Hearing Outcomes Research Articles

Predicting Postoperative Speech Perception and Audiometric Thresholds Using Intracochlear Electrocochleography in Cochlear Implant Recipients.

Electrocochleography (ECochG) appears to offer the most accurate prediction of post-cochlear implant hearing outcomes. This may be related to its capacity to interrogate the health of underlying cochlear tissue. The four major components of ECochG (cochlear microphonic [CM], summating potential [SP], compound action potential [CAP], and auditory nerve neurophonic [ANN]) are generated by different cochlear tissue components. Analyzing characteristics of these components can reveal the state of hair and neural cell in a cochlea. There is limited evidence on the characteristics of intracochlear (IC) ECochG recordings measured across the array postinsertion but compared with extracochlear recordings has better signal to noise ratio and spatial specificity. The present study aimed to examine the relationship between ECochG components recorded from an IC approach and postoperative speech perception or audiometric thresholds. In 113 human subjects, responses to 500 Hz tone bursts were recorded at 11 IC electrodes across a 22-electrode cochlear implant array immediately following insertion. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the CM and added to one another to emphasize the SP, ANN, and CAP. Maximum amplitudes and extracochlear electrode locations were recorded for each of these ECochG components. These were added stepwise to a multi-factor generalized additive model to develop a best-fit model predictive model for pure-tone audiometric thresholds (PTA) and speech perception scores (speech recognition threshold [SRT] and consonant-vowel-consonant phoneme [CVC-P]) at 3- and 12-month postoperative timepoints. This best-fit model was tested against a generalized additive model using clinical factors alone (preoperative score, age, and gender) as a null model proxy. ECochG-factor models were superior to clinical factor models in predicting postoperative PTA, CVC-P, and SRT outcomes at both timepoints. Clinical factor models explained a moderate amount of PTA variance ( r2 = 45.9% at 3-month, 31.8% at 12-month, both p < 0.001) and smaller variances of CVC-P and SRT ( r2 range = 6 to 13.7%, p = 0.008 to 0.113). Age was not a significant predictive factor. ECochG models explained more variance at the 12-month timepoint ( r2 for PTA = 52.9%, CVC-P = 39.6%, SRT = 36.4%) compared with the 3-month one timepoint ( r2 for PTA = 49.4%, CVC-P = 26.5%, SRT = 22.3%). The ECochG model was based on three factors: maximum SP deflection amplitude, and electrode position of CM and SP peaks. Adding neural (ANN and/or CAP) factors to the model did not improve variance explanation. Large negative SP deflection was associated with poorer outcomes and a large positive SP deflection with better postoperative outcomes. Mid-array peaks of SP and CM were both associated with poorer outcomes. Postinsertion IC-ECochG recordings across the array can explain a moderate amount of postoperative speech perception and audiometric thresholds. Maximum SP deflection and its location across the array appear to have a significant predictive value which may reflect the underlying state of cochlear health.

A tailored approach in cholesteatoma surgery.

In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB). The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.

Auditory brainstem implants: an analysis of adverse events in the MAUDE database

ObjectiveAuditory Brainstem Implants (ABI) are used to restore hearing in patients lacking appropriate cochlear anatomy and/or cochlear nerve. The objective of this study was to examine the Manufacture and User Facility Device Experience (MAUDE) database to analyze adverse events. Study designThis is a study of a multi-institutional database maintained by the US FDA. SettingA database analysis was performed via collaboration of multiple clinicians at tertiary referral centers. MethodsThe MAUDE database was queried for Medical Device Reports (MDRs) relating to ABIs. MDRs were identified using the advanced search term “Implant, Auditory Brainstem” and reviewing all reports with the basic search term “Brainstem Implant”. All collected reports were individually reviewed. ResultsA total of 265 individual patient reports were reviewed, of which 55 reports met inclusion criteria. Reports regarding audiologic outcome included failure to provide hearing benefit (n = 27), implant failure/device malfunction (n = 10), and device non-use (n = 6). Postoperative complications included local skin infection (n = 3), CSF leak (n = 3), elevated ICP (n = 1), surgical site dehiscence (n = 1), swelling (n = 1), seroma formation requiring drainage (n = 1), and meningitis (n = 2). Two patients had dislodged magnets during 1.5 Tesla MRI acquisition. There were 35 instances of full explantation of the device and 1 partial removal; 13 patients had a new device implanted following explantation. ConclusionsPoor hearing results, device failure, and non-use were commonly reported causes for explanation in this analysis. This information can aid physicians in counseling patients and family members and managing device expectations.

Evaluation and outcome of hearing in meningitis patients

Background: Meningitis remains the most common cause of acquired severe to profound SNHL in childhood. Likewise, deafness is the most common long-term neurological sequelae of the disease. Important consideration following meningitis is the development of labyrinthitis ossificans in which there is new bone formation within the lumen of the otic capsule. Ossification of the labyrinth can develop within a few days of meningitis which can make cochlear implantation difficult. Every newborn should be promptly screened for any hearing deficit along with the patients having meningitis. The most easily available investigation are OAE and BERA. Methods: Our ambispective study of 25 patients was undertaken in a duration of 2 years in ENT department of civil hospital, Ahmedabad. All the patients underwent a detailed clinical examination and all routine audiological, and radiological investigations. Results: The prevalence of hearing loss in post meningitis pediatric age group is 40%. Females are affected more than males. Median age group of presentation with hearing deficit is 4 years. Patients with complete immunization history have lower incidence of hearing loss associated with meningitis than incomplete immunization. Ossification of the cochlea can develop as early as 6 days from the development of first symptom. Conclusions: Ossification of the cochlea can develop as early as 6 days from the development of first symptom. These are the candidates who should be prioritized for cochlear implant surgery. Patients with mild hearing loss recovered completely whereas those with profound hearing loss underwent cochlear implant surgery and were benefited with it.

Evaluating the benefits and outcomes of second ear surgeries in bilateral stapedectomies: a comprehensive analysis

Background: Objectives of the study were to evaluate the anatomical abnormalities and benefits of second ear surgery in patients with bilateral otosclerosis undergoing stapedectomy. Methods: A descriptive retrospective study was done in 43 patients undergoing bilateral stapedotomy in a tertiary care centre. Anatomical abnormalties presenting intraoperative were recorded in both operated ears. Hearing outcomes after the first and second ear surgeries were recorded. Chi square and paired t test was used to find the association between categorical and continuous variables between both groups. We correlated the post-operative air conduction (AC) averages, air bone gap (ABG) gain, AC gain between first and second operated ears. Results: Obliterative FP was the most common abnormality seen 7%, followed by facial nerve anamolies 5%. Bilateral variations were seen in 66% and 60% respectively. 66% required bilateral drill outs. After 1st ear and 2nd ear surgery 81% and 76% gained normal hearing. Average postop AC threshold was significantly higher after first ear surgery (p&lt;0.001). ABG and AC gain had no significant difference in both ears. Binaural symmetrical hearing with inter aural difference AB&lt;10 dB was achieved in 90% of patients. Conclusions: It is worthwhile to recommend the patients to undergo contralateral ear surgery if the first ear had achieved normal or socially acceptable hearing, as the chances of achieving a comparable hearing outcome as that of 1st ear is high. Following 2nd ear surgery an effective binaural symmetric hearing can be achieved.

Predicting Individual Hearing-Aid Preference From Self-Reported Listening Experiences in Daily Life.

The study compared the utility of two approaches for collecting real-world listening experiences to predict hearing-aid preference: a retrospective questionnaire (Speech, Spatial, and Qualities of Hearing Scale [SSQ]) and in-situ Ecological Momentary Assessment (EMA). The rationale being that each approach likely provides different and yet complementary information. In addition, it was examined how self-reported listening activity and hearing-aid data-logging can augment EMAs for individualized and contextualized hearing outcome assessments. Experienced hearing-aid users (N = 40) with mild-to-moderate symmetrical sensorineural hearing loss completed the SSQ questionnaire and gave repeated EMAs for two wear periods of 2-weeks each with two different hearing-aid models that differed mainly in their noise reduction technology. The EMAs were linked to a self-reported listening activity and sound environment parameters (from hearing-aid data-logging) recorded at the time of EMA completion. Wear order was randomized by hearing-aid model. Linear mixed-effects models and Random Forest models with five-fold cross-validation were used to assess the statistical associations between listening experiences and end-of-trial preferences, and to evaluate how accurately EMAs predicted preference within individuals. Only 6 of the 49 SSQ items significantly discriminated between responses made for the end-of-trial preferred versus nonpreferred hearing-aid model. For the EMAs, questions related to perception of the sound from the hearing aids were all significantly associated with preference, and these associations were strongest in EMAs completed in sound environments with predominantly low SNR and listening activities related to television, people talking, nonspecific listening, and music listening. Mean differences in listening experiences from SSQ and EMA correctly predicted preference in 71.8% and 72.5% of included participants, respectively. However, a prognostic classification of single EMAs into end-of-trial preference with a Random Forest model achieved a 93.8% accuracy when contextual information was included. SSQ and EMA predicted preference equally well when considering mean differences, however, EMAs had a high prognostic classifications accuracy due to the repeated-measures nature, which make them ideal for individualized hearing outcome investigations, especially when responses are combined with contextual information about the sound environment.

P.096 Hearing preservation and quality of life outcomes in partial labyrinthectomy petrous apicectomy for microsurgical resection of large posterior fossa skullbase tumors

Background: The Partial Labyrinthectomy Petrous Apicectomy (PLPA) aims to give transpetrosal access whilst preserving hearing for challenging tumors such as petroclival meningioma. There are few studies assessing resection and morbidity and no large studies that document hearing preservation and quality of life (QOL). We present the first large series to do so. Methods: A retrospective review was performed of all PLPA cases between 2005 and 2023 at a tertiary center. Demographics, tumor characteristics, neuromonitoring, hearing and surgical outcomes were collected. QOL was measured with the 36-item short form survey (SF-36). Results: Of 73 PLPAs, data for 56 patients undergoing 57 surgeries was obtained. Petroclival meningioma (57.8%) and epidermoid tumors (21.0%) were common indications . The mean patient age and tumor size were 51.6 years and 44mm. Gross total resection was achieved in 40.3%, near total in 15.8% and subtotal in 43.8% of cases with no perioperative mortality and was not influenced by attempted hearing preservation (p=0.183). Of 39 hearing preservation cases, 27 (69.2%) were preserved, 10 (25.6%) were lost and 2 had unclear outcomes. Conclusions: Improved microsurgery and neuromonitoring during PLPA leads to decreased mortality and morbidity compared to historical cohorts while achieving a high rate of resection, hearing preservation and maintained QOL.

Debutul subliminal al surdităţii neurosenzoriale brusc instalate în hipotiroidism – revizuire a literaturii

Sudden sensorineural hearing loss (SSNHL) is a frequent oc­cur­rence in audiology and otolaryngology. It refers to a sen­so­rineural hearing loss of 30 dB or more across three con­se­cu­tive audiometric frequencies, developing within 72 hours. While the causes of SSNHL vary widely, most cases lack a clear origin. Studies have suggested a po­ten­tial re­la­tion­ship between thyroid dysfunction and the onset of SSNHL, yet establishing a definitive causal link re­mains un­cer­tain. Our review aims to meticulously explore the impact of thyroid function on SSNHL. The treatment for SSNHL with iden­ti­fiable causes typically targets the un­der­lying agent, often resulting in poor hearing outcomes due to inner ear hair cell damage. In cases of idiopathic SSNHL, steroid the­r­apy is the current standard of care. The prognosis for hea­r­ing recovery in idiopathic SSNHL hinges on factors such as the severity of hearing loss, age, presence of vertigo, and le­­­vels of thyroid hormones.

Evaluation of Cochlear Implantation in Children With Cochlear Nerve Absence or Deficiency.

To identify associations between cochleovestibular anatomy findings and hearing outcomes found in children with imaging evidence of an absent or hypoplastic cochlear nerve treated with cochlear implantation (CI). retrospective review. Cochlear implant program at tertiary care center. A retrospective review was performed to identify children with imaging evidence of cochlear nerve absence or deficiency who underwent CI evaluation. High-resolution 3-dimensional T2-weighted magnetic resonance imaging in the oblique sagittal and axial planes were reviewed by a neuroradiologist to identify cochleovestibular anatomy. Hearing was assessed pre and postoperatively with Speech Perception Category scores. Seven CI recipients were identified (n = 10 ears) who had bilateral severe to profound sensorineural hearing loss with lack of auditory development with binaural hearing aid trial and imaging evidence of cochlear nerve aplasia/hypoplasia. All ears had 2 nerves in the cerebellopontine angle (100%, n = 10), half of the ears had evidence of 2 or less nerves in the internal auditory canal (IAC). All children showed large improvement in speech perception after CI. Our experience with CIs for children with absent or hypoplastic cochlear nerves demonstrates that CI can be a viable option in select patients who satisfy preoperative audiological criteria. Radiological identification of a hypoplastic or aplastic cochlear nerve does not preclude auditory innervation of the cochlea. CI recipients in this subgroup must be counseled on difficulty in predicting postimplantation language and speech outcomes, and cautioned about facial nerve stimulation.

Study of Predictive Value of Middle Ear Risk Index on Hearing Improvement in Patients Undergoing Surgery for Chronic Suppurative Otitis Media

Introduction: Middle ear risk index is one of the most reliable measuring tools to predict and evaluate the results of tympanoplasty. This study was done to analyse the predictive value of revised middle ear risk index on hearing improvement in patients undergoing surgery for chronic otitis media and to correlate the association between each index factor with hearing results. Materials and Methods: This prospective observational study was done over 2 years in a tertiary care Army Hospital with 88 patients in the age group of 10-65 years. Preoperative hearing thresholds and air-bone gaps were recorded. Patients were assigned to mild, moderate and severe groups with risk index scores. Hearing thresholds were assessed at 3 and 6 months following surgery for chronic otitis media. Data was statistically analysed. Results: 92.04% and 77.27% showed hearing improvements, 4.54% and 1.13% had deterioration and 3.40% and 21.59% had no change when compared to preoperative results in AC and BC thresholds respectively. 57.95% had post-operative closure of air bone gap of ≤ 12. Compared to cases with AB gap closure ≤ 12, those with AB gap closure &gt; 12 showed statistically significant gain in BC by 0.2dB. Each unit increase in risk index score was associated with statistically significant increase of 0.64 dB in BC. Out of the seven individual factors, only perforation and previous surgery showed statistical significance in terms of hearing improvement. Conclusion: Middle ear risk index is not a good predictor of hearing improvement in ear surgery. Individually, risk index or air bone gap are not strong predictors but jointly, they show strong association with hearing improvement both in terms of AC and BC. Keywords: Middle ear risk index; Air conduction; Bone conduction; Air-bone gap; Hearing improvement.

"Minimally symptomatic" congenital cytomegalovirus infection: latest data and emerging concepts.

Universal and targeted screening of newborns for congenital cytomegalovirus (CMV) infection is increasing globally. Questions remain concerning the management of infants who have been identified with congenital CMV infection, especially those with "minimally symptomatic" or clinically inapparent infection. Our objective is to discuss current management of CMV-infected neonates with a focus on less affected infants with or without sensorineural hearing loss (SNHL). Valganciclovir is being prescribed increasingly in neonates with congenital CMV infection for improvement in hearing outcomes through 2 years of age. Treatment initiated in the first month of age is recommended for clinically apparent disease. A recent study showed hearing improvement at 18-22 months of age when therapy was initiated at age 1-3 months in infants with clinically inapparent CMV infection and isolated SNHL. Antiviral therapy with either ganciclovir or valganciclovir has shown moderate benefit in prevention of hearing deterioration among infants with clinically apparent CMV infection or isolated SNHL. Sustainability of benefit beyond 2 years of age remains unknown. At present, infants with clinically inapparent CMV infection (normal complete evaluation including hearing) should not receive antiviral therapy. All CMV-infected infants require close audiological and neurodevelopmental follow-up.

Validity of endoscopic ossiculoplasty immediately after its introduction for ossicular chain disruption

BackgroundTranscanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution.MethodsTEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann–Whitney U test and Fisher’s exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air–bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann–Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air–bone gaps between the diagnoses.ResultsNo significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air–bone gaps, or incidence of air–bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air–bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air–bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days).ConclusionsTEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.

Evaluation Of Hearing Results Following Ossiculoplasty In Canal Wall Down Tympanoplasty For Middle‐Ear Cholesteatoma

Evaluation Of Hearing Results Following Ossiculoplasty In Canal Wall Down Tympanoplasty For Middle‐Ear Cholesteatoma

Effect of COVID-19 on the characteristics and outcome of patients who have otitis media with effusion: a case-control study

BackgroundFew studies have examined the otologic symptoms of Coronavirus disease 2019 (COVID-19). The objective of this study was to identify the effect of COVID-19 on the characteristics and outcomes of patients who have otitis media with effusion (OME).MethodsThis case-control study compared the characteristics and outcomes of OME patients who did or did not have COVID-19. A total of 65 patients with previous COVID-19 and 40 patients who did not have COVID-19 (controls) were enrolled from October 1, 2022 to January 31, 2023 at a single institution in China. Demographics, medical histories, morbidities, hearing test results, treatments, and outcomes of the two groups were compared.ResultsThe COVID-19 group had significantly better outcomes from OME than the control group, with higher rates of complete resolution (64.6% vs. 30%) and improvement (30.8% vs. 17.5%), and a lower rate of persistent OME (4.6% vs. 52.5%). Previous COVID-19 was independently associated with a more favorable OME outcome in three multivariate logistic regression models. The COVID-19 group also had a greater improvement in hearing threshold based on air-bone gap measurements.ConclusionThe outcomes of OME patients who had previous COVID-19 were generally good, in that most patients responded well to treatment and achieved complete resolution or improvement within one month.

Mitigation of Effect Modification by Psychological Status in Patients With Hearing Loss

Although patient-reported outcomes provide valuable insights, these subjective data may not align with objective test results. Hearing loss is a pervasive problem, such that concordance between subjective perceptions of hearing ability and objective audiogram assessments would be beneficial. To determine (1) whether psychological status is an effect modifier of the association between subjective patient reports of hearing ability and objective audiometry results, and (2) whether any effect modification observed in standard static questionnaires would be either mitigated or exacerbated by adaptive testing based on Item Response Theory analyses. This diagnostic study at a tertiary care center and community-based practice included consecutive adults who presented with queries related to hearing loss. Participants were recruited and enrolled and data analyses occurred from 2022 to 2024. Participants prospectively reported their hearing-specific abilities through either a standard static or adaptive version of the Inner Effectiveness of Auditory Rehabilitation (EAR) scale, alongside validated measures of their mental health and audiometry. Word recognition scores (WRS) and pure tone averages (PTA) were used to analyze audiometric testing. The association between subjective Inner EAR results and audiometry was evaluated. Stratified analyses were used to assess for effect modification by psychological status. The results of standard static and adaptive testing were compared. In this study of 395 patients (mean [range] age, 55.9 [18-89] years; 210 [53.2%] female), standard static Inner EAR mean scores were appropriately higher in patients with higher (better) WRS (50.7, 95% CI, 46.4-54.9), compared with patients with lower (worse) WRS (34.7, 95% CI, 24.3-45.1). However, among patients with worse mental health, there was no association between standard static Inner EAR scores and WRS. In contrast, adaptive Inner EAR mean scores were significantly higher for those with better WRS, regardless of mental health status. Thus, effect modification was observed in standard static assessments, whereas adaptive testing remained durably associated with audiometry, regardless of mental health. Psychological status was an effect modifier of the association between standard Inner EAR scale scores and audiometry, with a positive association observed only in those with better mental health. Adaptive testing scores, however, remained significantly associated with audiometry, even when mental status was worse. Adaptive testing may stabilize the association between subjective and objective hearing outcomes.

Frequency-Specific Analysis of Hearing Outcomes after Surgery for Chronic Ear Diseases

Frequency-Specific Analysis of Hearing Outcomes after Surgery for Chronic Ear Diseases

Endoscopic transcanal underlay myringoplasty using a platelet-rich fibrin (PRF) membrane

BackgroundTympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty.MethodsWe conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry.ResultsSixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported.ConclusionEndoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Cochlear implant electrode design for safe and effective treatment.

The optimal placement of a cochlear implant (CI) electrode inside the scala tympani compartment to create an effective electrode-neural interface is the base for a successful CI treatment. The characteristics of an effective electrode design include (a) electrode matching every possible variation in the inner ear size, shape, and anatomy, (b) electrically covering most of the neuronal elements, and (c) preserving intra-cochlear structures, even in non-hearing preservation surgeries. Flexible electrode arrays of various lengths are required to reach an angular insertion depth of 680° to which neuronal cell bodies are angularly distributed and to minimize the rate of electrode scalar deviation. At the time of writing this article, the current scientific evidence indicates that straight lateral wall electrode outperforms perimodiolar electrode by preventing electrode tip fold-over and scalar deviation. Most of the available literature on electrode insertion depth and hearing outcomes supports the practice of physically placing an electrode to cover both the basal and middle turns of the cochlea. This is only achievable with longer straight lateral wall electrodes as single-sized and pre-shaped perimodiolar electrodes have limitations in reaching beyond the basal turn of the cochlea and in offering consistent modiolar hugging placement in every cochlea. For malformed inner ear anatomies that lack a central modiolar trunk, the perimodiolar electrode is not an effective electrode choice. Most of the literature has failed to demonstrate superiority in hearing outcomes when comparing perimodiolar electrodes with straight lateral wall electrodes from single CI manufacturers. In summary, flexible and straight lateral wall electrode type is reported to be gentle to intra-cochlear structures and has the potential to electrically stimulate most of the neuronal elements, which are necessary in bringing full benefit of the CI device to recipients.

Audiologic Outcomes After Vestibulotomy in Patients With Congenital Absence of the Oval Window.

To examine the clinical features and surgical outcomes in patients with congenital absence of the oval window (CAOW), and to investigate the potential factors that affect audiologic results. A retrospective chart review. A tertiary academic center. A total of 17 ears among 16 patients were confirmed to have CAOW. Among them, 13 ears underwent vestibulotomy for hearing reconstruction. Clinical parameters associated with the hearing outcomes were analyzed. A mean air-bone gap (ABG) after 6-month and long-term follow-up was compared with preoperative measurements. Intraoperative findings showed that anomalies of the malleus or incus were observed in 11 ears (64.7%), stapes anomalies were present in all ears (100%), and facial nerve anomalies were present in 10 ears (58.8%). Because of unfavorable facial nerve anomalies, hearing reconstruction was aborted in four cases (23.5%). In the hearing reconstruction group, the mean ABG at 6 months postoperation was significantly reduced after compared with the preoperative value (44.0 ± 8.4 dB versus 58.8 ± 9.1 dB, p = 0.006). After dividing ears into a success subgroup (ABG ≤ 30 dB, seven ears) and non-success subgroup (ABG > 30 dB, six ears), the use of a drill during vestibulotomy was significantly related to a poor hearing outcome (100% versus 16.7%, p = 0.015). The long-term follow-up result (mean, 60 mo) revealed no deterioration compared with the 6-month postoperative result. Five ears (29.4%) underwent revision surgery, and three of them showed ABG improvements. No serious complications were reported. Vestibulotomy is an effective and safe option for hearing restoration in patients with CAOW, particularly when the use of a drill is not required. The long-term audiologic outcome is also reliable.

Hearing outcomes following reimplantation of functional legacy cochlear implants

ObjectivesRecently, patients with certain legacy cochlear implants (CIs) have sought out reimplantation to enjoy the benefits offered by newer processor technology. This decision can be difficult, especially when the individual relies exclusively on the device for communication and scores at the ceiling of performance metrics. To date, most outcome data is derived from reimplantation of a non-functioning CI—a relatively easy decision. The aim of this study is to report hearing outcomes following reimplantation of legacy implants to guide surgeons and patients approaching this high-stakes clinical situation. Patients and interventionFour patients implanted with Advanced Bionics Clarion C1 devices over 20 years ago underwent reimplantation. ResultsThree reimplanted patients demonstrated a maintenance or improvement in their audiometric performance with one patient experiencing only a 5 % decrease in AzBioQ score. Each patient expressed satisfaction with the expansion of technological capabilities including improved battery life, and device connectivity. There were no failed reimplantations or other adverse effects. ConclusionsReimplantation of a functioning legacy CI result in stability or improvement in auditory performance. All individuals in this series report that they enjoy the new connectivity and programming technologies. As the rate advancement in CI technology continues to increase and newer device architectures emerge, these data will help to inform the decision to reimplant functioning devices.