Evaluation of hearing preservation in adults with a slim perimodiolar electrode

Abstract Purpose Numerous endeavors have been undertaken to preserve hearing in cochlear implant (CI) patients. Particularly, optimization of electrode array design aims at preservation of residual hearing (RH). This study examines whether a slim perimodiolar (PM) electrode array could bear the capability to preserve hearing. Methods A total of 47 patients underwent cochlear implantation receiving the PM electrode. (i) Patients with pure tone audiogram (PTA) thresholds better than 85 dB and/or hearing loss for Freiburg speech test numbers less than 60 dB and more than 50% maximum monosyllabic understanding were assigned to the RH group (n = 17), while all others belonged to the noRH group (n = 30). (ii) Another group implanted with a slim straight, lateral wall (LW) electrode was recruited for comparison. Results We compared 17 RH–30 noRH patients all receiving the PM electrode. RH in PM recipients decreased faster than in LW recipients. No significant differences were observed between both (RH v/s noRH) groups in NRT thresholds, Freiburg speech test and A§E® phonemes. Analogous satisfaction levels were indicated through the questionnaires in terms of sound quality, hearing in silence, noise and directional hearing in both groups. Conclusions The results suggest that hearing preservation is influenced not only by electrode shape but various factors. This study opens an avenue for further investigations to elucidate and enumerate the causes for progressive hearing loss.

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A maradványhallás megőrzésének lehetőségei cochlearis implantáció során Nucleus CI532 Slim Modiolar elektródasorral

Orvosi Hetilap ◽

10.1556/650.2018.31113 ◽

2018 ◽

Vol 159 (41) ◽

pp. 1680-1688 ◽

Cited By ~ 1

Author(s):

Roland Nagy ◽

János András Jarabin ◽

Balázs Dimák ◽

Ádám Perényi ◽

Ferenc Tóth ◽

...

Keyword(s):

Hearing Loss ◽

Minimally Invasive ◽

Cochlear Implantation ◽

Basilar Membrane ◽

Round Window ◽

Spiral Ganglion ◽

Hearing Threshold ◽

Electrode Array ◽

Hearing Preservation ◽

Residual Hearing

Abstract: During the rehabilitation of hearing-impaired patients, the preservation of residual acoustic hearing following cochlear implantation by minimizing the implantation trauma allows for improved hearing performance. To achieve this, minimally invasive, soft surgery methods and thinner, atraumatic electrodes were required. In our present study, we reported a case where Cochlear® Nucleus CI532 Slim Modiolar electrode was implanted in a patient with residual hearing. Our aim was to study the possible preservation of postoperative acoustic residual hearing by audiological monitoring. Since childhood, due to her congenital hearing loss, she has been wearing a conventional, airborne hearing correction device on both ears. Six months before cochlear implantation, we measured the progression on both sides of the hearing loss, so we decided to perform cochlear implantation. The patient had residual hearing on both ears prior to surgery thus the Cochlear® Nucleus CI532 Slim Modiolar Implant was used. The minimally invasive surgery was performed on the patient’s right ear through the round window approach. Compared to the preoperative hearing threshold (average 85 dBHL) in the 4th postoperative week, an initial hearing threshold progression of 20–25 dBHL was observed between 0.25 and 1.0 kHz, while of 5–10 dBHL between 2.0–4.0 kHz. Hearing threshold measured in the 6th month showed a slight progression in the range above 1 kHz, but improved by the 12th month, to the results achieved at the 4th week. The effects of cochlear implantation on residual hearing have been studied in numerous studies, in which several key surgical and technical factors have been identified. Nucleus CI532 is a Slim Modiolar electrode profile that is close to the modiolus, so it is expected to have a lower endocochlear hydrodynamic load since it lies in the covering of the osseus spiral lamina, thus less influencing the dynamics of the basilar membrane. However, the perimodiolar location of the electrode array allows the adjacent nerve elements of the spiral ganglion to be stimulated with a lower electrical intensity and a reduced surface that may be neuroprotective. Preservation of acoustic residual hearing following cochlear implantation improves the patient’s speech perception and the sound localization skills, particularly in difficult circumstances. Long-term residual hearing preservation may also be of great importance in the subsequent feasibility for regenerative procedures and drug treatments. Orv Hetil. 2018; 159(41): 1680–1688.

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Hearing Preservation Cochlear Implants: A Review of Potential Mechanisms of Hearing Loss After Implantation

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig6.54 ◽

2017 ◽

Vol 2 (6) ◽

pp. 54-63

Author(s):

Conor Kelly ◽

Lina A. J. Reiss

Keyword(s):

Hearing Loss ◽

Cochlear Implants ◽

High Frequency ◽

Music Perception ◽

Low Frequency ◽

Lateral Wall ◽

Hearing Preservation ◽

Acoustic Stimulation ◽

Residual Hearing ◽

Wide Range

Hearing preservation cochlear implants (CIs) are specifically designed to preserve residual low-frequency acoustic hearing for use together with electrically stimulated high-frequency hearing. This combined electro-acoustic stimulation (EAS) provides a promising treatment option for patients with severe high-frequency hearing loss, but with some residual low-frequency hearing, and has been shown to improve speech perception, especially in background noise, music perception, and sound source localization. Thus, preservation of residual hearing should be a priority in treatment. Although residual low-frequency hearing is successfully preserved to varying degrees in many patients, some patients experience a loss of residual hearing following implantation. A wide range of potential causes of, or contributors to, loss of residual hearing in EAS CI users have been proposed. In this paper, we review the evidence for several of the proposed causes of hearing loss with EAS CI. We conclude that its etiology is likely a multifactorial, heterogeneous phenomenon. Furthermore, we suggest that studies to further elucidate effects of ischemia on lateral wall function and maintenance of endocochlear potential in the context of EAS CI implantation and use are needed.

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Preservation of residual hearing following cochlear implantation: comparison between three surgical techniques

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000254 ◽

2007 ◽

Vol 122 (3) ◽

pp. 246-252 ◽

Cited By ~ 36

Author(s):

S Berrettini ◽

F Forli ◽

S Passetti

Keyword(s):

Cochlear Implant ◽

Cochlear Implantation ◽

Surgical Techniques ◽

Electrode Array ◽

Lateral Wall ◽

Hearing Preservation ◽

Acoustic Stimulation ◽

Residual Hearing ◽

Electrode Arrays ◽

Electrode Insertion

AbstractThe preservation of residual hearing is becoming a high priority in cochlear implant surgery. It allows better speech understanding and ensures long-lasting and stable performance; it also allows the possibility, in selected cases, of combining electro-acoustic stimulation in the same ear.We present the results of a retrospective study of the conservation of residual hearing in three different groups of patients who had undergone cochlear implantation using three different cochlear implant electrode arrays, combined with three different surgical techniques for the cochleostomy. The study aimed to evaluate which approach allowed greater preservation of residual hearing.The best residual hearing preservation results (i.e. preservation in 81.8 per cent of patients) were achieved with the Contour Advance electrode array, using the Advance Off-Stylet technique and performing a modified anterior inferior cochleostomy; this combination enabled reduced trauma to the lateral wall of the cochlea during electrode insertion.

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A filtered speech test for an aging population

South African Journal of Communication Disorders ◽

10.4102/sajcd.v23i1.389 ◽

1976 ◽

Vol 23 (1) ◽

Author(s):

Hanna Klein

Keyword(s):

Hearing Loss ◽

High Frequency ◽

Aging Population ◽

Control Group ◽

High Frequency Hearing Loss ◽

Speech Test ◽

Males And Females ◽

The Right ◽

Filtered Speech ◽

Better Than

A filtered speech test was presented to sixty males and females above the age of sixty years. Thirty of these subjects had complained of, and demonstrated clinically, a high frequency hearing loss for pure-tones. Thirty subjects, who had never complained of a hearing loss, but who nevertheless were found to have mild-to-moderate high frequency hearing losses, were included as a control in the study. The ability to discriminate among phonetically-balanced words where certain frequencies had been filtered out deteriorated with age, although those subjects in the control group performed better than those in the experimental group. However both groups showed poorer ability to discriminate with the right ear, than with the left, or with both ears. The results seemed to indicate a particular retrocochlear involvement in an aging population.

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Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): A study protocol for a randomised single blind controlled trial

10.21203/rs.3.rs-36735/v1 ◽

2020 ◽

Author(s):

Saad Jwair ◽

Ralf Boerboom ◽

Huib Versnel ◽

Robert Stokroos ◽

Hans Thomeer

Keyword(s):

Randomized Controlled Trial ◽

Hearing Loss ◽

Surgical Approach ◽

Controlled Trial ◽

Round Window ◽

Electrode Array ◽

Hearing Preservation ◽

Residual Hearing ◽

Structure Preservation ◽

Randomized Controlled

Abstract BackgroundIn order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a ‘straight’ lateral wall lying electrode array (LW), or a ‘pre-curved’ perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that the combination of a RW approach and a LW lying electrode array minimizes insertion trauma, leading to better hearing outcome for SNHL patients. MethodsWe designed a monocenter, 2x2, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar transposition, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG).DiscussionCochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relative simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation. Trial registrationThis trial is registered in the Netherlands Trial Register (NTR) (www.trialregister.nl): NL8586, date of registration: 4th of May 2020. Retrospectively registered; 3/48 participants were included before registration.

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Hearing Outcome of Stapes Surgery in NIENT, Bangladesh

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v26i1.47950 ◽

2020 ◽

Vol 26 (1) ◽

pp. 31-36

Author(s):

Md Zakaria Sarkar ◽

AHM Ferdows Nur ◽

Utpal Kumar Dutta ◽

Muhammad Rafiqul Islam ◽

Debabrota Roy ◽

...

Keyword(s):

Hearing Loss ◽

Cross Sectional Study ◽

Surgical Trauma ◽

Group 14 ◽

Progressive Hearing Loss ◽

Cross Sectional ◽

Hearing Gain ◽

Hearing Outcome

Objective: The aim of this study was to evaluate hearing outcome after stapedotomy in patients with Otosclerosis. Methods: This cross sectional study was carried out from July 2017 to January 2019 in National Institute of ENT, Unit V. About 22 patients with Otosclerosis were included in this study. Diagnosis of Otosclerosis was based on the history, medical status with Otoscopy, Tuning fork tests and Audiometric tests. We compiled data on the pre and post operative air-bone gap (ABG) at 0.5, 1, 2 KHZ. The ABG was Calculated using AC and BC thresholds on the same audiogram. Post operative hearing gain was then Calculated from the ABG before the operation minus the ABG of the last follow up examination Results: In this study most of the cases were age group 14-30 years (72.7%), female (54.5%). Most common symptoms was progressive hearing loss, tinnitus (77.8%).The average preoperative hearing loss in this study was (AC) was 48.31±7.68. The average post opt. hearing (AC) at follow up was 28.95±10.30 with an average hearing gain of 15.40±8.53 dB which was significant. The average pre-operative ABG was 28.99 dB ± 8.10. The average post opt. ABG was analyzed at 1 follow up showed ABG 13.18±8.09 dB which was found to be significant. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patient’s quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 31-36

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