Patients with otosclerosis who have progressed to profound hearing loss derive significant benefit from cochlear implants; however, an increased risk of cochlear ossification and facial nerve stimulation has to be taken in account during preoperative counseling. The advance in imaging techniques, CI technology and the possibility to stimulate precise regions of the cochlea with lower intensities make it possible for the surgeons and audiologists to readily and successfully manage these complications as they arise.
Preservation of residual hearing should be attempted in all cases. In fact, although effects on the speech perception are not evident with the standard evaluation, larger electrical dynamic range can be achieved and may represent a sign of cochlear "well-being," potentially allowing a more complex electric stimulation of the nerve.
The purpose of this study was to evaluate the effect of the application of newer generation cochlear implants on facial nerve stimulation. This was a retrospective case review in a tertiary referral centre. We report two patients implanted with a Nucleus 22 cochlear implant (Cochlear Corp.) experiencing facial nerve stimulation and in one case Jacobson nerve stimulation is reported in one case. New generation cochlear implants with modiolus hugging electrodes (Nucleus 24 Contour and Corp.) were implanted in these patients Á in one case, on the implanted side (revision surgery), and in the contralateral side in the other case. In both cases the application of a newer generation modiolus hugging cochlear implant did not induce abnormal facial nerve or Jacobson's nerve stimulation. In addition, all the implant electrodes were activated and the patients showed good speech perception. Patients with otosclerosis have a high risk of facial nerve and Jacobson's nerve stimulation. The application of a new generation cochlear implant in the implanted ear or in the contralateral ear represents a viable option in order to reduce the risk of extra-auditory stimulation.
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