Cochlear implantation with the nucleus slim modiolar electrode (CI532): a preliminary experience

Purpose To evaluate the insertion results and hearing preservation of a novel slim modiolar electrode (SME) in patients with residual hearing. Methods We retrospectively collected the data from the medical files of 17 patients (18 ears) implanted with a SME. All patients had functional low frequency hearing (PTA (0.125-0.5 kHz) ≤ 80 dB HL). The insertion results were reexamined from the postoperative cone-beam computed tomography scans. Postoperative thresholds were obtained at the time of switch-on of the sound processors (mean 43 days) and at latest follow-up (mean 582 days). The speech recognition in noise was measured with the Finnish matrix sentence test preoperatively and at follow-up. Results The mean insertion depth angle (IDA) was 395°. Neither scala dislocations nor tip fold over were detected. There were no total hearing losses. Functional low-frequency hearing was preserved in 15/18 (83%) ears at switch-on and in 14/17 (82%) ears at follow-up. According to HEARRING classification, 55% (10/18) had complete HP at switch-on and 41% (7/17) still at follow-up. Thirteen patients (14 ears) were initially fitted with electric-acoustic stimulation and seven patients (8 ears) continued to use it after follow-up. Conclusions The preliminary hearing preservation results with the SME were more favorable than reported for other perimodiolar electrodes. The results show that the array may also be feasible for electro-acoustic stimulation; it is beneficial in that it provides adequate cochlear coverage for pure electrical stimulation in the event of postoperative or progressive hearing loss.

Section: Discussionmentioning

confidence: 99%

Preservation of residual hearing after cochlear implant surgery with slim modiolar electrode

Iso-Mustajärvi

Sipari

Löppönen

et al. 2019

“…Previous studies using the Slim Modiolar electrode array showed consistent perimodiolar placement and scala tympani insertions in at least 87% of the patients assessed with imaging [1][2][3]. They reported hearing preservation is better than with older perimodiolar and straight designs, but possibly not as good as hybrid or electroacoustic devices that are specifically designed for hearing preservation [2,3,[9][10][11].…”

Section: Introductionmentioning

confidence: 94%

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

Hey¹,

Neben²,

Stöver

et al. 2020

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.

“…It was observed that independent of the type of electrode used, full scala tympani (ST) position [8] and preservation of residual hearing [8,10] is more likely using a RW or eRW approach, compared to the CS approach. These findings might contribute to the fact that to-date, eRW and RW approaches were used in 91.8% (236/257) of the participants in the five studies that investigated the SPE [11,12,[14][15][16].…”

Section: Rationalementioning

confidence: 99%

“…Characteristics of participants a Participant numbers 1, 2, 4, 5, 6, 9, 10, 13, 18, 20, 22 and 23 were defined as having late onset of hearing loss and participants numbers3,7,8,11,12,14,15,16,17,19 and 21 were defined as…”

mentioning

confidence: 99%

The evaluation of a slim perimodiolar electrode: surgical technique in relation to intracochlear position and cochlear implant outcomes

Heutink

Verbist

Mens

et al. 2019

Purpose In cochlear implantation (CI), the two factors that are determined by the surgeon with a potential significant impact on the position of the electrode within the cochlea and the potential outcome, are the surgical technique and electrode type. The objective of this prospective study was to evaluate the position of the slim, perimodiolar electrode (SPE), and to study the influence of the SPE position on CI outcome. Methods Twenty-three consecutively implanted, adult SPE candidates were included in this prospective cohort study conducted between December 2016 and April 2019. Mean age at surgery was 59.5 years. Mean preoperative residual hearing was 92.2 dB. Intra-operative fluoroscopy and high-resolution computed tomography scans were performed to evaluate electrode position after insertion using a cochleostomy (CS) approach. Follow-up was 12 months after implantation; residual hearing (6-8 weeks) and speech perception (6-8 weeks and 12 months) were evaluated in relation to the intracochlear SPE position. Results In most patients in whom the SPE was positioned in the scala tympani residual hearing was preserved [mean absolute increase in PTA of 4.4 dB and 77.2% relative hearing preservation (RHP%)]. Translocation into the scala vestibuli occurred in 36% of the insertions, resulting in a mean absolute increase in PTA of 17.9 dB, and a RHP% of 19.2%. Participants with a translocation had poorer speech perception scores at 12-month follow-up. Conclusion Given the incidence of CS-associated translocations with the SPE and the negative effect on outcome, it is advised to insert the SPE using the (extended) round window approach.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.