Implications of Minimizing Trauma During Conventional Cochlear Implantation

Objective: To describe the relationship between implantation-associated trauma and postoperative speech perception scores among adult and pediatric patients undergoing cochlear implantation using conventional length electrodes and minimally traumatic surgical techniques. Study Design: Retrospective chart review (2002-2010). Setting: Tertiary academic referral center. Patients: All subjects with significant preoperative low-frequency hearing (≤70 dB HL at 250 Hz) who underwent cochlear implantation with a newer generation implant electrode (Nucleus Contour Advance, Advanced Bionics HR90K [1J and Helix], and Med El Sonata standard H array) were reviewed. Intervention(s): Preimplant and postimplant audiometric thresholds and speech recognition scores were recorded using the electronic medical record. Main Outcome Measure(s): Postimplantation pure tone threshold shifts were used as a surrogate measure for extent of intracochlear injury and correlated with postoperative speech perception scores. Results: Between 2002 and 2010, 703 cochlear implant (CI) operations were performed. Data from 126 implants were included in the analysis. The mean preoperative low-frequency pure-tone average was 55.4 dB HL. Hearing preservation was observed in 55% of patients. Patients with hearing preservation were found to have significantly higher postoperative speech perception performance in the CI-only condition than those who lost all residual hearing. Conclusion: Conservation of acoustic hearing after conventional length cochlear implantation is unpredictable but remains a realistic goal. The combination of improved technology and refined surgical technique may allow for conservation of some residual hearing in more than 50% of patients. Germane to the conventional length CI recipient with substantial hearing loss, minimizing trauma allows for improved speech perception in the electric condition. These findings support the use of minimally traumatic techniques in all CI recipients, even those destined for electric-only stimulation.

[1]  Donald K. Eddington,et al.  Quantitative Evaluation of New Bone and Fibrous Tissue in the Cochlea following Cochlear Implantation in the Human , 2007, Audiology and Neurotology.

[2]  Thomas Klenzner,et al.  Quality Control After Insertion of the Nucleus Contour and Contour Advance Electrode in Adults , 2007, Ear and hearing.

[3]  Stephen J. Rebscher,et al.  A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I: Comparison of Nucleus banded and Nucleus Contour ™ electrodes , 2005, Hearing Research.

[4]  J. Fayad,et al.  Spiral Ganglion Cell Loss Is Unrelated to Segmental Cochlear Sensory System Degeneration in Humans , 2009, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[5]  M. Liberman,et al.  Influence of Supporting Cells on Neuronal Degeneration After Hair Cell Loss , 2005, Journal of the Association for Research in Otolaryngology.

[6]  J. Nadol,et al.  Patterns of degeneration in the human cochlear nerve , 1995, Hearing Research.

[7]  F. Telischi,et al.  Pattern Of Hearing Loss In A Rat Model Of Cochlear Implantation Trauma , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[8]  A. Hodges,et al.  Conservation of residual hearing with cochlear implantation. , 1997, The American journal of otology.

[9]  René H. Gifford,et al.  Evidence for the Expansion of Adult Cochlear Implant Candidacy , 2010, Ear and hearing.

[10]  G. E. Peterson,et al.  Revised CNC lists for auditory tests. , 1962, The Journal of speech and hearing disorders.

[11]  P. Blamey,et al.  Are spiral ganglion cell numbers important for speech perception with a cochlear implant? , 1997, The American journal of otology.

[12]  Peter S Roland,et al.  Surgical aspects of cochlear implantation: mechanisms of insertional trauma. , 2006, Advances in oto-rhino-laryngology.

[13]  William F. House,et al.  Cochlear Implants: Histopathologic Findings Related to Performance in 16 Human Temporal Bones , 1991, The Annals of otology, rhinology, and laryngology.

[14]  B. Woodson,et al.  Prediction of uvulopalatopharyngoplasty response using cephalometric radiographs. , 1997, American journal of otolaryngology.

[15]  Jan Kiefer,et al.  Conservation of low-frequency hearing in cochlear implantation , 2004, Acta oto-laryngologica.

[16]  G M Clark,et al.  Surgical implications of perimodiolar cochlear implant electrode design: avoiding intracochlear damage and scala vestibuli insertion , 2001, Cochlear implants international.

[17]  R. Snyder,et al.  Chronic electrical stimulation by a cochlear implant promotes survival of spiral ganglion neurons after neonatal deafness , 1999, The Journal of comparative neurology.

[18]  H. Spoendlin.  Factors Inducing Retrograde Degeneration of the Cochlear Nerve , 1984, The Annals of otology, rhinology & laryngology. Supplement.

[19]  J. Fayad,et al.  Multichannel Cochlear Implants: Relation of Histopathology to Performance , 2006, The Laryngoscope.

[20]  Margaret W Skinner,et al.  In Vivo Estimates of the Position of Advanced Bionics Electrode Arrays in the Human Cochlea , 2007, The Annals of otology, rhinology & laryngology. Supplement.

[21]  F. Linthicum,et al.  The Effect of Organ of Corti Loss on Ganglion Cell Survival in Humans , 2006, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[22]  Fred F Telischi,et al.  Conservation of Residual Acoustic Hearing After Cochlear Implantation , 2006, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[23]  Helge Rask-Andersen,et al.  Variational Anatomy of the Human Cochlea: Implications for Cochlear Implantation , 2009, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[24]  Margaret W Skinner,et al.  Role of Electrode Placement as a Contributor to Variability in Cochlear Implant Outcomes , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[25]  Thomas Lenarz,et al.  Hearing Conservation Surgery Using the Hybrid-L Electrode , 2009, Audiology and Neurotology.

[26]  J Thomas Roland,et al.  A Model for Cochlear Implant Electrode Insertion and Force Evaluation: Results with a New Electrode Design and Insertion Technique , 2005, The Laryngoscope.

[27]  Toshio Ishibashi,et al.  Factors Associated with Poor Outcome in Children with Acute Otitis Media , 2003, Acta oto-laryngologica.

[28]  J Thomas Roland,et al.  Evaluation of the Short Hybrid Electrode in Human Temporal Bones , 2008, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[29]  Peter S Roland,et al.  Advanced Bionics Thin Lateral and Helix II Electrodes: A Temporal Bone Study , 2005, The Laryngoscope.

[30]  Donald K. Eddington,et al.  Histopathology of Cochlear Implants in Humans , 2001, The Annals of otology, rhinology, and laryngology.

[31]  Adrien A Eshraghi,et al.  Cochlear implantation trauma and noise-induced hearing loss: Apoptosis and therapeutic strategies. , 2006, The anatomical record. Part A, Discoveries in molecular, cellular, and evolutionary biology.

[32]  Long-term clinical course and temporal bone histology after cochlear implantation , 2005, Cochlear implants international.