Precision Medicine Approach to Cochlear Implantation

Abstract

In the early days of cochlear implantation (CI) surgery when the types of electrodes were limited and the etiology of sensorineural hearing loss (SNHL) was not well understood, the one-size-fits-all approach to CI held true like all other fields. However, in the era of personalized medicine, there have been attempts to associate CI performance with etiology of SNHL and to establish customized surgical techniques that can maximize performance according to individual cochlear dimensions. Personalized genomic-driven assessment of CI candidates and better understanding of genotype-phenotype correlations could provide clinically applicable diagnostic and prognostic information about questions such as who, how, and when to implant. Rigorous and strategic imaging assessments also provide a better insight into anatomic etiology of SNHL and cochlear dimensions, leading to individualized surgical techniques to augment CI outcome. Further, precision medicine approach to CI is not necessarily limited to preoperative planning but can be extended to either intraoperative electrode positioning or even decision of a timing of initial switch-on. In this review, we will discuss the implications of personalized diagnosis (both genetic and nongenetic) on planning and performance of CI in prelingual and postlingual SNHL.

Revisiting Genetic Epidemiology with a Refined Targeted Gene Panel for Hereditary Hearing Impairment in the Taiwanese Population

“…To date, more than 200 genes have been implicated in HHI ( , last accessed on 19 February 2023). Because of its impact on speech/language development and cognitive functions [ 6 , 7 ], it is crucial to intervene in HHI early in life, and genetic testing assists in its prognostication and selection of management [ 8 , 9 , 10 , 11 , 12 ].…”

The impact of the size and angle of the cochlear basal turn on translocation of a pre-curved mid-scala cochlear implant electrode

“…In this context, the most basic surgical aim would be to place the electrode within the scala tympani (ST) compartment of the cochlea without translocation to the scala media (SM) or scala vestibuli (SV), which has been shown to influence CI outcomes 12 . A number of studies to date have examined various cochlear parameters as defined by pre-operative imaging and CI outcomes, the estimated cochlear duct length and angular insertion depth (AID) being the most studied parameters 13 – 15 . Identification of anatomical factors associated with increased likelihood of scalar translocation could be useful in two broad aspects.…”

Clinical characteristics and hearing loss etiology of cochlear implantees undergoing surgery in their teens, 20s, and 30s

“…This may be attributed to the variety of causative genes in this age group and their diverse impacts on CI outcomes. However, knowledge of these genes can assist in estimating onset age or DoD and provide evidence for recommending CI surgery in patients with favorable SIR scores [34,35]. According to Lee et al (2020), patients with postlingual hearing loss fared better when timely CI surgery was performed after a mutation in a known hearing loss gene was discovered [11].…”