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Collins A, Foghsgaard S, Druce E, Margani V, Mejia O, O'Leary S. The Effect of Electrode Position on Behavioral and Electrophysiologic Measurements in Perimodiolar Cochlear Implants. Otol Neurotol 2024; 45:238-244. [PMID: 38238914 DOI: 10.1097/mao.0000000000004080] [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: 02/17/2024]
Abstract
BACKGROUND The shape and position of cochlear implant electrodes could potentially influence speech perception, as this determines the proximity of implant electrodes to the spiral ganglion. However, the literature to date reveals no consistent association between speech perception and either the proximity of electrode to the medial cochlear wall or the depth of insertion. These relationships were explored in a group of implant recipients receiving the same precurved electrode. METHODS This was a retrospective study of adults who underwent cochlear implantation with Cochlear Ltd.'s Slim Perimodiolar electrode at the Royal Victorian Eye and Ear Hospital between 2015 and 2018 (n = 52). Postoperative images were obtained using cone beam computed tomography (CBCT) and analyzed by multi-planar reconstruction to identify the position of the electrode contacts within the cochlea, including estimates of the proximity of the electrodes to the medial cochlear wall or modiolus and the angular depth of insertion. Consonant-vowel-consonant (CVC) monosyllabic phonemes were determined preoperatively, and at 3 and 12 months postoperatively. Electrically evoked compound action potential (ECAP) thresholds and impedance were measured from the implant array immediately after implantation. The relationships between electrode position and speech perception, electrode impedance, and ECAP threshold were an analyzed by Pearson correlation. RESULTS Age had a negative impact on speech perception at 3 months but not 12 months. None of the electrode-wide measures of proximity between electrode contacts and the modiolus, nor measures of proximity to the medial cochlear wall, nor the angular depth of insertion of the most apical electrode correlated with speech perception. However, there was a moderate correlation between speech perception and the position of the most basal electrode contacts; poorer speech perception was associated with a greater distance to the modiolus. ECAP thresholds were inversely related to the distance between electrode contacts and the modiolus, but there was no clear association between this distance and impedance. CONCLUSIONS Speech perception was significantly affected by the proximity of the most basal electrodes to the modiolus, suggesting that positioning of these electrodes may be important for optimizing speech perception. ECAP thresholds might provide an indication of this proximity, allowing for its optimization during surgery.
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Affiliation(s)
- Aaron Collins
- Department of Otolaryngology, The University of Melbourne, Melbourne, Australia
| | - Søren Foghsgaard
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Edgar Druce
- Department of Otolaryngology, The University of Melbourne, Melbourne, Australia
| | - Valerio Margani
- Department of Neuroscience, Mental Health, and Sense Organs (NEMOS), Sant' Andrea University Hospital, Sapienza University, Rome, Italy
| | - Olivia Mejia
- sENTro Head and Neck Clinic, Manila, Philippines
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Geerardyn A, Zhu M, Verhaert N, Quesnel AM. Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes. Otol Neurotol 2024; 45:245-255. [PMID: 38270168 PMCID: PMC10922381 DOI: 10.1097/mao.0000000000004102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
HYPOTHESIS Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis. BACKGROUND The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this. METHODS Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point. RESULTS Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the -26 to -18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations. CONCLUSION OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
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Affiliation(s)
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Vohra V, Andresen NS, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Creighton FX, Bowditch SP, Sun DQ. Cochlear Implant Electrode Array Design and Speech Understanding. Otol Neurotol 2024; 45:136-142. [PMID: 38152035 DOI: 10.1097/mao.0000000000004083] [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: 12/29/2023]
Abstract
OBJECTIVE Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations. DESIGN Retrospective cohort study. SETTING Single academic medical center. PARTICIPANTS A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017. INTERVENTIONSS PM versus LW cochlear implants. MAIN OUTCOMES AND MEASURES Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years. RESULTS Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 [interquartile range, 38-68] versus 48 [31-62], p = 0.036) and from 2 to 5 years (58 [43-72] versus 48 [33-66], p < 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w ( β = 4.4 [95% confidence interval, 0.6-8.3], p = 0.023) and HINT testing ( β = 4.5 [95% confidence interval, 0.3-8.7], p = 0.038). CONCLUSIONS This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
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Affiliation(s)
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Carver
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dunham
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dawn Marsiglia
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenifer Yeagle
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles C Della Santina
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen P Bowditch
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kaul VF, Brannan Z, Keith J, Hittle B, Riggs W, Hiss M, Varadarajan V, Zhan K, Powell K, Wiet GJ, Adunka OF. Post-operative evaluation of computed tomography imaging following cochlear implantation. Am J Otolaryngol 2024; 45:104081. [PMID: 37820391 DOI: 10.1016/j.amjoto.2023.104081] [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: 08/21/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE This study utilized an automated segmentation algorithm to assess the cochlear implant electrode array within the cochlea and investigate its impact on audiologic outcomes as measured by post-operative speech perception scores. Furthermore, manual evaluations of electrode placement were compared to automatic segmentation methods to determine their accuracy in predicting post-operative audiologic outcomes. MATERIALS AND METHODS This retrospective chart review was conducted at a tertiary care referral center involving adult post-lingually deafened cochlear implant recipients implanted from 2015 to 2019. Patients with appropriate postoperative imaging and speech testing were included. Patients were excluded if non-English speaking, had a cognitive deficit, or a labyrinthine malformation. Automated and manual methods were used to analyze computed tomography (CT) scans and correlate the findings with post-operative speech perception scores and detection of electrode translocation. RESULTS Among the 47 patients who met inclusion criteria, 15 had electrode translocations confirmed by automatic segmentation methods. Controlling for CI usage and pre-operative AzBio scores, patients with translocation exhibited significantly lower consonant-nucleus consonant (CNC) and AzBio scores at 6-months post-implantation compared to patients with ST insertions. Moreover, the number of translocated electrode contacts was significantly associated with post-operative CNC scores. Manual evaluations of electrode location were predictive but less sensitive to electrode translocations when compared with automated 3D segmentation. CONCLUSIONS Placement of CI electrode contacts within ST without translocation into SV, leads to improved audiologic outcomes. Manual assessment of electrode placement via temporal bone CT, without 3D reconstruction, provides a less sensitive method to determine electrode placement than automated methods. LEVEL OF EVIDENCE Level 4. LAY SUMMARY This study investigated the impact of electrode placement on speech outcomes for cochlear implant recipients. Using advanced imaging techniques, the researchers compared automated and manual methods for evaluating electrode position and examined the relationship between electrode translocation and audiologic outcomes. The findings revealed that proper placement within the cochlea without translocation into inappropriate compartments inside the cochlea improves speech understanding. Manual evaluations were somewhat accurate but less sensitive in detecting translocations compared to automated methods, which offer more precise predictions of patient outcomes. These results contribute to our understanding of factors influencing cochlear implant success and highlight the importance of optimizing electrode placement for improved speech outcomes.
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Affiliation(s)
- Vivian F Kaul
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Zachary Brannan
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America
| | - Jason Keith
- Ohio State University College of Engineering, 2070 Neil Ave, Columbus, OH 43210, United States of America.
| | - Bradley Hittle
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America.
| | - William Riggs
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America
| | - Meghan Hiss
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Varun Varadarajan
- Associates of Otolaryngology Colorado, 850 E Harvard Ave # 505, Denver, CO 80210, United States of America
| | - Kevin Zhan
- Northwestern Medical Group, 251 East Huron Street, Chicago, IL 60611, United States of America.
| | - Kimerly Powell
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America.
| | - Gregory J Wiet
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America; Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States of America.
| | - Oliver F Adunka
- The Ohio State Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, United States of America; Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, United States of America.
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Franke-Trieger A, Lailach S, Shetty J, Murrmann K, Zahnert T, Neudert M. Word Recognition with a Cochlear Implant in Relation to Prediction and Electrode Position. J Clin Med 2023; 13:183. [PMID: 38202190 PMCID: PMC10780042 DOI: 10.3390/jcm13010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the word recognition score (WRS) achieved with cochlear implants (CIs) varies widely. To account for this, a predictive model was developed based on patients' age and their pre-operative WRS. This retrospective study aimed to find out whether the insertion depth of the nucleus lateral-wall electrode arrays contributes to the deviation of the CI-achieved WRS from the predicted WRS. MATERIALS AND METHODS patients with a pre-operative maximum WRS > 0 or a pure-tone audiogram ≥80 dB were included. The insertion depth was determined via digital volume tomography. RESULTS fifty-three patients met the inclusion criteria. The median WRS achieved with the CI was 70%. The comparison of pre- and post-operative scores achieved with a hearing aid and a CI respectively in the aided condition showed a median improvement of 65 percentage points (pp). A total of 90% of the patients improved by at least 20 pp. The majority of patients reached or exceeded the prediction, with a median absolute error of 11 pp. No significant correlation was found between the deviation from the predicted WRS and the insertion depth. CONCLUSIONS our data support a previously published model for the prediction of the WRS after cochlear implantation. For the lateral-wall electrode arrays evaluated, the insertion depth did not influence the WRS with a CI.
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Affiliation(s)
- Annett Franke-Trieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany (T.Z.)
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Al-Khalil RH, Al-Sowayan BS, Albdah B. The impact of the COVID-19 pandemic on rehabilitation services provided for cochlear implant recipients in Saudi Arabia. Ann Med 2023; 55:869-880. [PMID: 36880843 PMCID: PMC10795609 DOI: 10.1080/07853890.2023.2175902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/30/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE This study examines the impact of the COVID-19 pandemic on cochlear implantation (CI) recipients in Saudi Arabia. The impact was measured using the results of an online survey that investigated challenges related to access to re/habilitation and programming services, increased dependence on virtual interaction, and emotional impact. METHODS The cross-sectional online survey reached 353 pediatric and adult CI recipients between April 21st and May 3rd 2020, during the first weeks of implementing the lockdown strategy and the transitioning to virtual settings. RESULTS It was revealed that overall access to aural re/habilitation was considerably affected during the pandemic, and that the impact of this disruption was significantly greater for pediatric recipients than for adults. On the other hand, overall access to programming services was not affected. Results also revealed that CI recipients' performance at school or work was negatively impacted by the transition to a virtual communication. In addition, participants noticed a decline in their auditory performance, language skills, and speech understanding. They also registered feelings of anxiety, social isolation, and fear related to sudden changes in their CI function. Finally, the study revealed a gap between CI clinical/non-clinical support provided during the pandemic and the expectations of CI recipients. CONCLUSION Collectively, outcomes from this study highlight the importance of shifting towards a more patient -centered model that offers empowerment and self-advocacy. In addition, the outcomes also emphasize the importance of developing and adapting emergency protocols. This will ensure continuation of services provided to CI recipients during scenario disasters like a pandemic.Key messagesPediatric aural re/habilitation was subjected to a significantly greater interruption, compared to adult aural re/habilitation, duringthe COVID-19 shutdown.Cochlear Implant (CI) recipients expressed feelings of anxiety, social isolation, and fear. These feelings were related to sudden changes in their CI functioning, caused by interruption of support services during the pandemic.Patient -centered model can offer emergency protocols that ensure a smooth continuation of cochlear implant-related re/habilitation and services during disaster scenarios such as the COVID-19 pandemic.
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Affiliation(s)
- Rihab H. Al-Khalil
- King Abdullah Specialized Children’s Hospital/King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Batla S. Al-Sowayan
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bayan Albdah
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Matin F, Krueger C, Avallone E, Rossberg W, Demyanchuk A, Guenther A, Lenarz T, Lesinski-Schiedat A. Influence of the Electrode Array Design on Incidence of Vertigo Symptoms and Vestibular Function After Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2023; 102:701-708. [PMID: 34182811 DOI: 10.1177/01455613211022075] [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: 11/16/2022] Open
Abstract
PURPOSE To evaluate if a specific type of cochlear implant (CI) electrode array (EA) reveals higher rates/prevalence of vestibular symptoms and to characterize their respective relationship to intracochlear position and objective vestibular function. METHODS This retrospective study included 71 cochlear implantations in patients older than 18 years. The electrode position within the cochlea, electrode insertion angle, and cochlear coverage were determined from postoperative multiplanar reconstructed cone-beam computed tomography scans. All device manufacturers were represented. Data related to preoperative and postoperative PTA as well as vestibular symptoms in the preoperative and postoperative stages were collected from the patient's records. RESULTS Twelve of the 71 (16.9%) CI patients experienced vertigo symptoms in the early postoperative period. In 5 (7.0%) patients, the vertigo complaints lasted until the time of the first activation (5-6 weeks postoperative). Postoperative onset of vestibular symptoms was more often seen in patients receiving lateral wall (LW)/straight EAs (19%) compared to perimodiolar/precurved EAs (7%), but this was only a trend and no statistical significance was observed. Moreover, preoperative pathologic caloric responses (CRs) better predicted the postoperative onset of vestibular symptoms. CONCLUSION The preoperative consideration of a complicated CI-induced vertigo is important in the counseling particularly of elderly patients. We identified some risk factors for post-CI vertigo that should be considered in the patient's counseling: preoperative pathologic CRs, the extent of surgical trauma, and possibly the use of an LW EA, regardless of the length.
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Affiliation(s)
- Farnaz Matin
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Caroline Krueger
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Emilio Avallone
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Willi Rossberg
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Alexey Demyanchuk
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Annette Guenther
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Thomas Lenarz
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Anke Lesinski-Schiedat
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
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An overview of factors affecting bimodal and electric-acoustic stimulation (EAS) speech understanding outcomes. Hear Res 2023; 431:108736. [PMID: 36931019 DOI: 10.1016/j.heares.2023.108736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Improvements in device technology, surgical technique, and patient outcomes have resulted in a broadening of cochlear implantation criteria to consider those with increasing levels of useful low-to-mid frequency residual acoustic hearing. Residual acoustic hearing allows for the addition of a hearing aid (HA) to complement the cochlear implant (CI) and has demonstrated enhanced listening outcomes. However, wide inter-subject outcome variability exists and thus identification of contributing factors would be of clinical interest and may aid with pre-operative patient counselling. The optimal fitting procedure and frequency assignments for the two hearing devices used in combination to enhance listening outcomes also remains unclear. The understanding of how acoustic and electric speech information is fundamentally combined and utilised by the listener may allow for the optimisation of device fittings and frequency allocations to provide best bimodal and electric-acoustic stimulation (EAS) patient outcomes. This article will provide an overview of contributing factors to bimodal and EAS listening outcomes, explore areas of contention, and discuss common study limitations.
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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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Abstract
INTRODUCTION More than 5% of the world's population have a disabling hearing loss which can be managed by hearing aids or implanted electrical devices. However, outcomes are highly variable, and the sound perceived by recipients is far from perfect. Sparked by the discovery of progenitor cells in the cochlea and rapid progress in drug delivery to the cochlea, biological and pharmaceutical therapies are currently in development to improve the function of the cochlear implant or eliminate the need for it altogether. AREAS COVERED This review highlights progress in emerging regenerative strategies to restore hearing and adjunct therapies to augment the cochlear implant. Novel approaches include the reprogramming of progenitor cells to restore the sensory hair cell population in the cochlea, gene therapy and gene editing to treat hereditary and acquired hearing loss. A detailed review of optogenetics is also presented as a technique that could enable optical stimulation of the spiral ganglion neurons, replacing or complementing electrical stimulation. EXPERT OPINION Increasing evidence of substantial reversal of hearing loss in animal models, alongside rapid advances in delivery strategies to the cochlea and learnings from clinical trials will amalgamate into a biological or pharmaceutical therapy to replace or complement the cochlear implant.
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Affiliation(s)
- Elise Ajay
- Bionics Institute, East Melbourne, Victoria, Australia.,University of Melbourne, Department of Engineering
| | | | - Rachael Richardson
- Bionics Institute, East Melbourne, Victoria, Australia.,University of Melbourne, Medical Bionics Department, Parkville, Victoria, Australia.,University of Melbourne, Department of Surgery (Otolaryngology), East Melbourne, Victoria, Australia
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Jwair S, Boerboom RA, Versnel H, Stokroos RJ, Thomeer HGXM. Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): a study protocol for a randomized single-blind controlled trial. Trials 2021; 22:895. [PMID: 34886884 PMCID: PMC8656003 DOI: 10.1186/s13063-021-05878-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2021] [Indexed: 12/26/2022] Open
Abstract
Background In order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a “straight” lateral wall lying electrode array (LW) or a “pre-curved” perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that there is a difference in hearing preservation outcomes between the four possible treatment options. Methods We designed a monocenter, multi-arm, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of an electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is the comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar translocation, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG). Discussion Cochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relatively simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation. Trial registration Netherlands Trial Register (NTR) NL8586. Registered on 4 May 2020. Retrospectively registered; 3/48 participants were included before registration. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05878-2.
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Affiliation(s)
- Saad Jwair
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands. .,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Ralf A Boerboom
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, 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, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, 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, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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Abstract
INTRODUCTION Despite substantial benefits of cochlear implantation (CI) there is a high variability in speech recognition, the reasons for which are not fully understood. Especially the group of low-performing CI users is under-researched. Because of limited perceptual quality, top-down mechanisms play an important role in decoding the speech signal transmitted by the CI. Thereby, differences in cognitive functioning and linguistic skills may explain speech outcome in these CI subjects. MATERIAL AND METHODS Fifteen post-lingually deaf CI recipients with a maximum speech perception of 30% in the Freiburger monosyllabic test (low performer = LP) underwent visually presented neurocognitive and linguistic test batteries assessing attention, memory, inhibition, working memory, lexical access, phonological input as well as automatic naming. Nineteen high performer (HP) with a speech perception of more than 70% were included as a control. Pairwise comparison of the two extreme groups and discrimination analysis were carried out. RESULTS Significant differences were found between LP and HP in phonological input lexicon and word retrieval (p = 0.0039∗∗). HP were faster in lexical access (p = 0.017∗) and distinguished more reliably between non-existing and existing words (p = 0.0021∗∗). Furthermore, HP outperformed LP in neurocognitive subtests, most prominently in attention (p = 0.003∗∗). LP and HP were primarily discriminated by linguistic performance and to a smaller extent by cognitive functioning (canonic r = 0.68, p = 0.0075). Poor rapid automatic naming of numbers helped to discriminate LP from HP CI users 91.7% of the time. CONCLUSION Severe phonologically based deficits in fast automatic speech processing contribute significantly to distinguish LP from HP CI users. Cognitive functions might partially help to overcome these difficulties.
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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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Assessing Cochlear Implant Insertion Angle From an Intraoperative X-ray Using a Rotating 3D Helical Scala Tympani Model. Otol Neurotol 2020; 41:e686-e694. [DOI: 10.1097/mao.0000000000002638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of electrophysiological parameters between perimodiolar and lateral wall electrodes in paediatric cochlear implant users. Eur Arch Otorhinolaryngol 2020; 277:2693-2699. [DOI: 10.1007/s00405-020-05927-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
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