The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation

Suhling, Marie-Charlot; Majdani, Omid; Salcher, Rolf; Leifholz, Melanie; Büchner, Andreas; Lesinski‐Schiedat, Anke; Lenarz, Thomas

doi:10.1097/mao.0000000000001110

Cited by 82 publications

(106 citation statements)

References 49 publications

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“…The use of local or systemic steroids may also have a protective effect. As mechanisms for postoperative hearing loss, different aspects are discussed such as for example foreign body reaction regarding the implant, mechanical damage of intracochlear structures, or functional impairment of the cochlear mechanics [41].…”

Section: Cochlea Implant Surgery and Hearing Preservationmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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Section: Cochlea Implant Surgery and Hearing Preservationmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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“…Regarding results from other studies, the same tendency was found for short and longer arrays. One has to keep in mind that different definitions and criteria of hearing preservation were used in different studies [Suhling et al, 2016].…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic evaluation of the residual hearing was completed at each follow-up interval (3, 6, and 12 months postoperatively) during the investigation. Differences were grouped into 3 categories, as recently defined [Dedhia et al, 2016;Suhling et al, 2016]:…”

Section: Audiological Testingmentioning

confidence: 99%

Hearing Preservation with the Slim Modiolar Electrode Nucleus CI532® Cochlear Implant: A Preliminary Experience

et al. 2017

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As the indications for cochlear implant have expanded to include younger patients and individuals with greater degrees of residual hearing, increasing emphasis has been placed on atraumatic surgery and the preservation of the cochlear structure. Here, a descriptive prospective randomized study was performed. It was shown that residual hearing preservation is possible 12 months postoperatively with an atraumatic perimodiolar flexible electrode array CI532® (Cochlear Ltd, Sydney, Australia). Residual hearing preservation, considered as < 15 dB, was obtained in 70% of the cases. Better clinical outcomes and performance could be obtained compared with the previous perimodiolar CI512®, but further research and a longer follow-up are necessary to verify the impact of outcomes.

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“…With greater insertion depth, hearing perception, including Hearing In Noise and Consonant Nucleus Consonant test scores appear to improve in some studies [3–5]. Conversely, deeper insertion can also increase iatrogenic injury to the cochlea, leading to decreased hearing preservation [6]. Although “soft surgery” techniques involving use of corticosteroids, and scala tympani insertion can minimize this damage, shallower insertion depths are still associated with a lower rate of iatrogenic injury [6–9].…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, deeper insertion can also increase iatrogenic injury to the cochlea, leading to decreased hearing preservation [6]. Although “soft surgery” techniques involving use of corticosteroids, and scala tympani insertion can minimize this damage, shallower insertion depths are still associated with a lower rate of iatrogenic injury [6–9]. Previously it was believed that CI surgery would destroy all residual hearing.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of skull X-RAY to determine cochlear implant insertion depth

Fernandes

Wang

Yeung

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundCochlear implant (CI) insertion depth can affect residual hearing preservation, tonotopic range coverage, and Mapping. Therefore, determining insertion depth has the potential to maximize CI performance. A post-op skull X-RAY is commonly used to assess insertion depth, however its effectiveness has not been well established. Our primary objective was to assess the accuracy of post-op skull X-RAYs to determine insertion depth, compared to CT as the gold standard. Secondary objectives were to compare experience level of raters and different skull X-RAY views.MethodsThirteen patients with Advanced Bionic HiRes 90 K implants, and post-operative temporal bone CT scans were selected from the CI database at Sunnybrook Health Sciences Centre. Medical students, otology fellows, and CI surgeons evaluated insertion depths on post-op skull X-RAYs, while neuroradiologists evaluated CT scans. Descriptive statistics, regression analysis, and paired t-tests were used to compare the two types of imaging.ResultsX-RAYs and CTs provided an equivalent mean insertion depth of 337 degrees (p = 0.93), a mean difference of − 0.9 degrees and a standard deviation of paired differences of 43 degrees. Although means were similar across rater groups, CI surgeons (45 degrees) had the lowest standard deviation of paired differences. Comparing X-RAY views, Caldwell (29 degrees) had less variation than Towne (59 degrees) for standard deviation of paired differences.ConclusionsSkull X-RAYs provide accurate and reliable measurements for CI insertion depth. The Caldwell view alone may be sufficient for evaluations of insertion depth, and experience has a minor impact on the variability of estimates.Electronic supplementary materialThe online version of this article (10.1186/s40463-018-0304-9) contains supplementary material, which is available to authorized users.

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The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation

Abstract: HP is possible in the majority of subjects who are implanted with a TFEA20, 24, or 28. Using shorter arrays led to greater HP and lower median HL.

Cited by 82 publications

References 49 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

Hearing Preservation with the Slim Modiolar Electrode Nucleus CI532® Cochlear Implant: A Preliminary Experience

Effectiveness of skull X-RAY to determine cochlear implant insertion depth

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