, and the rate/onset/presentation of delayed hearing loss (DHL). Subset analyses stratified data by presenting LtPTA and surgeon experience.
RESULTS
Forty-seven patients and 52 ears were included. Mean follow-up was 20.7 ± 12.6 months. When adjusted for preoperative LtPTA less than 60 dB, the LtHP rate was 77%. This was significantly better than for patients with LtPTA more than 60 dB (24%; p < 0.0001). Outcomes were highly durable. EAS usage was excellent in those with LtPTA less than 60 dB (100%). Nine patients developed DHL. Three additional patients (25%) were successfully salvaged via steroids. Both CNC and AzBio scores improved significantly (p < 0.0001) at definitive testing. Speech-hearing scores did not differ significantly between patients using/not using EAS. The complication rate was 3.8%; none were caused by the laser. Surgeon experience was associated with significantly better outcomes.
CONCLUSION
Use of a CO2 laser-assisted HPCI protocol was safe and effective. Outcomes were consistent with contemporary literature reporting. Patient selection and surgeon experience both significantly impacted outcomes.
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