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Parker R, Muzaffar J, AuD MA, Brassington W. Early activation of cochlear implants: a systematic review and narrative synthesis. Cochlear Implants Int 2024; 25:81-92. [PMID: 38111171 DOI: 10.1080/14670100.2023.2290777] [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: 12/20/2023]
Abstract
BACKGROUND Device activation typically occurs four weeks post cochlear implant surgery. Emerging evidence suggests earlier activation is feasible and beneficial, giving patients quicker access to sound and rehabilitation. OBJECTIVES Assess current literature for effects of early cochlear implant activation. METHODS Electronic searches of Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Studies investigating any aspect of early activation were included for review. RESULTS From 15 studies, 625 patients received early activation, compared with 243 patients in the control groups. Early activation was considered as within 7 days post-operatively with 12 studies reporting within 1 day post-operatively, compared with standard activation of 9-46 days post-operatively in the control group. Some studies indicated earlier low levels of impedance in the early activation group. Magnet strength adjustment or off-ear processor wear was often recommended within the early activation cohort. Complication rates were low in both groups. Early activation improved patient satisfaction and anxiety levels without detriment to speech recognition or rehabilitation. CONCLUSION Early cochlear implant activation is feasible and allows patients with no contraindications, earlier access to auditory perception and rehabilitation and reduces anxiety linked to delay in activation. Further evidence is required to monitor long-term effects of early activation.
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Affiliation(s)
- Rosalyn Parker
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jameel Muzaffar
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammed Ayas AuD
- Emmeline Centre Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - William Brassington
- Audiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Schraivogel S, Aebischer P, Wagner F, Weder S, Mantokoudis G, Caversaccio M, Wimmer W. Postoperative Impedance-Based Estimation of Cochlear Implant Electrode Insertion Depth. Ear Hear 2023; 44:1379-1388. [PMID: 37157125 PMCID: PMC10583924 DOI: 10.1097/aud.0000000000001379] [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: 01/06/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Reliable determination of cochlear implant electrode positions shows promise for clinical applications, including anatomy-based fitting of audio processors or monitoring of electrode migration during follow-up. Currently, electrode positioning is measured using radiography. The primary objective of this study is to extend and validate an impedance-based method for estimating electrode insertion depths, which could serve as a radiation-free and cost-effective alternative to radiography. The secondary objective is to evaluate the reliability of the estimation method in the postoperative follow-up over several months. DESIGN The ground truth insertion depths were measured from postoperative computed tomography scans obtained from the records of 56 cases with an identical lateral wall electrode array. For each of these cases, impedance telemetry records were retrieved starting from the day of implantation up to a maximum observation period of 60 mo. Based on these recordings, the linear and angular electrode insertion depths were estimated using a phenomenological model. The estimates obtained were compared with the ground truth values to calculate the accuracy of the model. RESULTS Analysis of the long-term recordings using a linear mixed-effects model showed that postoperative tissue resistances remained stable throughout the follow-up period, except for the two most basal electrodes, which increased significantly over time (electrode 11: ~10 Ω/year, electrode 12: ~30 Ω/year). Inferred phenomenological models from early and late impedance telemetry recordings were not different. The insertion depth of all electrodes was estimated with an absolute error of 0.9 mm ± 0.6 mm or 22° ± 18° angle (mean ± SD). CONCLUSIONS Insertion depth estimations of the model were reliable over time when comparing two postoperative computed tomography scans of the same ear. Our results confirm that the impedance-based position estimation method can be applied to postoperative impedance telemetry recordings. Future work needs to address extracochlear electrode detection to increase the performance of the method.
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Affiliation(s)
- Stephan Schraivogel
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Aebischer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, 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 Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Technical University of Munich, Germany; TUM School of Medicine, Klinikum rechts der Isar, Department of Otorhinolaryngology
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Alahmadi A, Abdelsamad Y, Alothman NI, Alshalan A, Almuhawas F, AlAmari NA, Alyousef MY, Alhabib SF, Hagr A. A Literature Review on Cochlear Implant Activation: From Weeks to Hours. EAR, NOSE & THROAT JOURNAL 2023:1455613231188294. [PMID: 37551795 DOI: 10.1177/01455613231188294] [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: 08/09/2023] Open
Abstract
Objectives: The present literature review discusses the chronological evolution of Cochlear Implant (CI) activation and its definition among the relevant studies in the literature. In addition, the benefits of standardizing the early activation process in implantation centers worldwide are discussed. Methods: A comprehensive literature search was conducted in the major databases such as PubMed, Scopus, and Embase to retrieve all the relevant articles that reported early activation approaches following CI. Results: The evolution of the timing of early activation after CI has been remarkable in the past few years. Some studies reported the feasibility of early activation 1 day after the CI surgery in their users. Conclusions: Within the last decade, some studies have been published to report the feasibility and outcomes of its early activation. However, the process of early activation was not adequately defined, and no apparent guidelines could be found in the literature.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Noura I Alothman
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf A AlAmari
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Y Alyousef
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman F Alhabib
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alshalan A, Abdelsamad Y, Yousef M, Alahmadi A, Almuhawas F, Hagr A. Early activation after cochlear implantation: a systematic review. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07965-3. [PMID: 37097468 DOI: 10.1007/s00405-023-07965-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To systematically review the outcomes of early activation following cochlear implantation (CI) based on the findings from different studies in the literature. METHODS A comprehensive search strategy was conducted through different databases to identify relevant articles. Our outcomes included impedance levels, rates of complications, hearing and speech perception performance, and patients' satisfaction levels. RESULTS The total number of included studies in this systematic review is 19, which recruited 1157 patients, including 857 who underwent early activation following CI. Seventeen studies investigated impedance levels or feasibility rates of early activation approaches. Most of these studies (n = 10) reported that mean impedance levels remarkably decreased within the first day-to-month (first measurement) post-activation. In addition, all 17 studies showed that impedance levels finally normalize and become comparable with intraoperative levels or the conventional activation group. Seventeen studies reported the occurrence of complications in their population. Ten of these studies indicated that none of their patients developed any post-operative complications after early activation. Seven studies reported the development of some minor complications, including pain 9.2% (28/304), infection 4.7% (13/275), swelling 8.2% (25/304), vertigo 15.1% (8/53), skin hyperemia 2.2% (5/228), and others 16.4% (9/55). Hearing and speech perception was assessed in six studies, which showed a remarkable improvement in their patients. Three studies investigated patients' satisfaction and showed high satisfaction levels. Only one report investigated the economic advantages of early activation. CONCLUSION Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.
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Affiliation(s)
- Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, PO Box 72418, Skaka, 23235, Saudi Arabia.
| | | | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Audiology Unit, ENT Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Cochlear implantation (CI) has become the standard treatment for patients with severe-to-profound hearing loss. To date, an estimated 750,000 individuals spanning the entire lifecycle have benefited from this life-changing technology. Traditionally, the device is not "activated" for 3 to 4 weeks after surgery. However, an increasing number of centers have recently begun to question the conventional wisdom that several weeks are necessary and are activating their patients' device sooner after CI. This review aimed to provide a comprehensive insight to better understand the feasibility, outcomes, benefits, and limitations of very early cochlear implant activation. Data sources from published medical literature were reviewed. A detailed examination and summary were provided. History and safety were also emphasized. It was observed that approximately 20 studies have reported their experience with very early cochlear implant activation, ranging from the day of surgery to 1 week. Outcome measures are disparate, although there is general agreement that early activation is not only feasible but also provides some real-life benefits to patients and caregivers. The surgical, electrophysiological, audiological, and other outcomes were also reviewed. Very early activation is safe and beneficial in patients with cochlear implants. Many CI centers believe that such a process can lead to improvements in both patient-centered and fiscally responsible care. Although not ideal for all patients, cochlear implant programs may consider this option for their patients.
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Affiliation(s)
- Daniel H Coelho
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - An-Suey Shiao
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Lieber Po-Hung Li
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
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Sunwoo W, Jeon HW, Choi BY. Effect of initial switch-on within 24 hours of cochlear implantation using slim modiolar electrodes. Sci Rep 2021; 11:22809. [PMID: 34815432 PMCID: PMC8611070 DOI: 10.1038/s41598-021-01862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/01/2021] [Indexed: 11/09/2022] Open
Abstract
Reducing electrode impedance is an important factor in improving the functional benefits of cochlear implants (CIs). The immediate effect of early switch-on within 24 h of surgery on impedance among CI recipients with various types of electrodes has been reported previously; however, the immediate change and the evolution of electrode impedances of slim modiolar electrodes after early switch-on within 24 h of implantation has not. Therefore, the focus of this retrospective cohort study of CI patients was to compare the effect of early switch-on (n = 36) and conventional switch-on (n = 72) 2–4 weeks post-operation on impedance. Compared with impedance measured intraoperatively, our results demonstrate a significant decrease in impedance from 11.5 to 8.9 kΩ (p < 0.001) at 2–4 weeks after implantation in the early switch-on group, which sharply contrasted with elevated impedance values for conventional switch-on 2–4 weeks after implantation (from 10.7 to 14.2 kΩ, p = 0.001). Notably, a comparatively lower impedance than the conventional switch-on protocol was observed for up to 2 months post-operation. Most importantly, a much earlier stabilization of impedance can be achieved with the early switch-on protocol coupled with the slim modiolar electrode array compared to the conventional switch-on protocol, offering the advantage of reducing the number of required mapping sessions in the early stages of rehabilitation.
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Affiliation(s)
- Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hyoung Won Jeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, 13620, Republic of Korea.
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Aldhafeeri AM, Saleh S, Almuhawas F, Hagr A. Feasibility of Day Surgery for Cochlear Implantation under Conscious Sedation with Same-Day Fitting. J Int Adv Otol 2021; 16:303-308. [PMID: 33136007 DOI: 10.5152/iao.2020.8208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of performing cochlear implantation under conscious sedation (CS) as day surgery with same-day fitting. MATERIALS AND METHODS All patients underwent cochlear implantation under CS between November 2017 and April 2018. The data collected included demographic information, preoperative clinical characteristics, surgical details, postoperative fitting information, and side effects, if any. RESULTS Nine patients had 11 cochlear implants (CIs) placed under CS (2 patients received bilateral CIs). One patient's data were excluded from the audiological results because conversion to general anesthesia (GA) was necessary. One patient (11%) vomited just before the end of the procedure. Seven patients had uneventful procedures. Eight (88%) patients were discharged home the same day. There was a statistically significant difference in recovery time between the CS group and the GA group (t=-2.26, df=12, p<0.05). In the CS group, there was no statistically significant change in the maximum comfortable loudness level for all electrodes from the day of the surgery to the following day. However, there was a statistically significant difference in the threshold levels of all electrodes from the day of the surgery to the following day (Z=-2.04, N=120, p<0.05). Further analysis revealed a statistically significant difference in the four most apical electrodes (Z=-3.496, N=40, p<0.0001), but not in the middle or basal electrodes. CONCLUSION Cochlear implantation can be performed under CS with careful patient selection. This approach facilitates same-day fitting and day surgery by minimizing comorbidity.
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Affiliation(s)
- Ahmad M Aldhafeeri
- Department of Otolaryngology, Hafr Albaten Central Hospital, Hafr Albaten, Saudi Arabia
| | - Shaza Saleh
- King Abdullah Ear Specialist Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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High Electrode Impedance Values in Pediatric Cochlear Implant Recipients May Imply Insufficient Auditory and Language Skills Development. J Clin Med 2020; 9:jcm9020506. [PMID: 32069787 PMCID: PMC7074351 DOI: 10.3390/jcm9020506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/22/2020] [Accepted: 02/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. Methods: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. Results: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. Conclusion: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.
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Hu HC, Chen WKH, Huang MJ, Lin CC, Chen JKC. Rounded Insertion Technique for Cochlear Implantation Surgery to Treat Cystic Inner Ear Malformation. Laryngoscope 2019; 130:2229-2233. [PMID: 31800101 DOI: 10.1002/lary.28425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/29/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This article outlines the advantages and applicability of the rounded insertion technique of cochlear implants in patients with cystic inner ear malformation. This technique enables the insertion of the maximum number of electrodes and prevents the unwanted entry of electrodes into the internal auditory canal. METHODS We conducted a retrospective chart review of consecutive patients with cochlear hypoplasia (CH) and/or common cavity (CC) who underwent CI (cochlear implantation) via rounded insertion technique. The position of the electrode array in each patient was confirmed postoperatively via X-ray, and the number of functional electrodes was confirmed during the mapping process. RESULTS This study included five male and two female patients (median age: 3 years; age range: 2-7 years). Among the seven patients, four received a cochlear implant on the right side, one on the left side, and two bilaterally. Of the nine ears, six were cases of CH, and three were CC. All cochlear implant surgeries via rounded insertion technique were completed without complications. The maximum number of electrode contacts with fair function in the cystic cochlea was confirmed via postoperative X-ray and the subsequent mapping process. CONCLUSION This consecutive series of patients demonstrated the safety and reliability of rounded insertion technique for CI in patients with CH and/or CC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2229-2233, 2020.
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Affiliation(s)
- Hao-Chun Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan, New Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - William Kuan-Hua Chen
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Jui Huang
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Ching Lin
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Joshua Kuang-Chao Chen
- Auditory Implantation Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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