Systematic review: Radiological and histological evidence of cochlear implant insertion trauma in adult patients

Hoskison, Emma; Mitchell, Scott C.; Coulson, Chris

doi:10.1080/14670100.2017.1330735

Cited by 44 publications

(36 citation statements)

References 28 publications

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“…In addition, since this review study focused on large insertion trauma (i.e., STL or TF), other more subtle insertion traumas might have been missed. 45 In current medical practice, postoperative CTs are not able to detect minute insertion traumas. Lastly, other factors like cochlear morphology, although not evidently shown by a previous study, might affect STLs (i.e., smaller cochleas leading to increased STLs).…”

Section: Stlmentioning

confidence: 99%

Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays ‐ A Meta‐Analysis

et al. 2020

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Objectives/Hypothesis: Two types of electrode arrays for cochlear implants (CIs) are distinguished: lateral wall and perimodiolar. Scalar translocation of the array can lead to intracochlear trauma by penetrating from the scala tympani into the scala vestibuli or scala media, potentially negatively affecting hearing performance of CI users. This systematic review compares the lateral wall and perimodiolar arrays with respect to scalar translocation.Study Design: Systematic review. Methods: PubMed, Embase, and Cochrane databases were reviewed for studies published within the last 11 years. No other limitations were set. All studies with original data that evaluated the occurrence of scalar translocation or tip fold-over (TF) with postoperative computed tomography (CT) following primary cochlear implantation in bilateral sensorineuronal hearing loss patients were considered to be eligible. Data were extracted independently by two reviewers.Results: We included 33 studies, of which none were randomized controlled trials. Meta-analysis of five cohort studies comparing scalar translocation between lateral wall and perimodiolar arrays showed that lateral wall arrays have significantly lower translocation rates (7% vs. 43%; pooled odds ratio = 0.12). Translocation was negatively associated with speech perception scores (weighted mean 41% vs. 55%). Tip fold-over of the array was more frequent with perimodiolar arrays (X 2 = 6.8, P < .01).Conclusions: Scalar translocation and tip fold-overs occurred more frequently with perimodiolar arrays than with lateral wall arrays. In addition, translocation of the array negatively affects hearing with the cochlear implant. Therefore, if one aims to minimize clinically relevant intracochlear trauma, lateral wall arrays would be the preferred option for cochlear implantation.

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Section: Stlmentioning

confidence: 99%

Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays ‐ A Meta‐Analysis

et al. 2020

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“…Improved surgical techniques and cochlear implant (CI) electrode designs minimise cochlear trauma and can allow preservation of residual hearing: When residual hearing is preserved patient outcomes tend to be better, regardless of whether that residual hearing is useable [4][5][6]. Nonetheless, a recent systematic review by Hoskison et al [7] shows that trauma to the cochlea does occur in 18% of implantations and in most cases occurs when the electrode array passes from the scala tympani to the scala vestibuli. A growing body of evidence suggests that patients with the electrode array positioned in the scala tympani have the best speech perception outcomes, and outcomes are poorer in patients where the array has dislocated through the basilar membrane and some or all of the electrode contacts reside within the scala vestibuli [2,4,8].…”

Section: Introductionmentioning

confidence: 99%

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

Hey¹,

Neben²,

Stöver

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Coch-lear™ Nucleus® CI532 with Slim Modiolar Electrode, for the purposes of postmarket clinical follow-up. Data was analysed for factors which may predict postoperative speech recognition scores. Methods Data was collected retrospectively from five German clinics for 159 subjects from March 2017 to August 2018. Hearing thresholds and recognition scores for monosyllabic words in quiet and sentences in noise were measured preoperatively and at 3 and 6 months postoperatively. Results There was a mean gain of 44% points (95% CI 39-49%) at 6 months in monosyllable scores in quiet for implanted ears. Preoperative hearing thresholds in implant ears increased systematically with decreasing age; however, younger subjects had better baseline monosyllable scores with hearing aids compared with older subjects. Baseline performance alone explained 14% of the variation in postoperative scores. Residual hearing was preserved on average to within 22 dB at 250 Hz and 30 dB at 500 Hz of preoperative levels. Conclusions In a large and varied cohort of routinely treated hearing-impaired adults, speech recognition with the CI532 for German monosyllabic words in quiet at 6 months was equivalent to performance reported at one year or more in other published studies. Although younger subjects had poorer preoperative pure-tone thresholds, they had better preoperative word recognition scores compared with older subjects, and also had higher post implant scores. Further research is required to identify if this phenomenon is just applicable to German health system assessment and referral practices.

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“…An electrode array located in an intermediate position close to the midline of the cochlear lumen elevates the basilar membrane and bends or deforms the spiral ligament (grade 1 trauma) [ 58 , 59 ]. It is more frequently observed using lateral wall electrodes compared with perimodiolar electrodes [ 60 ].…”

Section: Post-operative Imagingmentioning

confidence: 99%

“…When the electrode array cannot be fully inserted, excessive pushing may result in a fold-over of the basal part of the electrode array. Extensive fold-over may present as a second electrode array in the basal turn [ 59 , 63 ]. The basilar membrane may often be ruptured.…”

Section: Post-operative Imagingmentioning

confidence: 99%

Pre- and post-operative imaging of cochlear implants: a pictorial review

et al. 2020

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Cochlear implants are increasingly used to treat sensorineural hearing disorders in both children and adults. Pre-operative computed tomography and magnetic resonance imaging play a pivotal role in patient selection, to rule out findings that preclude surgery or identify conditions which may have an impact on the surgical procedure. The post-operative position of the electrode array within the cochlea can be reliably identified using cone-beam computed tomography. Recognition of scalar dislocation, cochlear dislocation, electrode fold, and malposition of the electrode array may have important consequences for the patient such as revision surgery or adapted fitting.

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Systematic review: Radiological and histological evidence of cochlear implant insertion trauma in adult patients

Cited by 44 publications

References 28 publications

Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays ‐ A Meta‐Analysis

Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays ‐ A Meta‐Analysis

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

Pre- and post-operative imaging of cochlear implants: a pictorial review

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