Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays

Sierra, Cristina; Calderón, Manuela; Bárcena, Eduardo; Tisaire, Alexandra; Raboso, Eduardo

doi:10.1097/mao.0000000000002170

Cited by 17 publications

(14 citation statements)

References 53 publications

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“…In contrast to this belief, Manjaly et al 27 in 2018 reported on complete hearing preservation with full insertion of FLEX 28 electrode array in patients with pre-operative hearing 85 dB HL at 250 Hz. Sierra et al 28 in 2019 reported on complete/partial hearing preservation using both FLEX SOFT (array length 31.5 mm), STANDARD (array length 31.5 mm) and FLEX 28 (array length 28 mm) electrode in majority of the cases. All these electrodes are capable of going beyond the basal turn of the cochlea is an indirect proof that the electrode array did not cause any intracochlear structural damage.…”

Section: Implications Of Choosing Electrode Array Matching the Cochle...mentioning

confidence: 99%

The rationale for FLEX (cochlear implant) electrode with varying array lengths

Dhanasingh

2021

World j. otorhinolaryngol.-head neck surg.

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With cochlear implantation (CI) being the standard of care for profoundly deaf cases, more and more patients with low frequency residual hearing are currently being treated with CI. In view of preserving the residual hearing, the ultimate aim of both the surgeons and the CI companies is to achieve zero-degree of electrode insertion trauma. Variations in the size and shape of cochlea, cross-sectional dimensions of ST, electrode insertion techniques with and without metal stylet rod and the experience level of the operating surgeons, all play a role in the electrode array related insertion trauma. An effective electrode design must include flexible array to accommodate the cochlear shape variation, electrode with variety of array lengths to support the concept of cochlear size specific electrode array and finally smaller cross-sectional dimensions of electrode array in matching the cross-sectional dimensions of ST. As per published reports, FLEX electrode array design offers minimal degree of electrode insertion trauma along with the possibility of patient specific electrode array length matching their cochlear size. Looking at the cross-sectional dimensions of FLEX electrode array along with its volume, it appear to be highly safe to the cochlea by not taking too much volume inside the ST. To offer additional support, otological pre-planning software tool like OTOPLAN is now clinically available in measuring the cochlear size in finding the best electrode array match along with the possibilities of anatomy based post-operative speech processor fitting.

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Section: Implications Of Choosing Electrode Array Matching the Cochle...mentioning

confidence: 99%

The rationale for FLEX (cochlear implant) electrode with varying array lengths

Dhanasingh

2021

World j. otorhinolaryngol.-head neck surg.

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“…LWEs. There is another report of complete hearing preservation in nine out 25 patients (35%) with LWEs of different lengths after 1 year[46].…”

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confidence: 94%

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

Iso-Mustajärvi

Sipari

Löppönen

et al. 2019

Eur Arch Otorhinolaryngol

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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.

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“…1 is the main outcome variable. Based on three studies in literature (35)(36)(37) we expect a large range of hearing preservation for each group, from 0 (no preservation, i.e., loss of all hearing) to 100 (full preservation, hearing stable), and occasionally above (improved hearing). These three studies showed means of 56, 74, and 53, respectively and within-group standard deviations, σ W, of 37, 19 and 37.…”

Section: Sample Size {14}mentioning

confidence: 99%

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

Jwair¹,

Boerboom²,

Versnel³

et al. 2020

Preprint

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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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Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays

Cited by 17 publications

References 53 publications

The rationale for FLEX (cochlear implant) electrode with varying array lengths

The rationale for FLEX (cochlear implant) electrode with varying array lengths

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

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

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