Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings

Abstract

Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories-closed-set words, open-set words, and open-set sentences-and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

“…In a recent meta-analysis, Farhood et al [2017] found IEM to be associated with a high rate of gusher (39.1%) and FN anomalies (34.4%). Confronted with an aberrant morphology, an intricate electrode insertion, a high risk of developing postoperative CSF leak/meningitis, and an inconsistent FN course, many groups advocate the use of STP for secure CI [Colletti et al, 1998;Free et al, 2013;Szymański et al, 2016].…”

Correlation between Preoperative Auditory Steady-State Response and Postoperative Electrically Evoked Auditory Brainstem Response and T Level in Cochlear Implantation for Child Patients with Inner-Ear Malformations

“…Thus, various methods such as ABR, the 40 Hz-related potential, and behavioral audiometry have failed in measuring residual hearing before implantation [7][8][9]. Before the operation, determining the residual hearing of patients and accordingly evaluating the function of the auditory nerve are important means to judge the curative effect of the cochlear surgery.…”

Kommentar der Schriftleitung

“…in Referiert + Diskutiert starten wir mit einer wegweisenden Arbeit aus dem New England Journal of Medicine, dass es bei einer Antibiotikatherapie der kindlichen Otitis media acuta wichtig ist auch konsequent über 10 Tage zu behandeln [1]; eine Kurzzeittherapie ist dem eindeutig unterlegen. Dann geht es um die Effektivität von Dehnungsimplantaten bei Septorhinoplastiken und dann um radiologische Befundung von Fazialisanomalien bei Innenohranomalien, was auch für CI Implantationen relevant ist, siehe weiter unten [2].…”