1
|
Dhanasingh A, Nielsen SB, Beal F, Schilp S, Hessler R, Jolly C, Hochmair I. Cochlear implant electrode design for safe and effective treatment. Front Neurol 2024; 15:1348439. [PMID: 38756216 PMCID: PMC11096578 DOI: 10.3389/fneur.2024.1348439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
The optimal placement of a cochlear implant (CI) electrode inside the scala tympani compartment to create an effective electrode-neural interface is the base for a successful CI treatment. The characteristics of an effective electrode design include (a) electrode matching every possible variation in the inner ear size, shape, and anatomy, (b) electrically covering most of the neuronal elements, and (c) preserving intra-cochlear structures, even in non-hearing preservation surgeries. Flexible electrode arrays of various lengths are required to reach an angular insertion depth of 680° to which neuronal cell bodies are angularly distributed and to minimize the rate of electrode scalar deviation. At the time of writing this article, the current scientific evidence indicates that straight lateral wall electrode outperforms perimodiolar electrode by preventing electrode tip fold-over and scalar deviation. Most of the available literature on electrode insertion depth and hearing outcomes supports the practice of physically placing an electrode to cover both the basal and middle turns of the cochlea. This is only achievable with longer straight lateral wall electrodes as single-sized and pre-shaped perimodiolar electrodes have limitations in reaching beyond the basal turn of the cochlea and in offering consistent modiolar hugging placement in every cochlea. For malformed inner ear anatomies that lack a central modiolar trunk, the perimodiolar electrode is not an effective electrode choice. Most of the literature has failed to demonstrate superiority in hearing outcomes when comparing perimodiolar electrodes with straight lateral wall electrodes from single CI manufacturers. In summary, flexible and straight lateral wall electrode type is reported to be gentle to intra-cochlear structures and has the potential to electrically stimulate most of the neuronal elements, which are necessary in bringing full benefit of the CI device to recipients.
Collapse
|
2
|
Wong D, Copson B, Gerard JM, Hill F, Leigh J, Dowell R. Cochlear implantation in advanced otosclerosis: utility of pre-operative radiological assessment in predicting intra-operative difficulty and final electrode position. J Laryngol Otol 2023; 137:1248-1255. [PMID: 37016895 DOI: 10.1017/s0022215123000609] [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: 04/06/2023]
Abstract
OBJECTIVE This study aimed to determine if pre-operative radiological scoring can reliably predict intra-operative difficulty and final cochlear electrode position in patients with advanced otosclerosis. METHOD A retrospective cohort study of advanced otosclerosis patients who underwent cochlear implantation (n = 48, 52 ears) was compared with a larger cohort of post-lingually deaf adult patients (n = 1414) with bilateral hearing loss and normal cochlear anatomy. Pre-operative imaging for advanced otosclerosis patients and final electrode position were scored and correlated with intra-operative difficulty and speech outcomes. RESULTS Advanced otosclerosis patients benefit significantly from cochlear implantation. Mean duration of deafness was longer in the advanced otosclerosis group (19.5 vs 14.3 years; p < 0.05). CONCLUSION Anatomical changes in advanced otosclerosis can result in increased difficulty of surgery. Evidence of pre-operative cochlear luminal changes was associated with intra-operative difficult insertion and final non-scala tympani position. Nearly all electrodes implanted in the advanced otosclerosis cohort were peri-modiolar. No reports of facial nerve stimulation were observed.
Collapse
Affiliation(s)
- D Wong
- Department of Otolaryngology, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - B Copson
- Department of Radiology, St Vincent's Hospital, Melbourne, Australia
- Department of Surgery (Otolaryngology), University of Melbourne, Parkville, Australia
| | - J-M Gerard
- Department of Otolaryngology, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - F Hill
- Department of Otolaryngology, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - J Leigh
- Department of Otolaryngology, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Audiology, University of Melbourne, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - R Dowell
- Department of Otolaryngology, Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Audiology, University of Melbourne, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| |
Collapse
|
3
|
Alahmadi A, Abdelsamad Y, Yousef M, Alhabib SF, Alshalan A, Hamed N, Alzhrani F. Risk factors and management strategies of inadvertent facial nerve stimulation in cochlear implant recipients: A systematic review. Laryngoscope Investig Otolaryngol 2023; 8:1345-1356. [PMID: 37899846 PMCID: PMC10601549 DOI: 10.1002/lio2.1121] [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: 07/20/2022] [Revised: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS. Data Source Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO). Review Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co-anomalies; and duration of hearing loss and their relationships with FNS were also studied. Results Twenty-one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients. Conclusion FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.
Collapse
Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of MedicineKing Saud University Medical City (KSUMC), King Saud UniversityRiyadhSaudi Arabia
| | | | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), College of MedicineKing Saud University Medical City (KSUMC), King Saud UniversityRiyadhSaudi Arabia
- Audiology Unit, ENT DepartmentMenoufia UniversityMenoufiaEgypt
| | - Salman F Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of MedicineKing Saud University Medical City (KSUMC), King Saud UniversityRiyadhSaudi Arabia
| | - Afrah Alshalan
- Department of Otolaryngology‐Head and Neck SurgeryCollege of Medicine, Jouf UniversitySakakaSaudi Arabia
| | - Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of MedicineKing Saud University Medical City (KSUMC), King Saud UniversityRiyadhSaudi Arabia
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of MedicineKing Saud University Medical City (KSUMC), King Saud UniversityRiyadhSaudi Arabia
| |
Collapse
|
4
|
Silva VAR, Pauna HF, Lavinsky J, Guimarães GC, Abrahão NM, Massuda ET, Vianna MF, Ikino CMY, Santos VM, Polanski JF, Silva MNLD, Sampaio ALL, Zanini RVR, Lourençone LFM, Denaro MMDC, Calil DB, Chone CT, Castilho AM. Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101303. [PMID: 37647735 PMCID: PMC10474207 DOI: 10.1016/j.bjorl.2023.101303] [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: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
Collapse
Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Guilherme Corrêa Guimarães
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Nicolau Moreira Abrahão
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericordia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Departamento de Cirurgia e Hospital Universitário, Florianópolis, SC, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackensie do Paraná, Curitiba, PR, Brazil
| | | | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | | | - Luiz Fernando Manzoni Lourençone
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil
| | | | - Daniela Bortoloti Calil
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| |
Collapse
|
5
|
Benson JC, Nassiri AM, Saoji AA, Carlson ML, Lane JI. Co-Registration of pre- and post-Operative images after cochlear Implantation: A proposed technique to Improve cochlear visualization and localization of cochlear electrodes. Neuroradiol J 2023; 36:194-197. [PMID: 35985649 PMCID: PMC10034710 DOI: 10.1177/19714009221122180] [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
BACKGROUND AND PURPOSE After cochlear implantation, metallic artifact can obscure nearby structures on CT images, which is problematic in patients with facial nerve stimulation (FNS). This study evaluated the usefulness of co-registered pre- and post-operative examinations to evaluate the cochlear implant and adjacent structures. MATERIALS AND METHODS A retrospective review was completed of consecutive patients that underwent CT imaging of the temporal bone before and after placement of a cochlear implant. Two blinded neuroradiologists independently reviewed all available examinations. All examinations were assessed for the presence or absence of dehiscence of the osseous ridge between the cochlea and facial nerve canal (FNC). Pre-operative and fused pre- and post-operative examinations were compared in their ability to visualize the osseous ridge using a 5-point Likert scale (ranging from 1 = unfused images were substantially superior to 5 = fused images were substantially superior). The electrode closest to the FNC were noted. RESULTS Of 34 included patients, 13 (38.2%) were female and 21 (61.8%) were male; average age was 72.2. Seven patients (20.6%) had frank dehiscence between the cochlea and FNC. Fused images were superior to the post-operative study alone for assessing the integrity of the osseous partition between the cochlea and FNC and for reducing artifact from the electrode array (average Likert scores for both reviewers were 4.4 and 4.7). There was good agreement between reviewers in noting electrode closest to the FNC (concordance correlation coefficient=0.82). CONCLUSIONS Following cochlear implantation, co-registered pre- and post-operative CT images are superior to conventional images in assessing the anatomic relationship between the cochlea and FNC.
Collapse
|
6
|
Herrmann DP, Kalkman RK, Frijns JHM, Bahmer A. Intra-cochlear differences in the spread of excitation between biphasic and triphasic pulse stimulation in cochlear implants: A modeling and experimental study. Hear Res 2023; 432:108752. [PMID: 37019060 DOI: 10.1016/j.heares.2023.108752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
Triphasic pulse stimulation can prevent unpleasant facial nerve stimulation in cochlear implant users. Using electromyographic measurements on facial nerve effector muscles, previous studies have shown that biphasic and triphasic pulse stimulations produce different input-output functions. However, little is known about the intracochlear effects of triphasic stimulation and how these may contribute to the amelioration of facial nerve stimulation. The present study used a computational model of implanted human cochleae to investigate the effect of pulse shape on the intracochlear spread of excitation. Biphasic and triphasic pulse stimulations were simulated from three different cochlear implant electrode contact positions. To validate the model results, experimental spread of excitation measurements were conducted with biphasic and triphasic pulse stimulation from three different electrode contact positions in 13 cochlear implant users. The model results depict differences between biphasic and triphasic pulse stimulations depending on the position of the stimulating electrode contact. While biphasic and triphasic pulse stimulations from a medial or basal electrode contact caused similar extents of neural excitation, differences between the pulse shapes were observed when the stimulating contact was located in the cochlear apex. In contrast, the experimental results showed no difference between the biphasic and triphasic initiated spread of excitation for any of the tested contact positions. The model was also used to study responses of neurons without peripheral processes to mimic the effect of neural degeneration. For all three contact positions, simulated degeneration shifted the neural responses towards the apex. Biphasic pulse stimulation showed a stronger response with neural degeneration compared to without degeneration, while triphasic pulse stimulation showed no difference. As previous measurements have demonstrated an ameliorative effect of triphasic pulse stimulation on facial nerve stimulation from medial electrode contact positions, the results imply that a complementary effect located at the facial nerve level must be responsible for reducing facial nerve stimulation.
Collapse
Affiliation(s)
- David P Herrmann
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University Hospital Würzburg, Josef-Schneider-Str. 11, Würzburg 97080, Germany.
| | - Randy K Kalkman
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Centre, PO Box 9600, RC Leiden 2300, the Netherlands
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Centre, PO Box 9600, RC Leiden 2300, the Netherlands; Leiden Institute for Brain and Cognition, PO Box 9600, RC Leiden 2300, the Netherlands
| | - Andreas Bahmer
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University Hospital Würzburg, Josef-Schneider-Str. 11, Würzburg 97080, Germany
| |
Collapse
|
7
|
Konerding WS, Baumhoff P, Kral A. Anodic Polarity Minimizes Facial Nerve Stimulation as a Side Effect of Cochlear Implantation. J Assoc Res Otolaryngol 2023; 24:31-46. [PMID: 36459250 PMCID: PMC9971531 DOI: 10.1007/s10162-022-00878-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/05/2022] [Indexed: 12/03/2022] Open
Abstract
One severe side effect of the use of cochlear implants (CI) is coincidental facial nerve stimulation (FNS). Clinical methods to alleviate FNS range from the reprogramming of processor settings to revision surgery. We systematically assessed different changes in CI stimulation modes that have been discussed in the literature as "rescue factors" from FNS: electrode configuration (broad to focused), pulse shape (symmetric biphasic to pseudo-monophasic), and pulse polarity (cathodic to anodic). An FNS was assessed, based on electrophysiological thresholds, in 204 electrically evoked compound action potential (eCAP) input/output functions recorded from 33 ears of 26 guinea pigs. The stimulation level difference between auditory nerve eCAP threshold and FNS threshold was expressed as the eCAP-to-FNS offset. Coincidental FNS occurred in all animals and in 45% of all recordings. A change from monopolar to focused (bipolar, tripolar) configurations minimized FNS. The Euclidean distance between the CI contacts and the facial nerve explained no more than 33% of the variance in FNS thresholds. For both the FNS threshold and the eCAP-to-FNS offset, the change from cathodic to anodic pulse polarity significantly reduced FNS and permitted a gain of 14-71% of the dynamic range of the eCAP response. This "anodic rescue effect" was stronger for pseudo-monophasic pulses as compared to the symmetric biphasic pulse shape. These results provide possible mechanisms underlying recent clinical interventions to alleviate FNS. The "anodic-rescue effect" may offer a non-invasive therapeutic option for FNS in human CI users that should be tested clinically, preferably in combination with current-focusing methods.
Collapse
Affiliation(s)
- Wiebke S. Konerding
- Department of Experimental Otology, Hannover Medical School, Nife Stadtfelddamm 34, 30559 Hannover, Germany
| | - Peter Baumhoff
- Department of Experimental Otology, Hannover Medical School, Nife Stadtfelddamm 34, 30559 Hannover, Germany
| | - Andrej Kral
- Department of Experimental Otology, Hannover Medical School, Nife Stadtfelddamm 34, 30559 Hannover, Germany ,Cluster of Excellence “Hearing 4 All” (DFG Exc. 2177), Hannover, Germany
| |
Collapse
|
8
|
Danieli F, Hyppolito MA, Hussain R, Hoen M, Karoui C, Reis ACMB. The Effects of Multi-Mode Monophasic Stimulation with Capacitive Discharge on the Facial Nerve Stimulation Reduction in Young Children with Cochlear Implants: Intraoperative Recordings. J Clin Med 2023; 12:jcm12020534. [PMID: 36675460 PMCID: PMC9863587 DOI: 10.3390/jcm12020534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Facial nerve stimulation (FNS) is a potential complication which may affect the auditory performance of children with cochlear implants (CIs). We carried out an exploratory prospective observational study to investigate the effects of the electrical stimulation pattern on FNS reduction in young children with CI. Ten ears of seven prelingually deafened children with ages up to 6 years old who undergone a unilateral or bilateral CI surgery were included in this study. Electromyographic (EMG) action potentials from orbicularis oculi muscle were recorded using monopolar biphasic stimulation (ST1) and multi-mode monophasic stimulation with capacitive discharge (ST2). Presence of EMG responses, facial nerve stimulation thresholds (T-FNS) and EMG amplitudes were compared between ST1 and ST2. Intra-cochlear electrodes placement, cochlear-nerve and electrode-nerve distances were also estimated to investigate their effects on EMG responses. The use of ST2 significantly reduced the presence of intraoperative EMG responses compared to ST1. Higher stimulation levels were required to elicit FNS with ST2, with smaller amplitudes, compared to ST1. No and weak correlation was observed between cochlea-nerve and electrode-nerve distances and EMG responses, respectively. ST2 may reduce FNS in young children with CI. Differently from the electrical stimulation pattern, the cochlea-nerve and electrode-nerve distances seem to have limited effects on FNS in this population.
Collapse
Affiliation(s)
- Fabiana Danieli
- Postgraduate Program at the Department of Health Sciences, RCS, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes 3900, Ribeirão Preto 14049-900, Brazil
- Clinical Department, Oticon Medical, Lino de Moraes Leme 883, São Paulo 04360-001, Brazil
- Correspondence:
| | - Miguel Angelo Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes 3900, Ribeirão Preto 14049-900, Brazil
| | - Raabid Hussain
- Research & Technology Department, Oticon Medical, 2765 Smørum, Denmark
| | - Michel Hoen
- Clinical Evidence Department, Oticon Medical, 2720 Chem de Saint-Bernard, 06220 Vallauris, France
| | - Chadlia Karoui
- Clinical Evidence Department, Oticon Medical, 2720 Chem de Saint-Bernard, 06220 Vallauris, France
| | - Ana Cláudia Mirândola Barbosa Reis
- Department of Health Sciences, RCS, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes 3900, Ribeirão Preto 14049-900, Brazil
| |
Collapse
|
9
|
Tuset M, Baptiste A, Cyna Gorse F, Sterkers O, Nguyen Y, Lahlou G, Ferrary E, Mosnier I. Facial nerve stimulation in adult cochlear implant recipients with far advanced otosclerosis. Laryngoscope Investig Otolaryngol 2022; 8:220-229. [PMID: 36846428 PMCID: PMC9948588 DOI: 10.1002/lio2.984] [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: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives The objective of this study was to predict occurrence of facial nerve stimulation (FNS) in cochlear implanted patients for far-advanced otosclerosis (FAO) by correlating preoperative computed tomography (CT)-scan data to FNS and to evaluate FNS impact on hearing outcomes. Methods Retrospective analysis on 91 ears (76 patients) implanted for FAO. Electrodes were straight (50%) or perimodiolar (50%). Demographic data, extension of otosclerosis on preoperative CT scan, occurrence of FNS, and speech performance were analyzed. Results Prevalence of FNS was 21% (19 ears). FNS appeared during the first month (21%), 1-6 months (26%), 6-12 months (21%), and over 1 year (32%) postimplantation. Cumulative incidence of FNS at 15 years was 33% (95% CI = [14-47%]). Extension of otosclerotic lesions on preimplantation CT-scan was more severe in FNS ears compared to No-FNS (p < .05): for Stage III, 13/19 (68%) and 18/72 (25%) ears for FNS and No-FNS groups, respectively (p < .05). Location of otosclerotic lesions relative to the facial nerve canal was similar whatever the presence or not of FNS. Electrode array had no impact on FNS occurrence. At 1 year post-implantation, duration of profound hearing loss (≥5 years) and previous stapedotomy were negatively associated with speech performance. FNS did not impact hearing outcomes, despite a lower percentage of activated electrodes (p < .01) in the FNS group. Nevertheless, FNS were associated with a decrease of speech performance both in quiet (p < .001) and in noise (p < .05). Conclusion Cochlear implanted patients for FAO are at greater risk of developing FNS affecting speech performance over time, probably due to a higher percentage of deactivated electrodes. High resolution CT-scan is an essential tool allowing FNS prediction but not time of onset. Level of evidence 2b, Laryngoscope Investigative Otolaryngology, 2022.
Collapse
Affiliation(s)
- Maria‐Pia Tuset
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | - Amandine Baptiste
- Département de Biostatistique, Santé Publique et Information médicale, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | | | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Ghizlène Lahlou
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| |
Collapse
|
10
|
Cochlear Implantation in Advanced Otosclerosis: Pitfalls and Successes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00383-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
This review will highlight recent outcome-based evidence guiding decision making for cochlear implantation in advanced otosclerosis, related complications, and technical surgical considerations in otosclerosis and the obstructed cochlea.
Recent Findings
Cochlear implantation in advanced otosclerosis results in consistent, excellent auditory outcomes with improvement in both objective speech recognition scores and subjective quality of life measures. Facial nerve stimulation may occur at higher rates in otosclerosis cochlear implant recipients. Cochlear implantation in the setting of luminal obstruction in osteosclerotic patients may be managed with altered surgical technique to achieve successful auditory improvements. Pre-operative imaging with high resolution CT or MRI may help anticipate intraoperative challenges and post-operative complications in cochlear implantation.
Summary
Cochlear implantation is an established, successful treatment for profound hearing loss in advanced otosclerosis. Surgeon knowledge of outcomes, complications, and potential surgical challenges is important to appropriately counsel patients regarding auditory rehabilitation options in advanced otosclerosis.
Collapse
|
11
|
Pieper SH, Hamze N, Brill S, Hochmuth S, Exter M, Polak M, Radeloff A, Buschermöhle M, Dietz M. Considerations for Fitting Cochlear Implants Bimodally and to the Single-Sided Deaf. Trends Hear 2022; 26:23312165221108259. [PMID: 35726211 PMCID: PMC9218456 DOI: 10.1177/23312165221108259] [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] [Indexed: 11/16/2022] Open
Abstract
When listening with a cochlear implant through one ear and acoustically through the other, binaural benefits and spatial hearing abilities are generally poorer than in other bilaterally stimulated configurations. With the working hypothesis that binaural neurons require interaurally matched inputs, we review causes for mismatch, their perceptual consequences, and experimental methods for mismatch measurements. The focus is on the three primary interaural dimensions of latency, frequency, and level. Often, the mismatch is not constant, but rather highly stimulus-dependent. We report on mismatch compensation strategies, taking into consideration the specific needs of the respective patient groups. Practical challenges typically faced by audiologists in the proposed fitting procedure are discussed. While improvement in certain areas (e.g., speaker localization) is definitely achievable, a more comprehensive mismatch compensation is a very ambitious endeavor. Even in the hypothetical ideal fitting case, performance is not expected to exceed that of a good bilateral cochlear implant user.
Collapse
Affiliation(s)
- Sabrina H Pieper
- Department of Medical Physics and Acoustic, University of Oldenburg, Oldenburg, Germany.,Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany
| | - Noura Hamze
- MED-EL Medical Electronics GmbH, Innsbruck, Austria
| | - Stefan Brill
- MED-EL Medical Electronics Germany GmbH, Starnberg, Germany
| | - Sabine Hochmuth
- Division of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany
| | - Mats Exter
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany.,Hörzentrum Oldenburg gGmbH, Oldenburg, Germany
| | - Marek Polak
- MED-EL Medical Electronics GmbH, Innsbruck, Austria
| | - Andreas Radeloff
- Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany.,Division of Otorhinolaryngology, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | | | - Mathias Dietz
- Department of Medical Physics and Acoustic, University of Oldenburg, Oldenburg, Germany.,Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| |
Collapse
|
12
|
Abstract
OBJECTIVES Postimplantation facial nerve stimulation is a common side-effect of intracochlear electrical stimulation. Facial nerve stimulation occurs when electric current intended to stimulate the auditory nerve, spread beyond the cochlea to excite the nearby facial nerve, causing involuntarily facial muscle contractions. Facial nerve stimulation can often be resolved through adjustments in speech processor fitting but, in some instances, these measures exhibit limited benefit or may have a detrimental effect on speech perception. In this study, apical reference stimulation mode was investigated as a potential intervention to facial nerve stimulation. Apical reference stimulation is a bipolar stimulation strategy in which the most apical electrode is used as the reference electrode for stimulation on all the other intracochlear electrodes. DESIGN A person-specific model of the human cochlea, facial nerve and electrode array, coupled with a neural model, was used to predict excitation of auditory and facial nerve fibers. These predictions were used to evaluate the effectiveness in reducing facial nerve stimulation using apical reference stimulation. Predictions were confirmed in psychoacoustic tests by determining auditory comfort and threshold levels for the apical reference stimulation mode while capturing electromyography data in two participants. RESULTS Models predicted a favorable outcome for apical reference stimulation, as facial nerve fiber thresholds were higher and auditory thresholds were lower, in direct comparison to conventional monopolar stimulation. Psychophysical tests also illustrated decreased auditory thresholds and increased dynamic range during apical reference stimulation. Furthermore, apical reference stimulation resulted in lower electromyography energy levels, compared to conventional monopolar stimulation, which suggests a reduction in facial nerve stimulation. Subjective feedback corroborated that apical reference stimulation alleviated facial nerve stimulation. CONCLUSION Apical reference stimulation may be a viable strategy to alleviate facial nerve stimulation considering the improvements in dynamic range and auditory thresholds, complemented with a reduction in facial nerve stimulation symptoms.
Collapse
|
13
|
Hodge SE, Ishiyama G, Lopez IA, Ishiyama A. Histopathologic Analysis of Temporal Bones With Otosclerosis Following Cochlear Implantation. Otol Neurotol 2021; 42:1492-1498. [PMID: 34607995 PMCID: PMC8595606 DOI: 10.1097/mao.0000000000003327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Analyze changes in osteoneogenesis and fibrosis following cochlear implant (CI) surgery in patients with otosclerosis and compare differences based on insertion technique. BACKGROUND When advanced otosclerotic disease extends to the otic capsule, severe and profound sensorineural hearing loss necessitates consideration of a cochlear implant. Histopathological analysis of the human temporal bone after implantation in the patient with otosclerosis may reveal important variables that predict CI success. METHODS Histopathological evaluation of archival human temporal bones from subjects with a history of CI for cochlear otosclerosis. A total of 17 human temporal bones (HTB) were analyzed, 13 implanted, and 4 contralateral non-implanted controls. RESULTS Histopathological studies revealed extensive osteoneogenesis and fibrosis which was more prominent at the cochleostomy insertion site in the basal turn of the cochlea often obliterating the scala tympani in the basal turn, and in some cases extending to the scala media and scala vestibuli. Cochlear hydrops was nearly universal in these cases. This contrasted with the round window insertion, which exhibited minimal osteoneogenesis within the cochlear duct. In addition, in the contralateral, unimplanted control ears, there was otosclerosis at the stapes footplate, fissula ante fenestrum but no osteoneogenesis within the cochlear duct. CONCLUSION Cochleostomy approach to CI insertion in otosclerosis patients is associated with significant fibrosis, osteoneogenesis, and cochlear hydrops. A round window insertion technique can be utilized to help minimize these histopathologic findings whenever feasible.
Collapse
Affiliation(s)
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Ivan A Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
14
|
Burck I, Helal RA, Naguib NNN, Nour-Eldin NEA, Scholtz JE, Martin S, Leinung M, Helbig S, Stöver T, Lehn A, Vogl TJ. Postoperative radiological assessment of the mastoid facial canal in cochlear implant patients in correlation with facial nerve stimulation. Eur Radiol 2021; 32:234-242. [PMID: 34226991 PMCID: PMC8660739 DOI: 10.1007/s00330-021-08128-w] [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: 12/15/2020] [Revised: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
Objectives To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence. Methods Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression. Results Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients’ age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression. Conclusion The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors. Key Points • Post-operative radiological assessment of the mastoid facial canal and the positional relationship with the CI electrode provide no predictor of post-cochlear implant facial nerve stimulation. • Radiological detection of extracochlear electrode contacts and the previous clinical history of meningitis/encephalitis are two important risk factors for postoperative facial nerve stimulation in cochlear implant patients. • The presence of scala vestibuli electrode insertion as well as the lateral wall electrode type, the younger patient’s age, and early onset of SNHL can play important role in the prediction of post-cochlear implant facial nerve stimulation.
Collapse
Affiliation(s)
- Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Rania A Helal
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Nagy N N Naguib
- Department of Radiology, AMEOS Clinic Halberstadt, Halberstadt, Sachsen-Anhalt, Germany
- Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria University, Alexandria, Egypt
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo University, Cairo, Egypt
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Simon Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Martin Leinung
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Silke Helbig
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Annette Lehn
- Department of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| |
Collapse
|
15
|
Factors Influencing Aberrant Facial Nerve Stimulation Following Cochlear Implantation: A Systematic Review and Meta-analysis. Otol Neurotol 2021; 41:1050-1059. [PMID: 32558747 DOI: 10.1097/mao.0000000000002693] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed. DATA SOURCES A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research. STUDY SELECTION Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis. DATA EXTRACTION Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool. DATA SYNTHESIS Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68-43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46-10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57-52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3-43%) and those with otosclerosis had an overall rate of 26% (range, 6.25-75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation. CONCLUSION Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.
Collapse
|
16
|
Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation. Eur Arch Otorhinolaryngol 2020; 278:3789-3794. [PMID: 33242112 DOI: 10.1007/s00405-020-06486-7] [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: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the preoperative computed tomography (CT) parameters, including the thickness and density of the bone separating the upper basal turn of the cochlea (UBTC) and the labyrinthine segment of the facial nerve (LSFN), in patients with and without facial nerve stimulation (FNS) in post-cochlear implants (CI). METHODS A retrospective case review of 1700 CI recipients in a tertiary referral center between January 2010 and January 2020 was performed; out of the 35 recipients who were found to have FNS, 29 were included in the study. The control group comprised the same number of randomly selected patients. CT parameters of the patients were measured independently by three fellowship-trained neuro-otologists blinded to the postoperative status of the patients. Thickness in axial and coronal views and density of the bone separating the UBTC and the LSFN were measured. RESULT There was satisfactory agreement between the readings of the three reviewers. The distances (in mm) between the UBTC and LSFN obtained from the coronal (0.43 ± 0.24 vs. 0.63 ± 0.2) and axial (0.42 ± 0.25 vs. 0.6 ± 0.18) views were statistically lower in the FNS group (p = 0.001 and 0.005, respectively). The density (in HU) of the bony partition was also statistically lower in the FNS group (1038 ± 821 vs. 1409 ± 519; p = 0.029). CONCLUSION Patients who experienced FNS postoperatively had significantly lower distance and bone density between the UBTC and the LSFN. This finding can help surgeons in preoperative planning in an attempt to decrease the occurrence of FNS.
Collapse
|
17
|
Badenhorst W, Hanekom T, Gross L, Hanekom JJ. Facial nerve stimulation in a post-meningitic cochlear implant user: using computational modelling as a tool to probe mechanisms and progression of complications on a case-by-case basis. Cochlear Implants Int 2020; 22:68-79. [PMID: 32993463 DOI: 10.1080/14670100.2020.1824431] [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: 10/23/2022]
Abstract
Facial nerve stimulation (FNS) is a side-effect of cochlear implantation that can result in severe discomfort for the user and essentially limits the optimal use of the implant. Three-dimensional cochlear implant modelling research has led to the progression from generic models to user-specific models with one of the intentions to develop model-based diagnostic tools. The objective of this study is to investigate the mechanisms that underlie the manifestation of FNS in the post-meningitic cochleae of a specific CI user through computational modelling. Bilateral models were created using a method previously developed for the construction of a three-dimensional user-specific volume conduction model of the cochlea and was expanded to include the facial nerve geometry. Reduced temporal bone density based on bone densitometry, cochlear duct ossification and degenerate auditory neural fibres were incorporated into a comprehensive FNS model. Auditory and facial nerve thresholds were predicted with the models showing good correspondence to perceptual thresholds and the user's FNS experience. Ossified cochlear ducts appear to aggravate the increase in thresholds caused by the otic capsule's decreased resistivity. This translational case study demonstrates the application of computational modelling as a clinical instrument in the assessment and management of complications with cochlear implantation.
Collapse
Affiliation(s)
- Werner Badenhorst
- Bioengineering, Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa
| | - Tania Hanekom
- Bioengineering, Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa
| | - Liezl Gross
- Bioengineering, Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa
| | - Johan J Hanekom
- Bioengineering, Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
18
|
Touska P, Connor S. Imaging of the temporal bone. Clin Radiol 2020; 75:658-674. [DOI: 10.1016/j.crad.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
|
19
|
Lateral Wall Electrodes Increase the Rate of Postactivation Nonauditory Percepts. Otol Neurotol 2020; 41:e575-e579. [DOI: 10.1097/mao.0000000000002610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
|
21
|
Kasetty VM, Zimmerman Z, King S, Seyyedi M. Comparison of Temporal Bone Parameters before Cochlear Implantation in Patients with and without Facial Nerve Stimulation. J Audiol Otol 2019; 23:193-196. [PMID: 31569310 PMCID: PMC6773959 DOI: 10.7874/jao.2019.00129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Facial nerve stimulation (FNS) is a complication of cochlear implantation (CI). This study compared the thickness and density of the bone separating the upper basal turn of the cochlea (UBTC) and the labyrinthine segment of the facial nerve (LSFN) on preoperative computed tomography (CT) in patients with and without FNS after CI. Subjects and Methods Adult patients who underwent CI from January 2011 to February 2017 with preoperative CT at a tertiary referral hospital were considered for this retrospective case–control study. Patients were divided into two groups: with FNS (n=4) and without FNS (n=53). The density and thickness of the bone between the LSFN and UBTC were measured on preoperative CT. Charts were reviewed for other parameters. Results A statistically significant difference was seen in the thickness (p=0.007) but not in the density (p=0.125) of the bone between the UBTC and LSFN. Four patients had FNS at the mid-range electrode arrays, and one of them additionally had FNS at the basal arrays. Conclusions Decreased thickness of the bone between the UBTC and LSFN can explain postoperative FNS, confirming the histologic and radiologic findings in previous studies, which indicated that the thickness of the temporal bone between the LSFN and UBTC is less in patients who experience FNS. While the density in this region was also less, it was not statistically significant.
Collapse
Affiliation(s)
| | - Zachary Zimmerman
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sarah King
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohammad Seyyedi
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| |
Collapse
|
22
|
Dumas AR, Schwalje AT, Franco-Vidal V, Bébéar JP, Darrouzet V, Bonnard D. Cochlear implantation in far-advanced otosclerosis: hearing results and complications. ACTA ACUST UNITED AC 2019; 38:445-452. [PMID: 30498273 PMCID: PMC6265674 DOI: 10.14639/0392-100x-1442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 08/22/2017] [Indexed: 11/23/2022]
Abstract
Severe forms of otosclerosis known as far-advanced otosclerosis (FAO) can lead to severe to profound sensorineural hearing loss and can justify cochlear implantation. Because of the pathophysiology of otosclerosis, patients implanted for FAO may experience an increased rate of complications, such as facial nerve stimulation or electrode dislocation, and may have poorer hearing outcomes than expected. This retrospective study aimed to compare cochlear implantation hearing outcomes, surgical difficulties and complications in FAO patients versus non-FAO patients. Moreover, we evaluated whether high resolution computed tomography (CT scan) findings were predictive of perioperative problems, complications and hearing outcomes. FAO patients were diagnosed based on medical history, examination and CT scan. Thirty-five ears from FAO patients were compared to 38 control ears. Audiometric results were assessed at least 12 months after implantation by pure tone average, speech reception threshold, monosyllabic and disyllabic word recognition score (WRS) and Central Institute for the Deaf (CID) sentences test. Complications and surgical difficulties were compiled. CT scan findings were categorised within 3 grades of otosclerotic extension. No significant difference was found between FAO and non-FAO hearing outcomes, except that monosyllabic WRS were lower for FAO patients, especially those who underwent previous stapedotomy. Facial nerve symptomatology occurred in 8.6% of FAO patients; among these, one required explantation-reimplantation surgery. 86% of FAO implanted patients had retrofenestral extension on CT. These were associated with poorer disyllabic WRS (51% vs 68%, p < 0.05) than those with only fenestral involvement. Although not significant, high grade of severity on CT tended to be associated with surgical difficulties and complications. Cochlear implantation in FAO patients is an effective treatment technique. Though the overall complication rate is low, it tends to be higher in cases of severe extension on CT. Patient counselling should be adjusted accordingly.
Collapse
Affiliation(s)
- A Ribadeau Dumas
- Department of Otorhinolaryngology and Skull Base Surgery, Pellegrin University Hospital F-33000, University of Bordeaux, France
| | - A T Schwalje
- Department of Otolaryngology, Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - V Franco-Vidal
- Department of Otorhinolaryngology and Skull Base Surgery, Pellegrin University Hospital F-33000, University of Bordeaux, France
| | - J P Bébéar
- Department of Otorhinolaryngology and Skull Base Surgery, Pellegrin University Hospital F-33000, University of Bordeaux, France
| | - V Darrouzet
- Department of Otorhinolaryngology and Skull Base Surgery, Pellegrin University Hospital F-33000, University of Bordeaux, France
| | - D Bonnard
- Department of Otorhinolaryngology and Skull Base Surgery, Pellegrin University Hospital F-33000, University of Bordeaux, France
| |
Collapse
|
23
|
Calvino M, Sánchez-Cuadrado I, Gavilán J, Lassaletta L. Cochlear Implant Users with Otosclerosis: Are Hearing and Quality of Life Outcomes Worse than in Cochlear Implant Users without Otosclerosis? Audiol Neurootol 2019; 23:345-355. [DOI: 10.1159/000496191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
Abstract
Background: The otosclerotic process may influence the performance of the cochlear implant (CI). Difficulty in inserting the electrode array due to potential ossification of the cochlea, facial nerve stimulation, and instability of the results are potential challenges for the CI team. Objectives: To evaluate hearing results and subjective outcomes of CI users with otosclerosis and to compare them with those of CI users without otosclerosis. Method: Retrospective review of 239 adults with bilateral profound postlingual deafness who underwent unilateral cochlear implantation between 1992 and 2017. Hearing and speech understanding were assessed via pure-tone audiometry and speech perception tests. Subjective outcomes were assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), and the Hearing Implant Sound Quality Index (HISQUI19) at 6 months, 12 months, and at the last follow-up. Results: Subjects were 22 CI users with otosclerosis and 217 without otosclerosis. Both groups had a similar duration of deafness and age at CI implantation. Results did not significantly differ according to group: no significant intergroup difference was found regarding the frequency of complete electrode insertion, facial stimulation, reimplantation, or PTA4 scores at the last follow-up. Regarding speech perception, no significant intergroup difference was found on any test or at any interval. Further, subjective outcomes, as measured by the GBI, NCIQ, and HISQUI19, did not significantly differ between groups. Conclusions: Adults with otosclerosis and profound hearing loss derive significant benefit from CI use. Audiological and self-reported outcomes are not significantly different from that of other CI users with postlingual deafness.
Collapse
|
24
|
Facial Nerve Stimulation Patterns Associated With Cochlear Implantation in Labyrinthitis Ossificans. Otol Neurotol 2018; 39:e992-e995. [DOI: 10.1097/mao.0000000000002028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Reis M, Boisvert I, Looi V, da Cruz M. Speech Recognition Outcomes After Cochlear Reimplantation Surgery. Trends Hear 2018; 21:2331216517706398. [PMID: 28752810 PMCID: PMC5536375 DOI: 10.1177/2331216517706398] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study compares speech recognition outcomes before and after cochlear reimplantation surgery, in relation to clinical factors known before and at time of surgery. Between 2006 and 2015, 2,055 adult cochlear implant surgeries were conducted at this center, of which 87 were reimplantation surgeries (4.2%). Speech recognition scores (SRS) assessed before and after reimplantation were available for 54 adults. Overall, SRS measured after reimplantation were similar to the best SRS obtained by the patient and greater than the last SRS measured before surgery. Additional complications were noted in the clinical files of all patients for which reimplantation was considered unsuccessful (16%).
Collapse
Affiliation(s)
- Mariana Reis
- 1 SCIC Cochlear Implant Program-An RIDBC Service, Sydney, Australia.,2 Department of Linguistics, Macquarie University, Sydney, Australia.,3 The HEARing CRC, Melbourne, Australia
| | - Isabelle Boisvert
- 1 SCIC Cochlear Implant Program-An RIDBC Service, Sydney, Australia.,2 Department of Linguistics, Macquarie University, Sydney, Australia.,3 The HEARing CRC, Melbourne, Australia
| | - Valerie Looi
- 1 SCIC Cochlear Implant Program-An RIDBC Service, Sydney, Australia
| | - Melville da Cruz
- 1 SCIC Cochlear Implant Program-An RIDBC Service, Sydney, Australia.,4 Westmead Hospital, Sydney, Australia.,5 University of Sydney, Sydney, Australia
| |
Collapse
|
26
|
Abstract
OBJECTIVES 1) To determine the ability of preoperative computed tomography (CT) to predict facial nerve stimulation (FNS) after cochlear implantation (CI). 2) To recognize the limitations of CT in predicting FNS. STUDY DESIGN Patient control study. SETTING Tertiary care academic medical center. SUBJECTS Adult patients with CI from 2003 to 2015. METHODS Patients with severe FNS (n = 4) were compared with randomly selected CI patients (n = 28). Three blinded reviewers evaluated preoperative temporal bone CT scans to measure the distance from the labyrinthine segment of the facial nerve to the basal turn of the cochlea and attempted to predict whether or not the subject had FNS after CI. RESULTS In total, 32 CT scans were evaluated representing 49 ears that underwent CI.The distances (mm) measured from the labyrinthine segment of the facial nerve to the basal turn of the cochlea in both the axial (0.3 ± 0.3 versus 0.6 ± 0.3) and coronal (0.4 ± 0.2 versus 0.6 ± 0.2) orientation were significantly different between the two groups (p = 0.0001 and p = 0.0034) respectively. The intraclass correlation coefficient demonstrated good (K > 0.7) reviewer correlation in both the reviewers' measurements and predictions. The sensitivity, specificity, positive predictive value, and negative predictive value for preoperative CT scans to predict FNS were 38.5, 85.1, 19.2, and 93.8% respectively. The reviewers were 23% accurate in predicting FNS. CONCLUSION Based on a blinded retrospective patient-control study, CT scan measurements show a significantly reduced distance between the labyrinthine facial nerve and the basal turn of the cochlea in patients with FNS. However, it is difficult to predict who will have FNS based on these measurements.
Collapse
|
27
|
|
28
|
|
29
|
Pires JS, Melo AS, Caiado R, Martins JH, Elói Moura J, Silva LF. Facial nerve stimulation after cochlear implantation: Our experience in 448 adult patients. Cochlear Implants Int 2018; 19:193-197. [DOI: 10.1080/14670100.2018.1452561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Joana Sanches Pires
- Department of Otolaryngology, Coimbra Hospital and University Centre, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal
| | - Ana Sofia Melo
- Department of Otolaryngology, Leiria Hospital Centre, Rua das Olhalvas, 2410-197, Leiria, Portugal
| | - Ricardo Caiado
- Department of Otolaryngology, Coimbra Hospital and University Centre, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal
| | - Jorge Humberto Martins
- Department of Otolaryngology, Coimbra Hospital and University Centre, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal
| | - João Elói Moura
- Department of Otolaryngology, Coimbra Hospital and University Centre, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal
| | - Luís Filipe Silva
- Department of Otolaryngology, Coimbra Hospital and University Centre, Av. Bissaya Barreto – Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal
| |
Collapse
|
30
|
Cochlear Implantation in Otosclerosis: Surgical and Auditory Outcomes With a Brief on Facial Nerve Stimulation. Otol Neurotol 2017; 38:e345-e353. [DOI: 10.1097/mao.0000000000001552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Cochlear implantation in patients with otosclerosis of the otic capsule. Am J Otolaryngol 2017; 38:556-559. [PMID: 28549773 DOI: 10.1016/j.amjoto.2017.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule. STUDY DESIGN A retrospective case series of 6 patients (7 ears). PATIENTS 6 patients (7 ears), 5 patients with severe to profound sensorineural hearing loss; 1 patient with mild to profound sensorineural hearing loss, with radiologic evidence of otosclerosis. All patients were adult males, with or without history of stapes surgery. INTERVENTION Cochlear implantation of 7 ears. 5 patients with severe to profound sensorineural hearing loss received the Nucleus Contour Advance peri-modiolar electrode array with binaural implantation performed in one patient. One patient with mild to profound sensorineural hearing loss received a Cochlear® Nucleus Hybrid L24 device. METHODS Preoperative temporal bone CT, audiometric and speech perception testing scores were reviewed, confirming presence of otosclerosis of the cochlea as well as cochlear implant candidacy. Speech perception testing included CNC words, HINT sentences and AZ Bio scores to measure hearing outcomes post implantation. RESULTS All recipients of the contour advance device had a significant improvement in hearing at both 3 and 6month follow up.The hybrid device recipient experienced loss of residual hearing in the implanted ear without improvement at 3months and mild improvement at 6months. CONCLUSION Cochlear implantation has proven to be effective in the treatment of patients with sensorineural hearing loss, including those with otosclerosis of the cochlea.Hybrid candidacy in the setting of otosclerosis of the cochlea may require consideration of alternative electrode devices, most likely a peri-modiolar device.
Collapse
|
32
|
Electrode Array Displacement into the Fallopian Canal in Revisions of Long-standing Cochlear Implants. Otol Neurotol 2017; 38:667-671. [DOI: 10.1097/mao.0000000000001376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Rah YC, Yoon YS, Chang MY, Lee JY, Suh MW, Lee JH, Oh SH, Chang SO, Park MK. Facial nerve stimulation in the narrow bony cochlear nerve canal after cochlear implantation. Laryngoscope 2015; 126:1433-9. [DOI: 10.1002/lary.25655] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Yoon Chan Rah
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
- Department of Otorhinolaryngology ; Korea University Ansan Hospital; Ansan Republic of Korea
| | - Young-sun Yoon
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Moon Young Chang
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Ji Young Lee
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Seung-ha Oh
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Sun O. Chang
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology ; Seoul National University College of Medicine, Seoul National University Hospital; Seoul Republic of Korea
| |
Collapse
|
34
|
Espahbodi M, Sweeney AD, Lennon KJ, Wanna GB. Facial nerve stimulation associated with cochlear implant use following temporal bone fractures. Am J Otolaryngol 2015; 36:578-82. [PMID: 25929977 DOI: 10.1016/j.amjoto.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture. PATIENTS One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS. MAIN OUTCOME MEASURES Presence of FNS after implantation and ability to modify implant programming to avoid FNS. RESULTS The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS. CONCLUSIONS CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs.
Collapse
Affiliation(s)
- Mana Espahbodi
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alex D Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kristen J Lennon
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN USA.
| |
Collapse
|
35
|
Decisive Criteria Between Stapedotomy and Cochlear Implantation in Patients with Far Advanced Otosclerosis. Otol Neurotol 2015; 36:e73-8. [DOI: 10.1097/mao.0000000000000692] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|