Cochlear implantation - Adverse effects on the cochlea and the vestibular organ

Abstract

Cochlear implantation is the treatment of choice for patients with profound hearing loss and deafness. At the same time, inserting a cochlear implant (CI) leaves damage to the inner ear. The preservation of inner ear structure and function has become a central issue in CI surgery. The reasons for this are i) electroacoustic stimulation (EAS), i.e., the option of joint stimulation by a hearing aid and a CI; ii) an improved audiologic outcome in electric-only stimulation; iii) the preservation of structures and residual hearing for potential future therapy options; and iv) the avoidance of side effects, such as vertigo. The exact mechanisms that determine the extent of damage to the inner ear and which factors contribute to preservation of residual hearing are not yet fully understood. In addition to the surgical technique, electrode selection may play a role. This article provides an overview of what is known about the direct and indirect adverse effects of cochlear implantation on the inner ear, of the methods available to monitor inner ear function during cochlear implantation, and of the focus of future research on preservation of inner ear structure and function.