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Yancey KL, Patro A, Smetak M, Perkins EL, Isaacson B, Bennett ML, O'Malley M, Haynes DS, Hunter JB. Evaluating calcium channel blockers and bisphosphonates as otoprotective agents in cochlear implantation hearing preservation candidates. Cochlear Implants Int 2024:1-9. [PMID: 38738388 DOI: 10.1080/14670100.2024.2338003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Evaluate potential effects of calcium channel blockers (CCB) and bisphosphonates (BP) on residual hearing following cochlear implantation. METHODS Medications of 303 adult hearing preservation (HP) candidates (low frequency pure tone average [LFPTA] of 125, 250, and 500 Hz ≤80 dB HL) were reviewed. Postimplantation LFPTA of patients taking CCBs and BPs were compared to controls matched by age and preimplantation LFPTA. RESULTS Twenty-six HP candidates were taking a CCB (N = 14) or bisphosphonate (N = 12) at implantation. Median follow-up was 1.37 years (range 0.22-4.64y). Among subjects with initial HP, 29% (N = 2 of 7) CCB users compared to 50% (N = 2 of 4) controls subsequently lost residual hearing 3-6 months later (OR = 0.40, 95% CI = 0.04-4.32, p = 0.58). None of the four BP patients with initial HP experienced delayed loss compared to 50% (N = 2 of 4) controls with initial HP (OR = 0.00, 95% CI = 0.00-1.95, P = 0.43). Two CCB and one BP patients improved to a LFPTA <80 dB HL following initial unaided thresholds that suggested loss of residual hearing. DISCUSSION There were no significant differences in the odds of delayed loss of residual hearing with CCBs or BPs. CONCLUSION Further investigation into potential otoprotective adjuvants for maintaining residual hearing following initial successful hearing preservation is warranted, with larger cohorts and additional CCB/BP agents.
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Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Miriam Smetak
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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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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Mussoi BS, Meibos A, Woodson E, Sydlowski S. The association between electrode impedance and short-term outcomes in cochlear implant recipients of slim modiolar and slim straight electrode arrays. Cochlear Implants Int 2024; 25:59-68. [PMID: 38081181 DOI: 10.1080/14670100.2023.2290768] [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: 07/17/2024]
Abstract
OBJECTIVES Electrode impedance measurements from cochlear implants (CI) reflect the status of the electrode array as well as the surrounding cochlear environment, and could provide a clinical index of functional changes with the CI. The goals of this study were to examine (1) the impact of electrode array type on electrode impedance, and (2) the relationship between electrode impedance and short-term hearing preservation and speech recognition outcomes. METHODS Retrospective study of 115 adult hearing preservation CI recipients of a slim modiolar or slim straight array. Common ground electrode impedances, pre- and post-operative hearing thresholds and CNC word recognition scores were retrieved. RESULTS Electrode impedances were significantly higher for recipients of the straight electrode array. Within individuals, electrode impedances were stable after the first week post-activation. However, increased standard deviation of electrode impedances was associated with greater loss of low frequency hearing at initial activation, and with poorer speech recognition at 6 months post-implantation. CONCLUSIONS Results demonstrate that electrode impedances depend on the type of implanted array. Findings also suggest that there may be a role for the variability in electrode impedance across electrodes as an indicator of changes in the intracochlear environment that contribute to outcomes with a CI.
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Affiliation(s)
- Bruna S Mussoi
- Speech Pathology and Audiology, Kent State University, Kent, OH, USA
| | - Alex Meibos
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, OH, USA
| | - Erika Woodson
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Sydlowski
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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Gay RD, Enke YL, Kirk JR, Goldman DR. Therapeutics for hearing preservation and improvement of patient outcomes in cochlear implantation—Progress and possibilities. Hear Res 2022; 426:108637. [DOI: 10.1016/j.heares.2022.108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022]
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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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Jensen MJ, Isaac H, Hernandez H, Oleson J, Dunn C, Gantz BJ, Hansen MR. Timing of Acoustic Hearing Changes After Cochlear Implantation. Laryngoscope 2022; 132:2036-2043. [PMID: 34882792 PMCID: PMC9177890 DOI: 10.1002/lary.29984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the timing of acoustic hearing changes among hearing preservation Cochlear implant (CI) recipients. To determine differences in hearing outcomes based on device type and demographic factors. To determine if there is a relationship between the extent of early hearing loss after CI and the subsequent rate of continued hearing loss. STUDY DESIGN Prospective, single subject study. METHODS Two hundred and eleven subjects who received a hearing preservation CI were included in the study-80 Nucleus Hybrid L24 (Cochlear), 47 422/522 (Cochlear), 24 S8 (Cochlear), 14 S12 (Cochlear), 6 SRW (Cochlear), 21 SLIM J (Advanced Bionics), and 19 Flex (Med-EL). Of these, 127 were included in the subsequent analyses. Audiometric thresholds (low frequency pure-tone-averages) were collected and compared pre and postoperatively. RESULTS Long-term hearing preservation rates were 65% (52/80) for L24, 83% (20/24) for S8, 79% (11/14) for S12, 83% (5/6) for SRW, 54% (25/47) for 422/522, 91% (21/23) for SLIM J, and 84% (16/19) for Flex. Hearing loss was not related to device type (P = .9105) or gender (P = .2169). Older subjects (age ≥65) had worse hearing outcomes than younger subjects after initial device activation (age <65, P = .0262). There was no significant difference in rate of hearing loss over time between older and younger patients (P = .0938). Initial postoperative hearing loss was not associated with the rate of long-term hearing loss. CONCLUSIONS Long-term low frequency hearing preservation is possible for CI recipients and is not associated with gender or device type. Rate of hearing loss over time is not dependent on patient age. Early hearing loss after CI does not predict the rate of long-term hearing loss. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2036-2043, 2022.
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Affiliation(s)
- Megan J. Jensen
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Heba Isaac
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Helin Hernandez
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Camille Dunn
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Bruce J. Gantz
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
- Departments of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Marlan R. Hansen
- Department of Otolaryngology – Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
- Departments of Neurosurgery, University of Iowa, Iowa City, IA, USA
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Perkins EL, Labadie RF, O’Malley M, Bennett M, Noble JH, Haynes DS, Gifford R. The Relation of Cochlear Implant Electrode Array Type and Position on Continued Hearing Preservation. Otol Neurotol 2022; 43:e634-e640. [PMID: 35709407 PMCID: PMC9824900 DOI: 10.1097/mao.0000000000003547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze the relationship of electrode array (EA) type and position on hearing preservation longevity following cochlear implantation. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Adult cochlear implant recipients between 2013 and 2019 with hearing preserved postoperatively and postoperative CT scans. INTERVENTIONS CT scan analysis of EA position. Stepwise regression to determine influence of EA position, EA type, and patient demographics on postoperative low frequency hearing. MAIN OUTCOME MEASURES Low frequency pure tone average (LFPTA), LFPTA shift, angular insertion depth, base insertion depth, scalar position, mean perimodiolar distance. RESULTS Of 792 cochlear implant recipients, 121 had preoperative LFPTA <80 dB HL with 60 of the 121 (49.6%) implanted with straight, 32 (26.4%) with precurved, styletted, and 29 (24.0%) implanted precurved, nonstyletted EA. Mean follow up was 28.6 months (range 1-103). There was no statistically significant difference in activation, 6- and 12-month, and last follow-up LFPTA (125, 250, and 500 Hz) shift based on EA type (straight p = 0.302, precurved, styletted p = 0.52, precurved, nonstyletted p = 0.77). Preoperative LFPTA and age of implantation were significant predictors of LFPTA shift at activation, accounting for 30.8% of variance ( F [2, 113] = 26.603, p < 0.0001). LFPTA shift at activation, scalar position, and base insertion depth were significant predictors of variability and accounted for 39.1% of variance in LFPTA shift at 6 months ( F [3, 87] = 20.269, p < 0.0001). Only LFPTA shift at 12 months was found to be a significant predictor of LFPTA shift at last follow up, accounting for 41.0% of variance ( F [1, 48] = 32.653, p < 0.0001). CONCLUSIONS Patients had excellent long-term residual hearing regardless of EA type. Age, preoperative acoustic hearing, and base insertion depth may predict short term preservation, while 12-month outcomes significantly predicted long-term hearing preservation.
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Affiliation(s)
- Elizabeth L. Perkins
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert F. Labadie
- Department of Otolarynology – Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Matthew O’Malley
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc Bennett
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Vanderbilt Bill Wilkerson Center, Department of Hearing and Speech Sciences, Nashville, Tennessee
| | - David S. Haynes
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René Gifford
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Wimmer W, Sclabas L, Caversaccio M, Weder S. Cochlear Implant Electrode Impedance as Potential Biomarker for Residual Hearing. Front Neurol 2022; 13:886171. [PMID: 35832176 PMCID: PMC9271767 DOI: 10.3389/fneur.2022.886171] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction and ObjectivesAmong cochlear implant candidates, an increasing number of patients are presenting with residual acoustic hearing. To monitor the postoperative course of structural and functional preservation of the cochlea, a reliable objective biomarker would be desirable. Recently, impedance telemetry has gained increasing attention in this field. The aim of this study was to investigate the postoperative course of the residual acoustic hearing and clinical impedance in patients with long electrode arrays and to explore the applicability of impedance telemetry for monitoring residual hearing.MethodsWe retrospectively analyzed records of 42 cochlear implant recipients with residual hearing covering a median postoperative follow-up of 25 months with repeated simultaneous pure tone audiometry and impedance telemetry. We used a linear mixed-effects model to estimate the relation between clinical electrode impedance and residual hearing. Besides the clinical impedance, the follow-up time, side of implantation, gender, and age at implantation were included as fixed effects. An interaction term between impedance and follow-up time, as well as subject-level random intercepts and slopes, were included.ResultsLoss of residual hearing occurred either during surgery or within the first 6 post-operative months. Electrode contacts inserted further apically (i.e., deeper) had higher impedances, independent of residual hearing. The highest impedances were measured 1 month postoperatively and gradually decreased over time. Basal electrodes were more likely to maintain higher impedance. Follow-up time was significantly associated with residual hearing. Regardless of the time, we found that a 1 kΩ increase in clinical impedance was associated with a 4.4 dB deterioration of residual hearing (p < 0.001).ConclusionPure tone audiometry is the current gold standard for monitoring postoperative residual hearing. However, the association of clinical impedances with residual hearing thresholds found in our study could potentially be exploited for objective monitoring using impedance telemetry. Further analysis including near-field related impedance components could be performed for improved specificity to local immune responses.
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Affiliation(s)
- Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Wilhelm Wimmer
| | - Luca Sclabas
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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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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Tejani VD, Yang H, Kim JS, Hernandez H, Oleson JJ, Hansen MR, Gantz BJ, Abbas PJ, Brown CJ. Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing. J Assoc Res Otolaryngol 2022; 23:95-118. [PMID: 34686938 PMCID: PMC8782980 DOI: 10.1007/s10162-021-00809-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/25/2021] [Indexed: 02/03/2023] Open
Abstract
Acoustic hearing can be preserved after cochlear implant (CI) surgery, allowing for combined electric-acoustic stimulation (EAS) and superior speech understanding compared to electric-only hearing. Among patients who initially retain useful acoustic hearing, 30-40 % experience a delayed hearing loss that occurs 3 or more months after CI activation. Increases in electrode impedances have been associated with delayed loss of residual acoustic hearing, suggesting a possible role of intracochlear inflammation/fibrosis as reported by Scheperle et al. (Hear Res 350:45-57, 2017) and Shaul et al. (Otol Neurotol 40(5):e518-e526, 2019). These studies measured only total impedance. Total impedance consists of a composite of access resistance, which reflects resistance of the intracochlear environment, and polarization impedance, which reflects resistive and capacitive properties of the electrode-electrolyte interface as described by Dymond (IEEE Trans Biomed Eng 23(4):274-280, 1976) and Tykocinski et al. (Otol Neurotol 26(5):948-956, 2005). To explore the role of access and polarization impedance components in loss of residual acoustic hearing, these measures were collected from Nucleus EAS CI users with stable acoustic hearing and subsequent precipitous loss of hearing. For the hearing loss group, total impedance and access resistance increased over time while polarization impedance remained stable. For the stable hearing group, total impedance and access resistance were stable while polarization impedance declined. Increased access resistance rather than polarization impedance appears to drive the increase in total impedances seen with loss of hearing. Moreover, access resistance has been correlated with intracochlear fibrosis/inflammation in animal studies as observed by Xu et al. (Hear Res 105(1-2):1-29, 1997) and Tykocinski et al. (Hear Res 159(1-2):53-68, 2001). These findings thus support intracochlear inflammation as one contributor to loss of acoustic hearing in our EAS CI population.
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Affiliation(s)
- Viral D. Tejani
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA USA
| | - Hyejin Yang
- Department of Biomedical Engineering, University of Ulsan, Ulsan, South Korea
| | - Jeong-Seo Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA USA
| | - Helin Hernandez
- Department of Biostatistics, University of Iowa, Iowa City, IA USA
| | - Jacob J. Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA USA
| | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Molecular Physiology and Biophysics, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Bruce J. Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Paul J. Abbas
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA USA
| | - Carolyn J. Brown
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA ,Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA USA
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Increasing the reliability of real-time electrocochleography during cochlear implantation: a standardized guideline. Eur Arch Otorhinolaryngol 2022; 279:4655-4665. [DOI: 10.1007/s00405-021-07204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
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Saoji AA, Graham M, Stein A, Koka K. Analysis of electrode impedance and its subcomponents for lateral wall, mid-scala, and perimodiolar electrodes in cochlear implants. Cochlear Implants Int 2021; 23:87-94. [PMID: 34895078 DOI: 10.1080/14670100.2021.2000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Electrode impedances play an important role in cochlear implant patient management. During clinical visits, electrode impedances are calculated from a single point voltage waveform. In the present study, multipoint electrode impedance analysis was performed to study electrode impedance and its subcomponents in patients with three different types of cochlear implant electrode arrays. DESIGN Voltage waveforms were measured at six different time points during the cathodic phase of a biphasic pulse in forty-seven cochlear implant patients with perimodiolar, mid-scala, or lateral wall electrode arrays. Multipoint electrode impedances were used to determine access resistance and polarization impedance. RESULTS Access resistance of approximately 5 kΩ was calculated across the three different electrode arrays. Mid-scala electrodes showed a smaller increase in impedances as a function of pulse duration compared to the other electrodes. Patients with lower impedances showed higher capacitance and lower resistance, suggesting that differences in electrochemical reaction at the electrodes' surface can influence impedances in cochlear implants. CONCLUSIONS Analysis of cochlear implant electrode impedances and their subcomponents provides valuable information about resistance to the flow of current between stimulating and return electrodes, and build an understanding of the contribution of electrochemical processes used to deliver electrical stimulation to the auditory nerve.
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Affiliation(s)
- Aniket A Saoji
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Madison Graham
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Amy Stein
- Research and Technology, Advanced Bionics, Valencia, CA, USA
| | - Kanthaiah Koka
- Research and Technology, Advanced Bionics, Valencia, CA, USA
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Long-term Hearing Preservation and Speech Perception Performance Outcomes With the Slim Modiolar Electrode. Otol Neurotol 2021; 42:e1486-e1493. [PMID: 34510116 DOI: 10.1097/mao.0000000000003342] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Describe audiologic outcomes in hearing preservation (HP) cochlear implant candidates using a slim modiolar electrode (SME). STUDY DESIGN Retrospective. SETTING Tertiary referral center. PATIENTS Two hundred three adult cochlear implant patients with preoperative low-frequency pure-tone average (LFPTA) ≤ 80 dB HL that received the SME. INTERVENTION Implantation with a SME electrode. MAIN OUTCOME MEASURES Primary outcome was postoperative HP, defined as LFPTA ≤80 dB HL. HP status was analyzed at "early" (activation or 3 mo) and "long-term" (6 or 12 mo) time frames using the patient's worst audiogram. Speech perception tests were compared between HP and non-HP cohorts. RESULTS Of the 203 HP candidates, the tip fold-over rate was 7.4%. The mean shifts in LFPTA at the "early" and "long-term" time points were 25.9 ± 16.2 dB HL and 29.6 ± 16.9 dB HL, respectively. Of 117 patients with preoperative LFPTA ≤60 dB HL, the early and long-term mean LFPTA shifts were 19.5 ± 12.3 dB HL and 32.6 ± 17.2 dB HL, respectively; early and long-term HP rates were 61.1% and 50.8%, respectively. For patients with preoperative LFPTA ≤80 dB HL, early and long-term HP rates were 45.5% and 43.7%, respectively. No significant difference was observed in postoperative speech perception performance (CNC, AzBio, HINT) at 3, 6, or 12 months between HP versus non-HP groups. CONCLUSIONS HP is feasible using the SME. While electroacoustic stimulation was not studied in this cohort, HP provided no clear advantage in speech perception abilities in this group of patients. The current reporting standard of what constitutes HP candidacy (preoperative LFPTA ≤80 dB HL) should be reconsidered.
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Abstract
OBJECTIVE The physical shape of cochlear implant (CI) arrays may impact hearing outcomes. The goal of this study was to compare post-operative speech and melody perception between patients with lateral wall (LW) and perimodiolar (PM) electrode arrays across a range of lengths and manufacturers. STUDY DESIGN Retrospective chart review. SETTING Tertiary Care Hospital. PATIENTS 119 adult patients with post-lingual hearing loss who underwent cochlear implantation. MAIN OUTCOME MEASURES A total of seven different electrodes were evaluated including 5 different LW electrodes (CI422 [Cochlear American], 1J [Advanced Bionics], Medium [Med El], Standard [Med El], Flex28 [Med El]) and 2 PM electrodes (Contour [Cochlear American], MidScala [Advanced Bionics]). Speech perception outcomes (n = 119 patients) were measured by Consonant-Nucleus-Consonant (CNC) scores collected 3, 6, 12 and 24 months after implantation. Melody perception outcomes (n = 35 CI patients and n = 6 normal hearing patients) were measured by Melodic Contour Identification (MCI). RESULTS CNC scores increased over time after implantation across all array designs. PM designs exhibited higher CNC scores compared to LW electrodes, particularly 6-months after implantation. Pre-operative pure tone averages did not correlate with post-operative CNC scores. PM arrays outperformed LW electrodes in terms of MCI scores. CONCLUSIONS The physical shape of cochlear implant electrode arrays may impact hearing performance. Compared to LW designs, PM arrays appear to offer superior speech perception during the first 6 months after implantation, with performance equalizing between groups by 24 months. Compared to LW designs, PM arrays also appear to afford superior melody perception.
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Jimenez JE, Govil N, Shaffer AD, Ledonne JC, Chi DH. Hearing preservation with a slim modiolar cochlear implant in a pediatric cohort. Int J Pediatr Otorhinolaryngol 2021; 140:110479. [PMID: 33190921 DOI: 10.1016/j.ijporl.2020.110479] [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: 07/26/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Recent cochlear implant (CI) electrodes are designed to be atraumatic to inner ear structures. Studies in adults have demonstrated improved hearing preservation rates with the CI532/632 electrode, but none have examined this in children. Our objective is to describe the hearing preservation rate with CI532/632 in pediatric patients and determine factors that influence hearing preservation. METHODS We conducted a retrospective cohort study of children undergoing CI over a three-year period. Inclusion criteria were: CI with the 532/632 electrode, presence of pre-operative low frequency hearing defined by pure tone average (PTA) of ≤80 dB at 250 Hz or at the average of 250 and 500 Hz, and post-operative unaided audiometry. Other data collected included demographics, otologic history, imaging, and surgical details. RESULTS A total of 13 patients and 15 ears were included. Hearing was preserved in 10/15 (66%) ears at an average follow-up of 6 months, similar to that reported in the adult literature. Patients with preserved hearing post-operatively were more likely to have a positive family history of hearing loss. There was a trend towards patients with anatomic inner ear abnormalities being more likely to lose hearing after CI, but this was not statistically significant. Pre-operative thresholds were not predictive of hearing preservation. Patients with preserved hearing had a significantly smaller shift in thresholds after cochlear implantation. Therefore, hearing preserved and non-preserved groups differed more by the magnitude of change in threshold, rather than their preoperative threshold. Other factors such as age, sex, surgeon, and surgery duration were not associated with hearing preservation. CONCLUSION This study describes low frequency hearing preservation after pediatric CI532/632 implantation. The hearing preservation rate in our cohort was consistent with that reported in the adult literature. Our data suggest that preoperative thresholds do not solely determine which patients will go on to experience hearing preservation. We believe this will aid surgeons with patient-specific device selection and counseling potential pediatric CI recipients with preserved hearing.
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Affiliation(s)
- Joaquin E Jimenez
- Department of Otolaryngology, University of Pittsburgh Medical Center, UPMC Eye & Ear Institute, 203 Lothrop Street, Suite 519, Pittsburgh, PA, 15213, United States.
| | - Nandini Govil
- Department of Otolaryngology-Head and Neck Surgery, Emory University & Children's Healthcare of Atlanta, 1400 Tullie Road NE, 1st Floor, Atlanta, GA, 30329, United States.
| | - Amber D Shaffer
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
| | - Jessica C Ledonne
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
| | - David H Chi
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
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Velandia S, Martinez D, Goncalves S, Pena S, Bas E, Ein L, Prentiss S, Telischi F, Angeli S, Dinh CT. Effect of age, electrode array, and time on cochlear implant impedances. Cochlear Implants Int 2020; 21:344-352. [PMID: 32640889 DOI: 10.1080/14670100.2020.1788859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To determine the impact of age, electrode array, and time on impedance patterns in cochlear implant (CI) patients. Methods: A retrospective case review was performed on 98 patients implanted with the CI24RE perimodiolar (PM) and CI422 lateral wall (LW) arrays between 2010 and 2014 to assess impedances at the 1 week and 3-6 month visit after initial stimulation (IS). Results: With respect to age, impedances were higher in young patients compared to older patients in the middle and apical turns. With time, there were significant reductions in impedances across most electrodes. Electrode array type also had a significant impact on impedance measurements with PM and LW arrays having higher impedances in the basal turn and apical turns, respectively. Furthermore, PM arrays demonstrated significantly lower impedances in the middle and apical turn with time, when compared to LW arrays. Conclusions: Age, electrode array, and time can independently affect CI impedances. Moreover, we show that PM arrays may be advantageous to LW arrays, due to demonstrated lower impedances in the middle and apical turns long term. Understanding the impact of impedance on speech discrimination and determining the intracochlear processes that contribute to differences in impedance are future research directions.
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Affiliation(s)
- Sandra Velandia
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diane Martinez
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefania Goncalves
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stefanie Pena
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Esperanza Bas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Liliana Ein
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sandra Prentiss
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fred Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simon Angeli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christine T Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
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