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Asfour L, Risi F, Treaba C, Kirk J, Roland Thomas J. Evaluation of a Slim Modiolar Electrode Array: A Temporal Bone Study. Otol Neurotol 2024; 45:870-877. [PMID: 39142309 DOI: 10.1097/mao.0000000000004253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
HYPOTHESIS Evaluation of the Slim Modiolar (SM) electrode in temporal bones (TB) will elucidate the electrode's insertion outcomes. BACKGROUND The SM electrode was designed for atraumatic insertion into the scala tympani, for ideal perimodiolar positioning and with a smaller caliber to minimize interference with cochlear biological processes. METHODS The SM electrode was inserted into TBs via a cochleostomy. First, the axial force of insertion was measured. Next, TBs were inserted under fluoroscopy to study insertion dynamics, followed by histologic evaluation of electrode placement and cochlear trauma. A subset of TBs were inserted with the Contour Advance (CA) electrode for comparison. RESULTS Sixteen of 22 insertions performed to measure the axial force of insertion had flat or near zero insertion force profiles. Six insertions had increased insertion forces, which were attributed to improper sheath depth before electrode insertion. Under real-time fluoroscopy, 23 of 25 TBs had uneventful insertion and good perimodiolar placement. There was 1 scala vestibuli insertion due to suboptimal cochleostomy position and 1 tip roll over related to premature electrode deployment. When compared with the CA electrode, 14 of 15 insertions with the SM electrode resulted in a more perimodiolar electrode position. No evidence of trauma was found in histologic evaluation of the 24 TBs with scala tympani insertions. CONCLUSION TB evaluation revealed that the SM electrode exerts minimal insertion forces on cochlear structures, produces no histologic evidence of trauma, and reliably assumes the perimodiolar position. Nonstandard cochleostomy location, improper sheath insertion depth, or premature deployment of the electrode may lead to suboptimal outcomes.
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Affiliation(s)
- Leena Asfour
- Department of Otolaryngology, New York University School of Medicine, New York, U.S.A
| | | | | | | | - J Roland Thomas
- Department of Otolaryngology, New York University School of Medicine, New York, U.S.A
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Meuser M, Schwitzer S, Thiele M, Boyle P, Ernst A, Basta D. Intra-Cochlear Electrode Position Impacts the Preservation of Residual Hearing in an Animal Model of Cochlear Implant Surgery. Audiol Neurootol 2024:1-11. [PMID: 38981457 DOI: 10.1159/000540266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/07/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Preservation of residual hearing after cochlear implantation remains challenging. There are several approaches to preserve residual hearing, but the configuration of the implant electrode array seems to play a major role. Lateral wall electrode arrays are seemingly more favorable in this context. To date, there are no experimental data available which correlate the spatial electrode position in the scala tympani with the extent of hearing preservation. METHODS Based on micro-computed tomography (µCT) imaging data, this study analyses the exact position of a pure silicone electrode array inserted into the cochlea of four guinea pigs. Array position data were correlated with the extent of hearing loss after implantation, measured using auditory brainstem measurements in the frequency range of the area occupied by the electrode array area as well as apical to the array. RESULTS The use of pure silicone arrays without electrodes resulted in artifact-free, high-resolution µCT images that allowed precise determination of the arrays' positions within the scala tympani. The electrode arrays' locations ranged from peri-modiolar to an anti-modiolar. These revealed a correlation of a lower postoperative hearing loss with a higher spatial proximity to the lateral wall. This correlation was found in the low-frequency range only. A significant correlation between the inter-individual differences in the diameter of the scala tympani and the postoperative hearing loss could not be observed. CONCLUSION This study demonstrates the importance of the intra-cochlear electrode array's position for the preservation of residual hearing. The advantage of such an electrode array's position approximated to the lateral wall suggests, at least for this type of electrode array applied in the guinea pig, it would be advantageous in the preservation of residual hearing for the apical part of the cochlea, beyond the area occupied by the electrode array.
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Affiliation(s)
- Max Meuser
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Susanne Schwitzer
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Mario Thiele
- Julius Wolff Institute, Center for Musculoskeletal Biomechanics and Regeneration, Charité Medical School, University of Berlin, Berlin, Germany
| | - Patrick Boyle
- Advanced Bionics GmbH, European Research Centre, Hanover, Germany
| | - Arne Ernst
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Dietmar Basta
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
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Thompson NJ, Dillon MT, Nix EP, Overton AB, Selleck AM, Dedmon MM, Brown KD. Variables Affecting Cochlear Implant Performance After Loss of Residual Hearing. Laryngoscope 2024; 134:1868-1873. [PMID: 37767794 DOI: 10.1002/lary.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Determine variables that influence post-activation performance for cochlear implant (CI) recipients who lost low-frequency acoustic hearing. METHODS A retrospective review evaluated CNC word recognition for adults with normal to moderately severe low-frequency hearing (preoperative unaided thresholds of ≤70 dB HL at 250 Hz) who were implanted between 2012 and 2021 at a tertiary academic center, lost functional acoustic hearing, and were fit with a CI-alone device. Performance scores were queried from the 1, 3, 6, 12, and 24-month post-activation visits. A linear mixed model evaluated the effects of age at implantation, array length (long vs. mid/short), and preoperative low-frequency hearing (normal to mild, moderate, and moderately severe) on speech recognition with a CI alone. RESULTS 113 patients met the inclusion criteria. There was a significant main effect of interval (p < 0.001), indicating improved word recognition post-activation despite loss of residual hearing. There were significant main effects of age (p = 0.029) and array length (p = 0.038), with no effect of preoperative low-frequency hearing (p = 0.171). There was a significant 2-way interaction between age and array length (p = 0.018), indicating that older adults with mid/short arrays performed more poorly than younger adults with long lateral wall arrays when functional acoustic hearing was lost. CONCLUSION CI recipients with preoperative functional low-frequency hearing experience a significant improvement in speech recognition with a CI alone as compared to preoperative performance-despite the loss of low-frequency hearing. Age and electrode array length may play a role in post-activation performance. These data have implications for the preoperative counseling and device selection for hearing preservation candidates. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1868-1873, 2024.
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Affiliation(s)
- Nicholas J Thompson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Margaret T Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Evan P Nix
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Andrea B Overton
- Audiology Department, UNC Health, Chapel Hill, North Carolina, U.S.A
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Matthew M Dedmon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Beck R, Aschendorff A, Arndt S, Hildenbrand T, Rauch AK, Ketterer MC. Evaluation of insertion quality of a slim perimodiolar electrode array. Eur Arch Otorhinolaryngol 2024; 281:1215-1220. [PMID: 37773530 PMCID: PMC10858093 DOI: 10.1007/s00405-023-08212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The influence of cochlear morphology and electrode array design on scalar position and dislocation rates is of great interest in CI surgery. The aim of this study is to evaluate scalar position and specific points of dislocation in relation to cochlear morphology in patients implanted with a new slim perimodiolar electrode array. MATERIALS AND METHODS Patients were implanted using the slim modiolar electrode array (= SMA) (= 532/632 electrode array of Cochlear™). Postoperative imaging was performed via cone beam computed tomography (CBCT) and the scans were analyzed regarding cochlear morphology (distances A and B and cochlear height), scalar location of the electrode array, basal insertion depth and apical insertion angle. Furthermore, electrode array design and surgical protocols were evaluated. RESULTS 81 ears implanted with the SMA were retrospectively included. We evaluated 3 electrode array tip fold over intraoperatively via X-ray imaging and performed revision during the same surgery. The CBCT scans showed 76 initial scala tympani (ST) insertions without dislocation. Two ears showed a dislocated array, one at 77° and the other at 163°. Three arrays were inserted into scala vestibuli (SV) via cochleostomy. These patients showed no signs of obliteration. Cochlear morphology showed no influence on angular insertion depth and scalar position. CONCLUSIONS The SMA showed a very low rate of scalar dislocations due to its slim electrode array design (2.7%). We could find a learning curve regarding the handling and the risk of dislocation and tip fold over with this electrode array. The rate of intraoperative tip fold over detection via X-ray imaging was 3.7%. Therefore, we highly recommend X-ray imaging and transimpedance matrix measurements within the surgery protocol. Scala vestibuli insertions happened in patients with cochleostomy only. We could identify two specific points of dislocation depending on electrode array design.
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Affiliation(s)
- R Beck
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Aschendorff
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - S Arndt
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - T Hildenbrand
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A K Rauch
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - M C Ketterer
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
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Höing B, Eichler T, Juelly V, Meyer M, Jung L, Waschkies L, Lang S, Arweiler-Harbeck D. Digital live imaging of intraoperative electrocochleography during cochlear implantation: the first 50 patients. Eur Arch Otorhinolaryngol 2024; 281:1175-1183. [PMID: 37646794 PMCID: PMC10858150 DOI: 10.1007/s00405-023-08197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. MATERIAL AND METHODS Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon's field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. RESULTS Mean insertion time was significantly longer in the picture-in-picture group (p = 0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group (p = 0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p = n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). DISCUSSION This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.
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Affiliation(s)
- Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Theda Eichler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Viktoria Juelly
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Moritz Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Lea Jung
- Cochlear Implant Rehabilitation Centre Ruhr (CIC), Essen, Germany
| | - Laura Waschkies
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Sipari S, Iso-Mustajärvi M, Linder P, Dietz A. Insertion Results and Hearing Outcomes of a Slim Lateral Wall Electrode. J Int Adv Otol 2024; 20:1-7. [PMID: 38454281 PMCID: PMC10895868 DOI: 10.5152/iao.2024.22962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/14/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The clinical outcomes of cochlear implantation vary for several reasons. It is necessary to study the different electrodes and variables for further development. The aim of this study is to report the clinical outcomes of a new slim lateral wall electrode (SlimJ). METHODS Data of 25 cochlear implantations in 23 patients with the SlimJ electrode were retrospectively collected. The insertion results were assessed by image fusion of the preoperative computed tomography (CT), magnetic resonance imaging (MRI), and postoperative cone-beam CT. The hearing outcomes were evaluated by the improvement of speech recognition in noise, measured preoperatively and at follow-up. Postoperative pure-tone thresholds were obtained in cases with preoperative functional low frequency hearing [PTA (0.125-0.5 kHz) ≤ 80 dB HL]. RESULTS The preoperative mean speech reception threshold (SRT) was +0.6 dB signal-to-noise ratio (SNR) (SD ± 4.2 dB) and the postoperative -3.5 dB SNR (SD ± 2.3 dB). The improvements between the preoperative and postoperative SRT levels ranged from 0.0 to 15.1 dB, with a mean improvement of 4.2 dB (SD ± 3.6 dB). Residual hearing in low frequencies (mean PTA(125-500 Hz)) was preserved within 30 dB HL in 70% and within 15 dB HL in 40% of patients who had preoperatively functional low frequency hearing. Mean insertion depth angle (IDA) was 401° (SD ± 41°). We observed scalar translocations from scala tympani to scala vestibuli in 2 ears (9%). CONCLUSION The relatively atraumatic insertion characteristics make the SlimJ array feasible for hearing preservation cochlear implantation. The hearing outcomes are comparable to those reported for other electrodes and devices.
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Affiliation(s)
- Sini Sipari
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Oh H, Kim Y, Lee SJ, Carandang M, Song JJ, Choi BY. Two Discrete Types of Tip Fold-Over in Cochlear Implantation Using Slim Modiolar Electrodes: Influence of Cochlear Duct Length on Tip Fold-Over. Otol Neurotol 2023; 44:1011-1014. [PMID: 37733985 DOI: 10.1097/mao.0000000000004022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Precise electrode positioning is crucial for achieving optimal audiological outcomes in cochlear implantation. The slim modiolar electrode (SME), a thin, flexible, and precurved electrode, exhibits favorable modiolar proximity. However, tip fold-over can affect optimal electrode placement. Herein, we share our experiences with tip fold-over in SMEs and present an analysis of conditions that may predispose to tip fold-over. STUDY DESIGN Retrospective medical record review. PATIENTS In total, 475 patients (671 ears) underwent cochlear implantation using SMEs (Nucleus CI532 or CI632 from Cochlear) performed by a single surgeon at a tertiary center between June 14, 2018, and December 1, 2022. INTERVENTIONS Intraoperative x-ray scans (cochlear view), operative records, and cochlear duct length (CDL) were reviewed. MAIN OUTCOME MEASURES Tip fold-over patterns on plain x-ray images (proximal versus distal). RESULTS Electrode tip fold-over was observed in 18 (2.7%) of the 671 ears with SMEs. This fold-over occurred more frequently in cases with long CDL (>36 mm). Among the 14 cases with available initial x-rays before correction of the tip fold-over, half were classified as proximal and the other half as distal. A predilection for proximal tip fold-over was found in those with a CDL of 36 mm or longer, and longer CDLs were observed for proximal cases than for distal cases. Our pilot data suggest that identifying the type of tip fold-over can aid in correcting it more efficiently. CONCLUSIONS Tip fold-over of SME does not occur uniformly and is more common in ears with long CDL. This tendency is particularly pronounced for the proximal type of tip fold-over. Therefore, preoperative measurement of the CDL and meticulous examination of intraoperative imaging are essential for customized correction.
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Affiliation(s)
- Heonjeong Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Marge Carandang
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Tondo Medical Center, Metro Manila, Philippines
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Savoca E, Smith B, Shaffer AD, Kitsko D, Chi D. Utility of Intraoperative Radiographs in Pediatric Cochlear Implant Surgery. Otolaryngol Head Neck Surg 2023; 169:1282-1289. [PMID: 37051895 DOI: 10.1002/ohn.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/04/2023] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To evaluate the role of intraoperative radiographs to confirm electrode position following pediatric cochlear implantation (CI). STUDY DESIGN Retrospective chart review. SETTING Single tertiary care pediatric center. METHODS A retrospective chart review was conducted, including all pediatric patients undergoing CI at UPMC Children's Hospital of Pittsburgh over a 13-year period. RESULTS We identified 326 patients undergoing 492 procedures. Across the cohort, there were 7 cases that required intraoperative electrode reinsertion due to malposition or presumed malposition. For 6 of the 7 cases, intraoperative X-ray identified electrode malposition. Neural response telemetry (NRT) testing was also abnormal for 4 of these cases prior to reinsertion. Implantation of Cochlear's Slim Modiolar electrode was associated with an abnormal perioperative X-ray (odds ratio [OR]: 9.2, p = 0.03) and increased change in management (OR: 9.2, p = 0.03) compared to Cochlear's Contour Advance (CA). Incidence of abnormal X-rays was 1.24% overall, 4% in the Slim Modiolar group, and 0.3% in the CA group. The Slim Modiolar electrode accounted for 4 of 7 cases requiring reinsertion, and in all 4 of these cases, electrode fold-over was identified on the X-ray. NRT was normal in 1 of these 4 cases. CONCLUSION The use of Cochlear's Slim Modiolar electrode was associated with a significantly increased risk of abnormal intraoperative X-ray compared to the CA electrode. Given the risk of fold-over with routine insertion and normal electrical testing using the Slim Modiolar electrode, we recommend routine use of intraoperative skull X-ray to confirm electrode position.
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Affiliation(s)
- Emily Savoca
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Ear, Nose & Throat Surgeons of Western New England, Springfield, Massachusetts, USA
| | - Brandon Smith
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber D Shaffer
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dennis Kitsko
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Chi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhan KY, Walia A, Durakovic N, Wick CC, Buchman CA, Shew MA, Herzog JA. One-Year Hearing Preservation and Speech Outcomes Comparing Slim Modiolar and Lateral Wall Arrays. Otolaryngol Head Neck Surg 2023; 169:340-347. [PMID: 36814321 DOI: 10.1002/ohn.273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Compare postoperative speech outcomes in hearing preservation (HP) cochlear implantation (CI) patients with a low-frequency pure-tone average (LFPTA) ≤ 60 dB using 2 electrode array designs. STUDY DESIGN Retrospective cohort study. SETTING Large academic cochlear implant referral center. METHODS We reviewed adult HP CI cases using either the slim modiolar electrode (SME) (CI 532/CI 632) or th slim lateral wall electrode (SLWE) (CI 624). One-year speech outcomes and HP status were the primary outcomes. RESULTS A total of 132 implanted ears were analyzed (mean age 73.1 years, standard deviation [SD] 12.6), with 72% (N = 95) with CI 532/632 and 28% (N = 37) with CI 624. The mean preoperative LFPTA was 44.8 dB, SD 11.8. One-year functional HP was 27.2% (mean LFPTA shift 46.1 dB, SD 22.1) and was as follows: SME 23.9% and SLWE 36.4%, p = .168. The mean age at implantation was significantly younger only in SLWE patients with preserved hearing (66.9 vs 80.3 years, p = .008). At 6 months, speech measures were significantly better in all outcomes in HP patients with an SLWE than nonpreserved SLWE patients; this effect abated at 1 year as performance among nonpreserved SLWE patients became equivalent to the remaining cohort. Speech outcomes in SME patients were similar regardless of HP status. Age at implantation and datalogging was correlated with speech outcomes. CONCLUSION In this cohort of HP patients, a 1-year functional HP rate of 23.9% (SME) and 36.4% (SLWE) was observed (p = 0.168). This was initially 57.1% (SME) and 70.3% (SLWE) at activation, p = .172. Datalogging and age at implantation were correlated with postoperative speech outcomes.
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Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology and Neurotology, Washington University in St Louis, St Louis, Missouri, USA
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Geiger S, Iso-Mustajärvi M, Nauwelaers T, Avci E, Julkunen P, Linder P, Silvast T, Dietz A. Automatic electrode scalar location assessment after cochlear implantation using a novel imaging software. Sci Rep 2023; 13:12416. [PMID: 37524776 PMCID: PMC10390550 DOI: 10.1038/s41598-023-39275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023] Open
Abstract
As of today, image-based assessment of cochlear implant electrode array location is not part of the clinical routine. Low resolution and contrast of computer tomography (CT) imaging, as well as electrode array artefacts, prevent visibility of intracochlear structures and result in low accuracy in determining location of the electrode array. Further, trauma assessment based on clinical-CT images requires a uniform image-based trauma scaling. Goal of this study was to evaluate the accuracy of a novel imaging software to detect electrode scalar location. Six cadaveric temporal bones were implanted with Advanced Bionics SlimJ and Mid-Scala electrode arrays. Clinical-CT scans were taken pre- and postoperatively. In addition, micro-CTs were taken post-operatively for validation. The electrode scalar location rating done by the software was compared to the rating of two experienced otosurgeons and the micro-CT images. A 3-step electrode scalar location grading scale (0 = electrode in scala tympani, 1 = interaction of electrode with basilar membrane/osseous spiral lamina, 2 = translocation of electrode into scala vestibuli) was introduced for the assessment. The software showed a high sensitivity of 100% and a specificity of 98.7% for rating the electrode location. The correlation between rating methods was strong (kappa > 0.890). The software gives a fast and reliable method of evaluating electrode scalar location for cone beam CT scans. The introduced electrode location grading scale was adapted for assessing clinical CT images.
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Affiliation(s)
- S Geiger
- Advanced Bionics, European Research Center, Hannover, Germany.
| | - M Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - T Nauwelaers
- Advanced Bionics, European Research Center, Hannover, Germany
| | - E Avci
- Advanced Bionics, European Research Center, Hannover, Germany
| | - P Julkunen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - P Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - T Silvast
- SIB Labs, Dempartment of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - A Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
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Kirk JR, Smyth D, Dueck WF. A new paradigm of hearing loss and preservation with cochlear implants: Learnings from fundamental studies and clinical research. Hear Res 2023; 433:108769. [PMID: 37120894 DOI: 10.1016/j.heares.2023.108769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 02/18/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
In 2010 Cochlear initiated a coordinated preclinical research program to identify the factors and underlying mechanisms of acoustic hearing loss following cochlear implantation and device use. At its inception the program was structured around several major hypotheses implicated in the loss of acoustic hearing. The understanding of causes evolved over the course of the program, leading to an increased appreciation of the role of the biological response in post-implant hearing loss. A systematic approach was developed which mapped the cochlear implant journey along a timeline that considers all events in an individual's hearing history. By evaluating the available data in this context, rather than by discrete hypothesis testing, causative and associated factors may be more readily detected. This approach presents opportunities for more effective research management and may aid in identifying new prospects for intervention. Many of the outcomes of the research program apply beyond preservation of acoustic hearing to factors important to overall cochlear health and considerations for future therapies.
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Affiliation(s)
- Jonathon R Kirk
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia.
| | - Daniel Smyth
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia
| | - Wolfram F Dueck
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia
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12
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Iso-Mustajärvi M, Silvast T, Heikka T, Tervaniemi J, Calixto R, Linder PH, Dietz A. Trauma After Cochlear Implantation: The Accuracy of Micro-Computed Tomography and Cone-Beam Fusion Computed Tomography Compared With Histology in Human Temporal Bones. Otol Neurotol 2023; 44:339-345. [PMID: 36843083 PMCID: PMC10022666 DOI: 10.1097/mao.0000000000003835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
HYPOTHESIS Micro-computed tomography (micro-CT) and cone-beam computed tomography (CBCT), in conjunction with the image fusion technique, may provide similar results for trauma assessment after cochlear implantation, with respect to the trauma evaluation in preclinical cochlear implant (CI) studies, as the histology. BACKGROUND Before clinical use, novel cochlear implant (CI) designs are tested in temporal bone (TB) studies for usability and risk evaluation. The criterion standard for evaluating intracochlear insertion trauma and electrode location has historically been with histological samples. Progress of modern imaging technology has created alternatives to classic histology. This study compares the micro-CT and CBCT fusion images between histological samples in a preclinical CI study. METHODS Fourteen freshly frozen TBs were inserted with a lateral wall research CI electrode. All TBs were scanned with CBCT preoperatively and postoperatively. After insertion, the TBs were prepared for micro-CT and histology. Twelve TBs underwent first a micro-CT and then the histological process. The CBCTs were used for image fusion, and all three different methods were used for intracochlear trauma evaluation. The results were compared between methods. RESULTS There were 4 of 14 translocations detected with the fusion image method and 3 of 12 with the micro-CT and histology. When compared, the trauma grades converged and were not statistically significant. CONCLUSION The trauma grading based on micro-CT is comparable to the histology. The image fusion technique based on CBCT is less accurate because it relies on an empirical assumption of the basal membrane localization, but it is clinically applicable.
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Affiliation(s)
| | - Tuomo Silvast
- SIB Labs Infrastructure Unit, Faculty of Science and Forestry, University of Eastern Finland
| | - Tuomas Heikka
- Department of Otorhinolaryngology, Kuopio University Hospital
| | - Jyrki Tervaniemi
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Pia H. Linder
- Department of Otorhinolaryngology, Kuopio University Hospital
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital
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13
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Inoue T, Tona Y, Okano T, Omori K, Yamamoto N. Detection of Tip Fold-Over of the Slim Modiolar Electrode Using Intraoperative Mobile Cone-Beam Computed Tomography. Otolaryngol Head Neck Surg 2023. [PMID: 36939567 DOI: 10.1002/ohn.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study aimed to evaluate the importance of mobile cone-beam computed tomography in detecting tip fold-over of a slim modiolar electrode within the cochlea during surgery. STUDY DESIGN Retrospective case review. SETTING Tertiary medical center. METHODS From January 2020 to June 2022, 33 ears of 30 patients with normal cochlear morphology underwent cochlear implantation with slim modiolar electrodes and intraoperative mobile cone-beam computed tomography imaging. Furthermore, we retrospectively reviewed the medical records and images. RESULTS The tip fold-over of the electrodes was detected using mobile cone-beam computed tomography in 3 out of 33 ears (9.1%). We could not identify the tip fold-over by scouting plain X-ray images in 2 out of 3 cases before taking the cone-beam computed tomography images. Electrode removal and reinsertion were performed before wound closure and the successful reinsertion was confirmed by mobile cone-beam computed tomography. The folded electrode tips were located at 238.8°, 152°, and 185.8°. CONCLUSION Intraoperative mobile cone-beam computed tomography is useful in detecting the tip fold-over of the slim modiolar electrodes during surgery. Therefore, it was possible to reinsert the electrodes in all cases before closing the wound, eliminating the need for revision surgeries. Moreover, the analysis of mobile cone-beam computed tomography images may help to elucidate the mechanisms of electrode tip fold-over.
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Affiliation(s)
- Taishi Inoue
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yosuke Tona
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Yamamoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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14
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Summating Potential as Marker of Intracochlear Position in Bipolar Electrocochleography. Ear Hear 2023; 44:118-134. [PMID: 35894668 DOI: 10.1097/aud.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cochlear implantation criteria include subjects with residual low-frequency hearing. To minimize implantation trauma and to avoid unwanted interactions of electric- and acoustic stimuli, it is often recommended to stop cochlear implantation before the cochlear implant (CI) reaches the cochlear partition with residual hearing, as determined by an audiogram. For this purpose, the implant can be used to record acoustically evoked signals during implantation, including cochlear compound action potentials (CAP), cochlear microphonics (CMs), and summating potentials (SPs). The former two have previously been used to monitor residual hearing in clinical settings. DESIGN In the present study we investigated the use of intracochlear, bipolar SP recordings to determine the exact cochlear position of the contacts of implanted CIs in guinea pig cochleae (n = 13). Polarity reversals of SPs were used as a functional marker of intracochlear position. Micro computed tomography (µCT) imaging and a modified Greenwood function were used to determine the cochleotopic positions of the contacts in the cochlea. These anatomical reconstructions were used to validate the SP-based position estimates. RESULTS The precision of the SP-based position estimation was on average within ± 0.37 octaves and was not impaired by moderate hearing loss caused by noise exposure after implantation. It is important to note that acute hearing impairment did not reduce the precision of the method. The cochleotopic position of CI accounted for ~70% of the variability of SP polarity reversals. Outliers in the dataset were associated with lateral CI positions. Last, we propose a simplified method to avoid implantation in functioning parts of the cochlea by approaching a predefined frequency region using bipolar SP recordings through a CI. CONCLUSIONS Bipolar SP recordings provide reliable information on electrode position in the cochlea. The position estimate remains reliable after moderate hearing loss. The technique presented here could be applied during CI surgery to monitor the CI approach to a predefined frequency region.
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15
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Sharma RK, Smetak MR, Patro A, Lindquist NR, Perkins EL, Holder JT, Haynes DS, Tawfik KO. Speech Recognition Performance Differences Between Precurved and Straight Electrode Arrays From a Single Manufacturer. Otol Neurotol 2022; 43:1149-1154. [PMID: 36201525 DOI: 10.1097/mao.0000000000003703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Precurved cochlear implant (CI) electrode arrays have demonstrated superior audiometric outcomes compared with straight electrodes in a handful of studies. However, previous comparisons have often failed to account for preoperative hearing and age. This study compares hearing outcomes for precurved and straight electrodes by a single manufacturer while controlling for these and other factors in a large cohort. STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PATIENTS Two hundred thirty-one adult CI recipients between 2015 and 2021 with cochlear (Sydney, Australia) 522/622 (straight) or 532/632 (precurved) electrode arrays. INTERVENTIONS Postactivation speech recognition and audiometric testing. MAIN OUTCOME MEASURES Speech recognition testing (consonant-nucleus-consonant word [CNCw] and AzBio) was collected at 6 and 12 months postactivation. Hearing preservation was characterized by a low-frequency pure-tone average shift, or the change between preoperative and postoperative low-frequency pure-tone average. RESULTS Two hundred thirty-one patients (253 ears) with 6-month and/or 12-month CNCw or AzBio testing were included. One hundred forty-nine (59%) and 104 (41%) ears were implanted with straight and precurved electrode arrays, respectively. Average age at implantation was 70 years (interquartile range [IQR], 58-77 y). There was no significant difference in mean age between groups. CNCw scores were significantly different ( p = 0.001) between straight (51%; IQR, 36-67%) and precurved arrays (64%; IQR, 48-72%). AzBio scores were not significantly different ( p = 0.081) between straight (72%; IQR, 51-87%) and precurved arrays (81%; IQR, 57-90%). Controlling for age, race, sex, preoperative hearing, and follow-up time, precurved electrode arrays performed significantly better on CNCw (b = 10.0; 95% confidence interval, 4.2-16.0; p < 0.001) and AzBio (b = 8.9; 95% confidence interval, 1.8-16.0;, p = 0.014) testing. Hearing preservation was not different between electrodes on adjusted models. CONCLUSION During the study period, patients undergoing placement of precurved electrode arrays had significantly higher CNC and AzBio scores than patients receiving straight electrodes, even after controlling for age, preoperative hearing, and follow-up time. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED Understanding the difference in audiometric outcomes between precurved and straight electrode arrays will help to guide electrode selection. LEARNING OBJECTIVE To understand differences in speech recognition scores postoperatively by electrode array type (precurved versus straight). DESIRED RESULT To demonstrate a difference in hearing performance postoperatively by electrode type. LEVEL OF EVIDENCE III. INDICATE IRB OR IACUC Approved by the Institutional IRB (090155).
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | - Miriam R Smetak
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | - Ankita Patro
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | - Nathan R Lindquist
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | | | - David S Haynes
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
| | - Kareem O Tawfik
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center
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16
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Starovoyt A, Quirk BC, Putzeys T, Kerckhofs G, Nuyts J, Wouters J, McLaughlin RA, Verhaert N. An optically-guided cochlear implant sheath for real-time monitoring of electrode insertion into the human cochlea. Sci Rep 2022; 12:19234. [PMID: 36357503 PMCID: PMC9649659 DOI: 10.1038/s41598-022-23653-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
In cochlear implant surgery, insertion of perimodiolar electrode arrays into the scala tympani can be complicated by trauma or even accidental translocation of the electrode array within the cochlea. In patients with partial hearing loss, cochlear trauma can not only negatively affect implant performance, but also reduce residual hearing function. These events have been related to suboptimal positioning of the cochlear implant electrode array with respect to critical cochlear walls of the scala tympani (modiolar wall, osseous spiral lamina and basilar membrane). Currently, the position of the electrode array in relation to these walls cannot be assessed during the insertion and the surgeon depends on tactile feedback, which is unreliable and often comes too late. This study presents an image-guided cochlear implant device with an integrated, fiber-optic imaging probe that provides real-time feedback using optical coherence tomography during insertion into the human cochlea. This novel device enables the surgeon to accurately detect and identify the cochlear walls ahead and to adjust the insertion trajectory, avoiding collision and trauma. The functionality of this prototype has been demonstrated in a series of insertion experiments, conducted by experienced cochlear implant surgeons on fresh-frozen human cadaveric cochleae.
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Affiliation(s)
- Anastasiya Starovoyt
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Bryden C. Quirk
- grid.1010.00000 0004 1936 7304Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Tristan Putzeys
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Laboratory for Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, 3000 Leuven, Belgium
| | - Greet Kerckhofs
- grid.7942.80000 0001 2294 713XBiomechanics Laboratory, Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, 1348 Louvain-La-Neuve, Belgium ,grid.5596.f0000 0001 0668 7884Department of Materials Science and Engineering, KU Leuven, 3000 Leuven, Belgium ,grid.7942.80000 0001 2294 713XInstitute of Experimental and Clinical Research, UCLouvain, 1200 Woluwé-Saint-Lambert, Belgium ,grid.5596.f0000 0001 0668 7884Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, 3000 Leuven, Belgium
| | - Johan Nuyts
- grid.5596.f0000 0001 0668 7884Department of Imaging and Pathology, Division of Nuclear Medicine, KU Leuven, 3000 Leuven, Belgium ,Nuclear Medicine and Molecular Imaging, Medical Imaging Research Center, 3000 Leuven, Belgium
| | - Jan Wouters
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Robert A. McLaughlin
- grid.1010.00000 0004 1936 7304Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1012.20000 0004 1936 7910School of Engineering, University of Western Australia, Perth, WA 6009 Australia
| | - Nicolas Verhaert
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals of Leuven, 3000 Leuven, Belgium
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17
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Munhall CC, Noble JH, Dawant B, Labadie RF. Cochlear Implant Translocation: Diagnosis, Prevention, and Clinical Implications. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Matsumoto N, Akagi-Tsuchihashi N, Noda T, Komune N, Nakagawa T. Orientation of the Cochlea From a Surgeon's Perspective. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e017. [PMID: 38516627 PMCID: PMC10950153 DOI: 10.1097/ono.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 03/23/2024]
Abstract
Background One of the mechanisms that cause tip fold-over is a misalignment between the electrode array's coiling direction and the cochlea's curving direction. Objectives We reviewed surgical videos and computed tomography (CT) datasets of the patients who underwent cochlear implantation procedures from January 2010 to December 2021, paying particular attention to the cochlea's orientation in the surgeon's microscopic view. Methods CT dataset and video recordings were analyzed to measure the "slope angle," which is the angle between the cochlea's coiling plane and the horizontal plane. Results There were 220 cases that met the criteria and completed the analysis. The mean slope angle was 12.1° ± 9.5°, with a minimum of -9.4° and maximum of 44.6°. However, each surgeon had a favored slope angle range. Conclusion Understanding the slope angle and making an effort to reduce the chance of misalignment during electrode insertion may help prevent tip fold-over of slim perimodiolar electrode arrays.
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Affiliation(s)
- Nozomu Matsumoto
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nana Akagi-Tsuchihashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Teppei Noda
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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19
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Illg A, Lenarz T. Cochlear Implantation in Hearing-Impaired Elderly: Clinical Challenges and Opportunities to Optimize Outcome. Front Neurosci 2022; 16:887719. [PMID: 35903809 PMCID: PMC9315238 DOI: 10.3389/fnins.2022.887719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Cochlear implant (CI) overall provides a very good outcome, but speech comprehension outcome in the elderly is more variable. Several clinical factors play an important role. The management of residual hearing, the presence of comorbidities, and especially the progression of cognitive decline seem to be the clinical parameters that strongly determine the outcome of cochlear implantation and need to be discussed prospectively in the consultation process with the elderly hearing impaired. In the context of this review article, strategies for dealing with these will be discussed. Timely cochlear implantation should already be considered by hearing aid acousticians or practicing otolaryngologists and communicated or initiated with the patient. This requires intensive cooperation between hearing aid acousticians and experts in the clinic. In addition, residual hearing and comorbidities in the elderly need to be considered to make realistic predictions about speech comprehension with CI. Long-term aftercare and its different implementations should be discussed preoperatively, so that the elderly person with hearing impairments feels well taken care of together with his or her relatives. Elderly patients with hearing impairments benefit most from a CI in terms of speech comprehension if there is a large cochlear coverage (electrical or acoustic electrical) and the therapy is not hampered by comorbidities, especially cognitive decline.
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Affiliation(s)
- Angelika Illg
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
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20
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Van de Heyning P, Roland P, Lassaletta L, Agrawal S, Atlas M, Baumgartner WD, Brown K, Caversaccio M, Dazert S, Gstoettner W, Hagen R, Hagr A, Jablonski GE, Kameswaran M, Kuzovkov V, Leinung M, Li Y, Loth A, Magele A, Mlynski R, Mueller J, Parnes L, Radeloff A, Raine C, Rajan G, Schmutzhard J, Skarzynski H, Skarzynski PH, Sprinzl G, Staecker H, Stöver T, Tavora-Viera D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Wimmer W, Zernotti M, Gavilan J. Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events. Front Surg 2022; 9:823219. [PMID: 35402479 PMCID: PMC8987358 DOI: 10.3389/fsurg.2022.823219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. Methods A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. Results A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4-6.6%) of ETFO, 28.6% (26.6-30.6%) of ESD, and 0.53% (0.2-1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1-1.3%), 11% (9.2-13.0%), and 3.2% (2.5-3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. Conclusion Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.
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Affiliation(s)
- Paul Van de Heyning
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Peter Roland
- Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marcus Atlas
- Ear Sciences Institute Australia, Lions Hearing Clinic, Perth, WA, Australia
| | | | - Kevin Brown
- UNC Ear and Hearing Center at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Marco Caversaccio
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | | | - Rudolf Hagen
- Würzburg ENT University Hospital, Würzburg, Germany
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Vladislav Kuzovkov
- St. Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - Martin Leinung
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Andreas Loth
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Magele
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner” Rostock University Medical Center, Rostock, Germany
| | - Joachim Mueller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Andreas Radeloff
- Division of Oto-Rhino-Laryngology, Evangelisches Krankenhaus Oldenburg, Research Center of Neurosensory Sciences, University Oldenburg, Oldenburg, Germany
| | - Chris Raine
- Bradford Royal Infirmary Yorkshire Auditory Implant Center, Bradford, United Kingdom
| | - Gunesh Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Medical Sciences Department of Health Sciences and Medicine. University of Lucerne, Luzern, Switzerland. Otolaryngology, Head & Neck Surgery, Medical School University of Western Australia, Perth, WA, Australia
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H. Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Georg Sprinzl
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Hinrich Staecker
- Kansas University Center for Hearing and Balance Disorders, Kansas City, KS, United States
| | - Timo Stöver
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Vedat Topsakal
- Department of ENT HNS, University Hospital Brussels, Brussels, Belgium
| | - Shin-Ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Mario Zernotti
- Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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21
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Kant E, Jwair S, Thomeer HGXM. Hearing preservation in cochlear implant recipients: A cross-sectional cohort study. Clin Otolaryngol 2022; 47:495-499. [PMID: 35263011 PMCID: PMC9314029 DOI: 10.1111/coa.13927] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen Kant
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saad Jwair
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Lee SY, Jeon H, Kim Y, Choi HY, Carandang M, Yoo HS, Choi BY. Natural course of residual hearing preservation with a slim, modiolar cochlear implant electrode array. Am J Otolaryngol 2022; 43:103382. [PMID: 35151931 DOI: 10.1016/j.amjoto.2022.103382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/09/2022] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Understanding residual hearing preservation and its natural course following cochlear implantation is important for developing rehabilitation strategies for hearing loss. However, non-uniform evaluation criteria and varying surgical skills pose challenges in fair comparison of the effect of different electrodes on residual hearing preservation. We compared the effect of a slim modiolar electrode (SME) and a slim straight electrode (SSE), implanted by a single surgeon, on progression of residual hearing using different parameters, based on cross-sectional and longitudinal audiological analyses. METHODS Patients with preoperative low-frequency pure-tone average (LFPTA) ≤85 dB at 250 and 500 Hz and who underwent minimally traumatic surgical techniques were included. The progression of residual hearing using threshold shifts, hearing preservation rate according to the HEARRING classification, and maintenance of functional low-frequency hearing potentially qualifying for a hybrid stimulation was analyzed up to five time points throughout the 1-year follow-up period. RESULTS Threshold shifts and hearing preservation rates according to the HEARRING classification of the electrodes were comparable from 3 months through 12 months postoperatively. Maintenance of functional low-frequency hearing, required for the usage of a hybrid stimulation, was similar for both electrodes. A substantial proportion of implantees with SME use a hybrid stimulation, resulting in long-term use. However, a difference in the pattern of postoperative residual hearing preservation between the two electrodes is possible, probably due to differences in their physical characteristics and location. Specifically, correlation analysis exhibited that significantly less tight modiolar proximity negatively affect the residual hearing preservation, albeit only at 3 months postoperatively, among patients with the SME. CONCLUSION Collectively, both SME and SSE implantation showed favorable residual hearing preservation. Our findings further refine the recently proposed hearing preservation with the SME and suggest that the physical characteristics and location of electrodes, in terms of electrode-to-modiolus distance, could affect loss of acoustic hearing in various ways.
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Kim Y, Han JH, Yoo HS, Choi BY. Molecular aetiology of ski-slope hearing loss and audiological course of cochlear implantees. Eur Arch Otorhinolaryngol 2022; 279:4871-4882. [PMID: 35212774 DOI: 10.1007/s00405-022-07317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE A challenge for patients with ski-slope hearing loss is that hearing aids do not adequately amplify the mid-to-high frequencies necessary for speech perception and conversely, cochlear implant (CI) may damage low-frequency hearing. We aimed to describe the clinical profile of patients with ski-slope hearing loss, with a special focus on aetiology of such hearing loss and audiological course of low-frequency hearing after CI. METHODS We recruited hearing-impaired patients who visited a tertiary referral centre and met the criteria for ski-slope hearing loss patients from 2015 to 2021. Genetic testing was performed in all ski-slope hearing loss patients unless refused. Baseline audiograms of patients who continued to use hearing aids or who finally underwent CIs were reviewed. As for CI patients, outcome and hearing preservation rate were rigorously analysed. RESULTS Of 46 recruited patients with ski-slope hearing loss, 45 agreed to undergo genetic testing and causative variants were identified in 17 (37.8%) patients. The TMC1, MYO7A, and TMPRSS3 variants were the most common, while LRTOMT was newly identified as a causative gene. Twenty-five patients eventually received CI, while 13 continued to wear the hearing aid and 8 patients did not ever try hearing aids. CI in ski-slope hearing loss led to immediate and sufficient improvement of sentence recognition by as early as 3 months, however, the duration of hearing loss was inversely correlated with the sentence recognition score. The average hearing preservation rate (using the HEARRING classification) after CI was 53.0% (SD 30.0) and 45.6% (SD 31.1) at 1 year. Seventy-nine percent of implantees maintained functional low-frequency hearing (better than 85 dB at 250 and 500 Hz) eligible for electric-acoustic stimulation (EAS). A trend was found that patients with hair cell stereocilia-associated genetic variants may have a slightly better preservation, albeit with no statistical significance. CONCLUSION Detection rate of a molecular genetic aetiology of ski-slope hearing loss appears to be lower than other type of hearing loss reported in the literature. Especially with short hearing loss duration, CI in ski-slope hearing loss leads to immediate and sufficient speech improvement, while preserving functional low-frequency hearing eligible for EAS as many as in 79%. A certain genetic aetiology might be associated with a trend towards better low-frequency hearing preservation.
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Affiliation(s)
- Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Jin Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Hyo Soon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, Republic of Korea.
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Intracochlear New Fibro-Ossification and Neuronal Degeneration Following Cochlear Implant Electrode Translocation: Long-Term Histopathological Findings in Humans. Otol Neurotol 2022; 43:e153-e164. [PMID: 35015749 DOI: 10.1097/mao.0000000000003402] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We aim to assess the histopathology of human temporal bones (TBs) with evidence of cochlear implantation (CI) electrode scalar translocation. STUDY DESIGN Otopathology study. SETTING Otopathology laboratory. PATIENTS TBs from patients who had a history of CI and histopathological evidence of interscalar translocation. Specimens with electrode placed entirely within the ST served as controls. INTERVENTION Histopathological assessment of human TBs. MAIN OUTCOME MEASURES TBs from each patient were harvested postmortem and histologically analyzed for intracochlear changes in the context of CI electrode translocation and compared to controls. Intracochlear new fibro-ossification, and spiral ganglion neuron (SGN) counts were assessed. Postoperative word recognition scores (WRS) were also compared. RESULTS Nineteen human TBs with electrode translocation and eight controls were identified. The most common site of translocation was the ascending limb of the basal turn (n = 14 TBs). The average angle of insertion at the point of translocation was 159° ± 79°. Eighteen translocated cases presented moderate fibroosseous changes in the basal region of the cochlea, extending to the translocation point and/or throughout the electrode track in 42%. Lower SGN counts were more pronounced in translocated cases compared to controls, with a significant difference for segment II (p = 0.019). Although final postoperative hearing outcomes were similar between groups, translocated cases had slower rate of improvement in WRS (p = 0.021). CONCLUSIONS Cochlear implant electrode translocation was associated with greater fibroosseous formation and lower SGN population. Our findings suggest that scalar translocations may slow the rate of improvement in WRS overtime as compared to atraumatic electrode insertions.Level of evidence: IV.
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Intracochlear electrode array position and cochlear implant outcomes using the nucleus slim modiolar electrode and the extended round window approach: a follow-up study. Eur Arch Otorhinolaryngol 2022; 279:4735-4743. [PMID: 35041067 PMCID: PMC9474433 DOI: 10.1007/s00405-021-07247-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to evaluate the intracochlear position of the Slim Modiolar Electrode (SME) after insertion via the extended Round Window (eRW) approach, and to correlate this with residual hearing preservation and speech perception outcomes. METHODS Twenty-three adult participants, consecutively implanted with the SME via the eRW approach, were included in this prospective, single-center, observational study. Electrode position was evaluated intra-operatively using X-ray fluoroscopy and TIM measurement, and post-operatively using ultra-high resolution CT. Residual hearing [threshold shift in PTA between pre- and post-operative measurement, relative hearing preservation (RHP%)] and speech perception were evaluated at 2 and 12 months after surgery. RESULTS In each of the 23 participants, complete scala tympani positioning of the electrode array could be achieved. In one participant, an initial tip fold-over was corrected during surgery. Average age at implantation was 63.3 years (SD 13.3, range 28-76) and mean preoperative residual hearing was 81.5 dB. The average post-operative PTA threshold shift was 16.2 dB (SD 10.8) at 2 months post-operatively, corresponding with a RHP% score of 44% (SD 34.9). At 12 months, the average RHP% score decreased to 37%. Postoperative phoneme scores improved from 27.1% preoperatively, to 72.1% and 82.1% at 2 and 12 months after surgery, respectively. CONCLUSION Use of the eRW approach results in an increased likelihood of complete scala tympani insertion when inserting the SME, with subsequent excellent levels of speech perception. However, residual hearing preservation was found to be moderate, possibly as a result of the extended round window approach, emphasizing that it is not an all-purpose approach for inserting this particular electrode array.
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Högerle C, Englhard A, Simon F, Grüninger I, Mlynski R, Hempel JM, Müller J. Cochlear Implant Electrode Tip Fold-Over: Our Experience With Long and Flexible Electrode. Otol Neurotol 2022; 43:64-71. [PMID: 34619728 DOI: 10.1097/mao.0000000000003362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively investigate if there is any incidence of electrode tip fold-over with 31.5 mm long and flexible lateral wall electrodes implanted in two high-volume Cochlear Implant (CI) centers in Germany. In addition, a detailed literature review was performed to capture all the peer-reviewed publications reporting on tip fold-over with CI electrodes from different CI brands for comparison. METHODS Post-operative X-ray images of FLEX SOFT electrode from MED-EL in Stenver's view were retrospectively investigated for the presence of electrode tip fold-over from 378 consecutive cases in two high-volume CI centers in Germany. All patients were implanted between 2010 and 2018 by three individual experienced CI surgeons using round window and extended round window approach for CI electrode insertion. A literature review was performed following a thorough PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) search using the keywords "cochlear implant electrode tip fold-over" or "cochlear implant electrode tip roll-over" to capture articles that were published until December 2020 in English language only. Articles selection was based on electrode-related issues investigated only in-patient cases applying imaging modality. Those studies investigated tip fold-over in cadaveric temporal bones and cases with inner-ear malformation excluded. RESULTS No single case of tip fold-over was clinically detected from the retrospective investigation of post-operative X-ray images from 378 consecutive cases. The electrode angular insertion depth as measured applying the cochlear coordinate system, varied from a minimum of 560° to a maximum of 720°. The literature review on the tip fold-over issue resulted in 24 peer-reviewed published articles in total. Tip fold-over with pre-curved modiolar-hugging electrodes was reported in 85 cases out of 1,606 implantations making an incidence rate of 5.3%. With the straight lateral wall electrodes, the tip fold-over was reported in four cases out of 398 implantations making an incidence rate of 1%, not including the number of implantations reported in the current study. Otherwise it would be 0.5%. CONCLUSION Electrode tip fold-over with 31.5 mm long flexible lateral wall electrodes is highly exceptional and this can be generalized to any of the straight lateral wall electrodes from any CI brand. The literature review on tip fold-over revealed an incidence rate of 5.3% with pre-curved or modiolar-hugging electrodes and 1% with straight lateral wall electrodes from CI brands. Including this series of 0% tip fold-over, the incidence rate of electrode tip fold-over with LW electrode type would be 0.5%.
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Affiliation(s)
- Catalina Högerle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
| | - Anna Englhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
| | - Florian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
| | - Ivo Grüninger
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner," Rostock University Medical Center, Rostock, Germany
| | - John-Martin Hempel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
| | - Joachim Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University, Munich
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One Year Assessment of the Hearing Preservation Potential of the EVO Electrode Array. J Clin Med 2021; 10:jcm10235604. [PMID: 34884306 PMCID: PMC8658238 DOI: 10.3390/jcm10235604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/25/2021] [Indexed: 12/01/2022] Open
Abstract
Background: A prospective longitudinal multicentre study was conducted to assess the one-year postsurgical hearing preservation profile of the EVOTM electrode array. Methods: Fifteen adults presenting indications of electro-acoustic stimulation (pure-tone audiometry (PTA) thresholds ≤70 dB below 750 Hz) were implanted with the EVO™ electrode array. Hearing thresholds were collected at five time-points from CI activation to twelve months (12M) after activation. Hearing thresholds and hearing preservation profiles (HEARRING group classification) were assessed. Results: All subjects had measurable hearing thresholds at follow-up. No case of complete loss of hearing or minimal hearing preservation was reported at any time point. At activation (Nact = 15), five participants had complete hearing preservation, and ten participants had partial hearing preservation. At the 12M time point (N12m = 6), three participants had complete hearing preservation, and three participants had partial hearing preservation. Mean hearing loss at activation was 11 dB for full range PTA and 25 dB for PTAs low-frequency (125–500 Hz). Conclusions: This study provides the first longitudinal follow-up on associated hearing profiles to the EVO™ electrode array, which are comparable to the literature. However, other studies on larger populations should be performed.
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Willberg T, Sivonen V, Linder P, Dietz A. Comparing the Speech Perception of Cochlear Implant Users with Three Different Finnish Speech Intelligibility Tests in Noise. J Clin Med 2021; 10:jcm10163666. [PMID: 34441961 PMCID: PMC8397150 DOI: 10.3390/jcm10163666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: A large number of different speech-in-noise (SIN) tests are available for testing cochlear implant (CI) recipients, but few studies have compared the different tests in the same patient population to assess how well their results correlate. Methods: A clinically representative group of 80 CI users conducted the Finnish versions of the matrix sentence test, the simplified matrix sentence test, and the digit triplet test. The results were analyzed for correlations between the different tests and for differences among the participants, including age and device modality. Results: Strong and statistically significant correlations were observed between all of the tests. No floor or ceiling effects were observed with any of the tests when using the adaptive test procedure. Age or the length of device use showed no correlation to SIN perception, but bilateral CI users showed slightly better results in comparison to unilateral or bimodal users. Conclusions: Three SIN tests that differ in length and complexity of the test material provided comparable results in a diverse CI user group.
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Affiliation(s)
- Tytti Willberg
- Department of Otorhinolaryngology, Turku University Hospital, 20521 Turku, Finland
- Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland
- Correspondence:
| | - Ville Sivonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland;
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland; (P.L.); (A.D.)
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland; (P.L.); (A.D.)
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Liebscher T, Mewes A, Hoppe U, Hornung J, Brademann G, Hey M. Electrode Translocations in Perimodiolar Cochlear Implant Electrodes: Audiological and Electrophysiological Outcome. Z Med Phys 2021; 31:265-275. [DOI: 10.1016/j.zemedi.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/16/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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Ludwig S, Riemann N, Hans S, Christov F, Ludwig JM, Saxe J, Arweiler-Harbeck D. Evaluation of hearing preservation in adults with a slim perimodiolar electrode. Eur Arch Otorhinolaryngol 2021; 279:1233-1242. [PMID: 33830367 PMCID: PMC8897335 DOI: 10.1007/s00405-021-06755-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Numerous endeavors have been undertaken to preserve hearing in cochlear implant (CI) patients. Particularly, optimization of electrode array design aims at preservation of residual hearing (RH). This study examines whether a slim perimodiolar (PM) electrode array could bear the capability to preserve hearing. METHODS A total of 47 patients underwent cochlear implantation receiving the PM electrode. (i) Patients with pure tone audiogram (PTA) thresholds better than 85 dB and/or hearing loss for Freiburg speech test numbers less than 60 dB and more than 50% maximum monosyllabic understanding were assigned to the RH group (n = 17), while all others belonged to the noRH group (n = 30). (ii) Another group implanted with a slim straight, lateral wall (LW) electrode was recruited for comparison. RESULTS We compared 17 RH-30 noRH patients all receiving the PM electrode. RH in PM recipients decreased faster than in LW recipients. No significant differences were observed between both (RH v/s noRH) groups in NRT thresholds, Freiburg speech test and A§E® phonemes. Analogous satisfaction levels were indicated through the questionnaires in terms of sound quality, hearing in silence, noise and directional hearing in both groups. CONCLUSIONS The results suggest that hearing preservation is influenced not only by electrode shape but various factors. This study opens an avenue for further investigations to elucidate and enumerate the causes for progressive hearing loss.
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Affiliation(s)
- Sonja Ludwig
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Niklas Riemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Hans
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Florian Christov
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- ENT Practice Cologne-Bonn, Wesseling, Germany
| | - Johannes Maximilian Ludwig
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Judith Saxe
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Jwair S, Prins A, Wegner I, Stokroos RJ, Versnel H, Thomeer HGXM. Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays - A Meta-Analysis. Laryngoscope 2020; 131:1358-1368. [PMID: 33159469 PMCID: PMC8246990 DOI: 10.1002/lary.29224] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
Objectives/Hypothesis Two types of electrode arrays for cochlear implants (CIs) are distinguished: lateral wall and perimodiolar. Scalar translocation of the array can lead to intracochlear trauma by penetrating from the scala tympani into the scala vestibuli or scala media, potentially negatively affecting hearing performance of CI users. This systematic review compares the lateral wall and perimodiolar arrays with respect to scalar translocation. Study Design Systematic review. Methods PubMed, Embase, and Cochrane databases were reviewed for studies published within the last 11 years. No other limitations were set. All studies with original data that evaluated the occurrence of scalar translocation or tip fold‐over (TF) with postoperative computed tomography (CT) following primary cochlear implantation in bilateral sensorineuronal hearing loss patients were considered to be eligible. Data were extracted independently by two reviewers. Results We included 33 studies, of which none were randomized controlled trials. Meta‐analysis of five cohort studies comparing scalar translocation between lateral wall and perimodiolar arrays showed that lateral wall arrays have significantly lower translocation rates (7% vs. 43%; pooled odds ratio = 0.12). Translocation was negatively associated with speech perception scores (weighted mean 41% vs. 55%). Tip fold‐over of the array was more frequent with perimodiolar arrays (X2 = 6.8, P < .01). Conclusions Scalar translocation and tip fold‐overs occurred more frequently with perimodiolar arrays than with lateral wall arrays. In addition, translocation of the array negatively affects hearing with the cochlear implant. Therefore, if one aims to minimize clinically relevant intracochlear trauma, lateral wall arrays would be the preferred option for cochlear implantation. Laryngoscope, 131:1358–1368, 2021
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Affiliation(s)
- Saad Jwair
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Adrianus Prins
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Huib Versnel
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
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The influence of Slim Modiolar electrode on residual hearing in pediatric patients. Eur Arch Otorhinolaryngol 2020; 278:2723-2732. [PMID: 32897440 DOI: 10.1007/s00405-020-06342-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hearing preservation cochlear implantation is an established procedure in patients with low-frequency residual hearing, especially in pediatric cochlear implantation. More delicate, thin electrode arrays can minimize damage in the inner ear and enhance the possibility for residual hearing preservation. The Cochlear® CI532 electrode has been reported as an electrode with the potential for residual hearing preservation. No similar studies pertaining to hearing preservation in pediatric patients have appeared to date. The aim of this study was to investigate whether the Cochlear® CI532 Slim Modiolar electrode allows the preservation of low-frequency residual hearing in children undergoing cochlear implantation. METHODS In this multicenter, nonrandomized, prospective clinical cohort study, medical data of 14 pediatric patients implanted with the CI532 were collected. All patients had residual low-frequency hearing (preoperative audiogram or ABR with at least one threshold better than 90 dB HL at 125, 250, 500, or 1000 Hz). Postoperative thresholds were obtained 1, 3, 6, and 12 months after cochlear implantation. RESULTS Based on the HEARRING classification, 78.6% of children (11/14) had complete hearing preservation at the last follow-up visit (12 months after CI, or if not available, 6 months). A total of 21.4% (3/14) had partial hearing preservation. At the last follow-up visit, neither minimal hearing preservation nor loss of hearing was observed. Functional low-frequency hearing was preserved in 13 out of 14 patients (93%). CONCLUSIONS The residual hearing preservation results in children were superior to the results previously reported in adults.
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