Intraindividual Comparison of Psychophysical Parameters Between Perimodiolar and Lateral-type Electrode Arrays in Patients With Bilateral Cochlear Implants

Jeong, Junhui; Kim, Minbum; Heo, Jae-Hyeok; Bang, Mi-Young; Bae, Mi Ran; Kim, Jungmin; Choi, Jae Young

doi:10.1097/mao.0000000000000672

Cited by 23 publications

(19 citation statements)

References 16 publications

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“…Several studies have demonstrated lower stimulation thresholds for permodiolar arrays than for straight arrays, either when measured psychophysically or when assessed by objective measures [Cohen et al, 2001;Gordin et al, 2009;Runge-Samuelson et al, 2009;Jeong et al, 2015;Müller et al, 2015;Telmesani and Said, 2015]. Other studies have reported a reduced spread of excitation using forward masking ECAP paradigms [Hughes and Abbas, 2006;Basta et al, 2010;Hughes and Stille, 2010] with improved spectral discrimination.…”

Section: Introductionmentioning

confidence: 99%

Clinical investigation of the Nucleus Slim Modiolar Electrode

et al. 2017

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Aims: The Nucleus CI532 cochlear implant incorporates a new precurved electrode array, i.e., the Slim Modiolar electrode (SME), which is designed to bring electrode contacts close to the medial wall of the cochlea while avoiding trauma due to scalar dislocation or contact with the lateral wall during insertion. The primary aim of this prospective study was to determine the final position of the electrode array in clinical cases as evaluated using flat-panel volume computed tomography. Methods: Forty-five adult candidates for unilateral cochlear implantation were recruited from 8 centers. Eleven surgeons attended a temporal bone workshop and received further training with a transparent plastic cochlear model just prior to the first surgery. Feedback on the surgical approach and use of the SME was collected via a questionnaire for each case. Computed tomography of the temporal bone was performed postoperatively using flat-panel digital volume tomography or cone beam systems. The primary measure was the final scalar position of the SME (completely in scala tympani or not). Secondly, medial-lateral position and insertion depth were evaluated. Results: Forty-four subjects received a CI532. The SME was located completely in scala tympani for all subjects. Pure round window (44% of the cases), extended round window (22%), and inferior and/or anterior cochleostomy (34%) approaches were successful across surgeons and cases. The SME was generally positioned close to the modiolus. Overinsertion of the array past the first marker tended to push the basal contacts towards the lateral wall and served only to increase the insertion depth of the first electrode contact without increasing the insertion depth of the most apical electrode. Complications were limited to tip fold-overs encountered in 2 subjects; both were attributed to surgical error, with both reimplanted successfully. Conclusions: The new Nucleus CI532 cochlear implant with SME achieved the design goal of producing little or no trauma as indicated by consistent scala tympani placement. Surgeons should be carefully trained to use the new deployment method such that tip fold-overs and over insertion may be avoided.

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Section: Introductionmentioning

confidence: 99%

Clinical investigation of the Nucleus Slim Modiolar Electrode

et al. 2017

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“…The majority of current literature evaluating effects of charge on array type reports that perimodiolar placements result in reduced charge for equivalent stimulation at threshold and at suprathreshold comfort levels (3, 5–6) and lower EABR thresholds (7–8). There are, however, a few published studies that have reported contrasting results.…”

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confidence: 99%

Relationship Between Electrode-to-Modiolus Distance and Current Levels for Adults With Cochlear Implants

Davis

Zhang

Gifford

et al. 2016

Otology &Amp; Neurotology

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Hypothesis Electrode-to-modiolus distance is correlated with clinically-programmed stimulation levels. Background Conventional wisdom has long supposed a significant relationship between cochlear implant (CI) stimulation levels and electrode-to-modiolus distance; however, to date, no such formal investigation has been completed. Thus the purpose of this project was to investigate the relationship between stimulation levels and electrode-to-modiolus distance. A strong correlation between the two would suggest that stimulation levels might be used to estimate electrode-to-modiolus geometry. Methods Electrode-to-modiolus distance was determined via CT imaging using validated CI position analysis software in 137 implanted ears from the three manufacturers holding FDA approval in the United States. Analysis included 2,365 total electrodes, with 1,472 from pre-curved arrays. Distances were compared to clinically-programmed C/M levels which were converted to charge units. Results Mean modiolar distance with perimodiolar and lateral wall electrodes was 0.47 mm and 1.15 mm, respectively. Mean suprathreshold charge values were significantly different between each manufacturer. When combining all data, we found a moderate positive correlation (r = 0.367, p <0.01) that was driven both by the different charge values across companies, and that the company with the highest mean charge values only offers straight electrode arrays. When grouped by electrode type, however, we found a weak correlation (r = 0.12, p <0.01) for perimodiolar array electrodes only. When considering a single array type from any one manufacturer, only one was observed where distance mildly predicted charge. Conclusion Our results suggest that electrode distance minimally contributes to the current level required for suprathreshold stimulation.

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“…As might be expected, compound action potential thresholds, T levels and C levels were lower in perimodiolar arrays but there was not any significant difference in dynamic range [27]. This study did not follow patients for long enough to comment on timing for stability, but given the lack of difference in dynamic range between array types, it would be unlikely to be an important variable for map stability.…”

Section: Array Typementioning

confidence: 90%

Variables that Effect Psychophysical Parameters and Duration to Stability in Cochlear Implant Mapping

Cs¹,

Pls²

2016

Otolaryngol

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The process of rehabilitation after cochlear implant surgery involves programming the psychophysical parameters of the implant in a process called mapping. The audiology appointments involved in the mapping process are large contributors to cost of implant rehabilitation. The map is defined as stable when there is little variation over time.Once an implant map is stable there is reduced need for intensive rehabilitation and an increase in implant patient satisfaction. A literature search was conducted using the terms "map cochlear implant", "mapping cochlear implant", "psychophysical cochlear implant" with a date range from August 1957 to February 2016. A total of 560 articles were identified and 29 articles were retrieved for detailed evaluation. The most important factor identified, that determines map stability, is the patient's subjective implant experience. Patient demographics and implant variables have not been identified as significant. The second side implant in bilateral implantation has been shown to have significantly less time to map stability. There is a need for further studies to examine relationships between preoperative variables and the mapping process, rather than applying a "one size fits all approach", which is the current standard of care. This is of particular need in the setting of the second side in bilateral implantation.

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Intraindividual Comparison of Psychophysical Parameters Between Perimodiolar and Lateral-type Electrode Arrays in Patients With Bilateral Cochlear Implants

Cited by 23 publications

References 16 publications

Clinical investigation of the Nucleus Slim Modiolar Electrode

Clinical investigation of the Nucleus Slim Modiolar Electrode

Relationship Between Electrode-to-Modiolus Distance and Current Levels for Adults With Cochlear Implants

Variables that Effect Psychophysical Parameters and Duration to Stability in Cochlear Implant Mapping

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