Initial Hearing Preservation Is Correlated With Cochlear Duct Length in Fully-inserted Long Flexible Lateral Wall Arrays

Hollis, Emily S.; Canfarotta, Michael W; Dillon, Margaret T.; Rooth, Meredith A; Bucker, Andrea L.; Dillon, Sarah; Young, Allison S.; Quinones, Kristen; Pillsbury, Harold C.; Dedmon, Matthew M.; O’Connell, Brendan P.; Brown, Kevin D.

doi:10.1097/mao.0000000000003181

Cited by 7 publications

(8 citation statements)

References 35 publications

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“…In addition, they found a better long-term speech recognition in patients with a 31.5 mm electrode, than those with a 24 mm array [46]. At the same time, the same research group observed a greater likelihood of preservation of the lower frequencies in patients with longer CDL (up to 36.5 mm) with the same electrode (31.5 mm) [47]. Another study group observed a beneficial influence of deep insertion with regard to thresholds up to 65 dB at 0.5 kHz [48].…”

Section: Discussionmentioning

confidence: 82%

Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software

Spiegel

Polterauer

Hempel

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose In cochlear implantation, thorough preoperative planning together with measurement of the cochlear duct length (CDL) assists in choosing the correct electrode length. For measuring the CDL, different techniques have been introduced in the past century along with the then available technology. A tablet-based software offers an easy and intuitive way to visualize and analyze the anatomy of the temporal bone, its proportions and measure the CDL. Therefore, we investigated the calculation technique of the CDL via a tablet-based software on our own cohort retrospectively. Methods One hundred and eight preoperative computed tomography scans of the temporal bone (slice thickness < 0.7 mm) of already implanted FLEX28™ and FLEXSOFT™ patients were found eligible for analysis with the OTOPLAN software. Measurements were performed by two trained investigators independently. CDL, angular insertion depth (AID), and cochlear coverage were calculated and compared between groups of electrode types, sex, sides, and age. Results Mean CDL was 36.2 ± 1.8 mm with significant differences between sex (female: 35.8 ± 0.3 mm; male: 36.5 ± 0.2 mm; p = 0.037), but none concerning side or age. Differences in mean AID (FLEX28: 525.4 ± 46.4°; FLEXSOFT: 615.4 ± 47.6°), and cochlear coverage (FLEX28: 63.9 ± 5.6%; FLEXSOFT: 75.8 ± 4.3%) were significant (p < 0.001). Conclusion A broad range of CDL was observed with significant larger values in male, but no significant differences concerning side or age. Almost every cochlea was measured longer than 31.0 mm. Preoperative assessment aids in prevention of complications (incomplete insertion, kinking, tipfoldover), attempt of atraumatic insertion, and addressing individual necessities (hearing preservation, cochlear malformation). The preferred AID of 720° (two turns of the cochlea) was never reached, opening the discussion for the requirement of longer CI-electrodes versus a debatable audiological benefit for the patient in his/her everyday life.

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Section: Discussionmentioning

confidence: 82%

Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software

Spiegel

Polterauer

Hempel

et al. 2021

Eur Arch Otorhinolaryngol

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“…Recent studies have shown that cochlear duct lengths vary across patients and the ideal insertion depth may be patient-specific (19,20). Hollis et al (21) showed that CI candidates with low-frequency hearing and short cochlear duct lengths were at greater risk of losing their residual hearing after CI when standard length electrodes were used. These findings suggest that accounting for the patient's cochlear duct length may be required for electrode selection to maximize both HP outcomes and cochlear coverage.…”

Section: Introductionmentioning

confidence: 99%

Early Hearing Preservation Outcomes Following Cochlear Implantation With New Slim Lateral Wall Electrode Using Electrocochleography

Walia

Shew

Ettyreddy

et al. 2022

Otology &Amp; Neurotology

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Objective: Describe early hearing preservation (HP) cochlear implantation (CI) outcomes using a new slim lateral wall electrode (SLWE). Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Adult CI candidates with preoperative low-frequency pure-tone average (LFPTA; 125, 250, 500 Hz) 60 dB HL. Intervention: CI with and without intracochlear real-time electrocochleography (RT-ECochG). Main Outcome Measure: HP (LFPTA 80 dB HL), LFPTA shift, speech-perception performance measures, postoperative CT reconstruction. Results: Forty-two subjects were implanted with the SLWE. Thirty patients underwent full insertion without RT-ECochG feedback, and HP was maintained at 3-months postactivation for 7 (23.3%) patients with mean LFPTA shift of 57.5 AE 25.6 dB HL. RT-ECochG feedback was utilized on 12 patients, of whom 6 patients had full insertions and 6 patients had anywhere from 1 to 3 electrodes left outside of the cochlea based on RT-ECochG feedback. At 3 months postoperatively, HP was achieved on 10 (83.3%) patients and mean LFPTA shift was 18.9 c 11.7 dB HL. Mean difference between LFPTA threshold shift at 3-months postactivation with and without RT-ECochG was 38.6 dB HL (95% CI, 25.6-51.67). There was an improvement in delta CNC from preoperative to 3-months postactivation when using RT-ECochG, with mean difference 20.7% (95% CI, 3.3-38.1). Conclusions: Use of RT-ECochG monitoring during SLWE placement results in fewer full electrode insertions and significantly better HP rates and speech-perception outcomes when compared with unmonitored insertions. Further investigation is needed to evaluate long-term audiologic outcomes to better understand the relationships among ECochG, cochlear trauma, functional outcomes, and HP.

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“…Another consideration is that although a complete insertion with a flexible 31.5‐mm array is feasible in most cases, the risk of apical trauma remains incompletely understood. As recent efforts have shown feasibility of hearing preservation with 31.5‐mm arrays, 57–59 intracochlear trauma may be less than previously thought when using soft surgical techniques. Nonetheless, future histological studies are needed to assess this variable.…”

Section: Discussionmentioning

confidence: 97%

Incidence of Complete Insertion in Cochlear Implant Recipients of Long Lateral Wall Arrays

Canfarotta

Dillon

Brown

et al. 2021

Otolaryngol.--head neck surg.

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Objective High rates of partial insertion have been reported for cochlear implant (CI) recipients of long lateral wall electrode arrays, presumably caused by resistance encountered during insertion due to cochlear morphology. With recent advances in long-electrode array design, we sought to investigate (1) the incidence of complete insertions among patients implanted with 31.5-mm flexible arrays and (2) whether complete insertion is limited by cochlear duct length (CDL). Study Design Retrospective review. Setting Tertiary referral center. Methods Fifty-one adult CI recipients implanted with 31.5-mm flexible lateral wall arrays underwent postoperative computed tomography to determine the rate of complete insertion, defined as all contacts being intracochlear. CDL and angular insertion depth (AID) were compared between complete and partial insertion cohorts. Results Most cases had a complete insertion (96.1%, n = 49). Among the complete insertion cohort, the median CDL was 33.6 mm (range, 30.3-37.9 mm), and median AID was 641° (range, 533-751°). Two cases of partial insertion had relatively short CDL (31.8 mm and 32.3 mm) and shallow AID (542° and 575°). Relatively shallow AID for the 2 cases of partial insertion fails to support the idea that CDL alone prevents a complete insertion. Conclusion Complete insertion of a 31.5-mm flexible array is feasible in most cases and does not appear to be limited by the range of CDL observed in this cohort. Future studies are needed to estimate other variations in cochlear morphology that could predict resistance and failure to achieve complete insertion with long arrays.

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Initial Hearing Preservation Is Correlated With Cochlear Duct Length in Fully-inserted Long Flexible Lateral Wall Arrays

Cited by 7 publications

References 35 publications

Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software

Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software

Early Hearing Preservation Outcomes Following Cochlear Implantation With New Slim Lateral Wall Electrode Using Electrocochleography

Incidence of Complete Insertion in Cochlear Implant Recipients of Long Lateral Wall Arrays

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