When to replace legacy cochlear implants for technological upgrades: Indications and outcomes

Abstract

Objective To determine indications, surgical efficacy, and audiologic outcomes of replacing Advanced Bionics Clarion C1.2 internal devices (Advanced Bionics, LLC, Valencia, CA) as a means of technology upgrade. Study Design Retrospective review, case series. Methods Ten patients were initially implanted as a child (mean age = 3.87 years) and underwent cochlear implant reimplantation (CIR) with current Advanced Bionics internal device as a young adult (mean duration of implant use = 15.66 years). Demographic data and pre‐ and post‐CIR speech perception scores were collected. Results Technology upgrade was the primary (9) or secondary (1) motivation for CIR. No surgical complications were noted, and full insertion was obtained in nine cases. Intraoperative impedance levels and neural response imaging measures were within normal limits for eight patients. At most recent post‐CIR follow‐up evaluation, all patients (100%) performed within or better than the 95% confidence interval of their pre‐CIR word and sentence recognition scores; and 55.6%, 50.0%, and 50.0% of patients performed above the 95% confidence interval of their pre‐CIR scores for the CNC words, sentences in quiet, and sentences in noise, respectively. Conclusion Post‐CIR audiological benefit was stable or improved compared to pre‐CIR results in all categories by 3 months after reactivation. Given these results, patients who are unable to use the most current external processors due to incompatibility with a legacy internal device could consider reimplanation to optimize their overall performance with a cochlear implant. Level of Evidence 4 Laryngoscope, 129:748–753, 2019

Audiological Outcomes and Associated Factors after Pediatric Cochlear Reimplantation

“…This is an encouraging result, as patients with CI offering good performances seemed not to be at risk of significant decrement after reimplantation. This outcome favors the feasibility of replacing the old CI for technological upgrading without risking audiological performance decrement [ 12 ]. However, we observed that patients with suboptimal speech rehabilitation presented a median decrease of −19% in their performances.…”

“…Device malfunctions can be separated into hard device failure (acute and complete loss of connection between the external and internal device with abnormal electrophysiological testing) and soft device failure (audiological performance decrement and exclusion of detectable hardware or software-related causes) [ 9 , 10 ]. More recently, the indication of reimplantation for technological upgrading of older implants has been discussed [ 11 , 12 ].…”

Research Status and Future Development of Cochlear Reimplantation

“…Some articles did not attempt to define cochlear reimplantation at all ( Bhadania et al, 2018 ; Batuk et al, 2019 ). “Reimplantation/re-implantation” are often used to mean CI reimplantation, and “reinsertion/replacement” are also used in the same context ( Desoyer and Burian, 1985 ; Parisier et al, 1991 ; Holcomb et al, 2018 ; Lane et al, 2019 ). However, there existed confusion and genericity between “revision” and “reimplantation” in many studies ( Lassig et al, 2005 ; Rivas et al, 2008 ; Hwang et al, 2019 ).…”

Speech comprehension across multiple CI processor generations: Scene dependent signal processing

“…Another main outcome measure is speech perception in noise. This can be assessed at fixed signal‐to‐noise ratios 5 , 6 , 7 for accessing percent correct scores or at variable signal‐to‐noise ratios by adaptively administering a speech reception threshold (SRT) test. 8 , 9 , 10 In noisy listening situations, CI recipients experience a larger deterioration of speech perception than normal hearing subjects 11 , 12 accompanied by a considerable variability in quiet as well in noise.…”

“…During the last two decades a range of dedicated signal processing algorithms for CI sound processors such as conventional beamformer, dynamic range optimization, and spatial post‐filter technologies were introduced. Each has aimed to improve the speech perception in a specific listening situation like speech in quiet, 10 , 22 speech in noise, 7 , 17 speech in spatially distributed noise, 2 , 23 , 24 , 25 and speech in fluctuating competing signals. 11 , 26 , 27 The most recent sound processor generation from Cochlear (CP1000) offers a dedicated preprocessing technology for spatially distributed fluctuating competing signals, enabling CI recipients to better understand conversations in one of the most challenging listening situations, 11 commonly referred to as cocktail party noise.…”