Thematic coverage and readability of online patient information on cochlear implant care.

INTRODUCTION: The treatment of patients with a cochlear implant (CI) is usually an elective, complex and interdisciplinary process. As an important source of information, patients often access the internet prior to treatment. The quality of internet-based information regarding thematic coverage has not yet been analysed in detail. Therefore, the aim of this study was to analyse the information on CI care available on the internet regarding its thematic coverage and readability. MATERIAL METHODS: Eight search phrases related to CI care were defined as part of the study. A checklist for completeness of thematic coverage was then created for each search phrase. The current German CI clinical practice guideline and the white paper on CI care in Germany were used as a basis. As a further parameter, readability was assessed using Flesch Reading Ease Scores. The search phrases were used for an internet search with Google. The first ten results were then analysed with regard to thematic coverage, readability and the provider of the website. RESULTS: A total of 80 websites were identified, which were set up by 54 different providers (16 providers were found in multiple entries) from eight different provider groups. The average completeness of thematic coverage was 41.6 ± 28.2%. Readability according to the Flesch Reading Ease Score was categorised as "hard to read" on average (34.7 ± 14.2 points, range: 0-72). There was a negative statistically significant correlation between the thematic coverage of content and readability (Spearman's rank correlation: r = - 0.413, p = 0.00014). The completeness of thematic coverage of information on CI care available on the internet was highly heterogeneous and had a significant negative correlation with the readability. This result should be taken into account by both the providers of internet information and by patients when using internet-based information on CI care and help to further improve the quality of web-based information.

Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare.

BACKGROUND: The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined. MATERIALS AND METHODS: The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation. RESULTS: Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1 dB SNR/-0.85 dB SNR; 12 months: -0.65 dB SNR/+0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups. CONCLUSION: A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.

Cochlear implant therapy improves the quality of life and social participation in the elderly: a prospective long-term evaluation.

PURPOSE: In recent years, the number of elderly cochlear implant (CI) candidates is continuously rising. In addition to the audiological improvement, other positive effects of CI treatment can also be observed in clinical routine. The "quality of life" as a parameter of success directly experienced by the patient is increasingly becoming the focus of clinical research. Although there are already clear indications of a rapid and significant improvement in quality of life, there is still a lack of systematic, prospectively collected longitudinal long-term data in patients over the age of 65. METHODS: This prospective longitudinal observational study included 31 patients between the age of 71 and 92 years who had first been treated unilaterally with a CI 6 years ago. In addition to free-field monosyllable recognition, quality of life was assessed using the World Health Organization Quality-of-Life Scale-old (WHOQL-OLD). The results were compared with the data from our previous study, in which we focused on the short- and medium-term effects on quality of life. In both studies, the same patient population was examined. In addition, these study data were compared with an age-matched average population. RESULTS: In speech recognition, there was no significant change from the control 6 months postoperatively compared with the results 6 years postoperatively. No significant changes occurred in the total quality of life score or any of the other six facets of quality of life when comparing the results 6 months postoperatively with the results 6 years postoperatively. In "Social participation", the CI patients even exceed the values of the age-matched average population 6 years after treatment. CONCLUSION: Improvement in the quality of life and especially in social participation appears stable over many years in elderly patients after hearing rehabilitation with a CI.

[Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare. German version]. / Frankfurter Konzept einer stationären Cochleaimplantat-Frührehabilitation : Untersuchung zur Durchführbarkeit als Anschlussheilbehandlung.

BACKGROUND: The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined. MATERIALS AND METHODS: The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation. RESULTS: Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1-0.85 dB SNR; 12 months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups. CONCLUSION: A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.

Prospective study on magnetic resonance imaging in cochlear implant patients.

PURPOSE: Monocentric, prospective study to investigate whether concomitant support of cochlear implant (CI) patients by CI-trained otolaryngologists and application of a standardized head bandage can minimize potential complications during magnetic resonance imaging (MRI). METHODS: Thirty-seven patients with 46 CIs underwent MRI with a prophylactic head bandage. All participants and the otolaryngologist at the CI center completed pre- and post-MRI questionnaires documenting body region scanned, duration of MRI and bandage wear, field strength during the scan, and any complications. If pain was experienced, it was assessed using a visual analog scale (1-10). RESULTS: MRI was performed without adverse events in 37.8% of cases. Magnet dislocation requiring surgical revision occurred in 2% of cases. Pain was reported in 86% of cases, often due to the tightness of the dressing. Patients with rotating, MRI-compatible magnets reported significantly less pain than participants with older-generation implants. In 11% of cases, the MRI was discontinued. CONCLUSION: Serious complications during MRI in cochlear implant patients are rare. Pain is the most common adverse event, probably mainly due to the tight bandage required by most implant types. With newer generations of magnets, these patients experience less pain, no dislocation of the magnets, and no need for bandaging. Although magnet dislocation cannot be completely prevented in older generations of implants, it appears to be reduced by good patient management, which recommends examination under the guidance of physicians trained in the use of hearing implants.

Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults.

PURPOSE: Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation. METHODS: 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared. RESULTS: In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2. CONCLUSION: In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.

[COVID-19 hygiene measures at an inpatient CI therapy center for children from the parents' perspective]. / Corona-Hygienemaßnahmen an einer stationären CI-Therapieeinrichtung für Kinder aus Sicht der Eltern.

BACKGROUND: Due to the COVID-19 pandemic, all essential treatment must adhere to strict health and hygiene protocols. New measures have been introduced in CI treatment centres in order to safely accommodate families and continue to provide effective follow-up CI therapy for children implanted with CIs. OBJECTIVES: The aim of this study was to document, over the course of the pandemic, how patients' parents viewed the likelihood and danger of infection and how necessary they thought the newly implemented protocols were. MATERIALS AND METHODS: All parents of children implanted with CIs who participated in therapy at the CIC treatment centre between August and November 2020 (N = 255) were requested to fill out a questionnaire anonymously following their stay. RESULTS: 255 questionnaires were distributed, 83 (32.5%) of which were filled out. During the course of the study, there was an increase in the parents' perceived risk of infection. Simultaneously, fewer parents felt well protected at the CIC. According to parents, the new hygiene protocols at the CIC did not negatively affect treatment. However, many parents noted that their interactions with other patient families had been better prior to introduction of the hygiene protocols. CONCLUSIONS: The CIC`s hygiene protocols were well received. However, data analysis over the course of the study suggests that hygiene protocols were not sufficient to prevent fear of infection in light of increasing rate of infection.

Postoperative radiological assessment of the mastoid facial canal in cochlear implant patients in correlation with facial nerve stimulation.

OBJECTIVES: To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence. METHODS: Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression. RESULTS: Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients' age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression. CONCLUSION: The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors. KEY POINTS: • Post-operative radiological assessment of the mastoid facial canal and the positional relationship with the CI electrode provide no predictor of post-cochlear implant facial nerve stimulation. • Radiological detection of extracochlear electrode contacts and the previous clinical history of meningitis/encephalitis are two important risk factors for postoperative facial nerve stimulation in cochlear implant patients. • The presence of scala vestibuli electrode insertion as well as the lateral wall electrode type, the younger patient's age, and early onset of SNHL can play important role in the prediction of post-cochlear implant facial nerve stimulation.

Visualization of Different Types of Cochlear Implants in Postoperative Cone-Beam CT Imaging.

RATIONALE AND OBJECTIVES: To evaluate cone-beam computed-tomography (CBCT) images of the temporal bone for radiological delineation, metal artifacts, and accuracy for localization of six different electrode arrays after cochlear device implantation. MATERIALS AND METHODS: This retrospective study included 116 patients who underwent CBCT (120kV, 7.1mA) within 24 hours after cochlear device implantation. Exclusion criteria were anatomical abnormalities, and electrode misinsertion. Six different CI electrodes were implanted: Advanced Bionics HiFocus Mid-Scala, Cochlear Contour Advance, Cochlear Slim-Straight, Cochlear Slim-Modiolar, MED-EL Flex 24 and MED-EL Flex 28. Two radiologists rated independently presence of metal artifacts, overall image quality, as well as dedicated visualization of the osseous spiral lamina, inner and outer cochlear wall, single electrode contacts, and electrode position using 5-point-Likert scales. Inter-rater agreement was calculated by using Cohen's kappa and intraclass correlation. RESULTS: Of 116 patients, 94 (81.0%; 56.1 ± 16.9 years; age range, 13-86 years; 49 [52.1%] females) were included in the study. Overall image quality was rated good for all electrode models without significant differences (p = 0.061). Depiction of electrode contacts was rated significantly better for Advanced Bionics HiFocus Mid-Scala, Cochlear Slim-Straight, and MED-EL Flex 24 and 28 compared to Cochlear Contour Advance and Slim-Modiolar (p < 0.001). Depiction of the osseous spiral lamina (p = 0.20), inner (p = 0.42) and outer cochlear wall (p = 0.35), metal artifacts (p = 0.18), and electrode position (p = 0.31) did not show significant differences between electrode models. Inter-rater agreement varied from substantial to almost perfect (0.70-0.93). CONCLUSION: CBCT provides excellent visualization of all evaluated CI electrode types, in particular electrode arrays with greater spacing between contacts and contact size allow improved radiologic evaluation.

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle.

Objective: Vertigo is a common side effect of cochlear implant (CI) treatment. This prospective study examines the incidence of postoperative vertigo over time and aims to analyze influencing factors such as electrode design and insertion angle (IA). Study Design and Setting: This is a prospective study which has been conducted at a tertiary referral center (academic hospital). Patients: A total of 29 adults were enrolled and received a unilateral CI using one of six different electrode carriers, which were categorized into "structure-preserving" (I), "potentially structure-preserving" (II), and "not structure-preserving" (III). Intervention: Subjective vertigo was assessed by questionnaires at five different time-points before up to 6 months after surgery. The participants were divided into four groups depending on the time of the presence of vertigo before and after surgery. Preoperatively and at 6 months postoperatively, a comprehensive vertigo diagnosis consisting of Romberg test, Unterberger test, subjective visual vertical, optokinetic test, video head impulse test, and caloric irrigation test was performed. In addition, the IA was determined, and the patients were divided in two groups (<430°; ≥430°). Main Outcome Measures: The incidence of vertigo after CI surgery (group 1) was reported, as well as the correlation of subjective vertigo with electrode array categories (I-III) and IA. Results: Among the participants, 45.8% experienced new vertigo after implantation. Based on the questionnaire data, a vestibular origin was suspected in 72.7%. The results did not show a significant correlation with subjective vertigo for any of the performed tests. In group 1 with postoperative vertigo, 18% of patients showed conspicuous results in a quantitative analysis of caloric irrigation test despite the fact that the category I or II electrodes were implanted, which are suitable for structure preservation. Average IA was 404° for the overall group and 409° for group 1. There was no statistically significant correlation between IA and perceived vertigo. Conclusions: Though vertigo after CI surgery seems to be a common complication, the test battery used here could not objectify the symptoms. Further studies should clarify whether this is due to the multifactorial cause of vertigo or to the lack of sensitivity of the tests currently in use. The proof of reduced probability for vertigo when using atraumatic electrode carrier was not successful, nor was the proof of a negative influence of the insertion depth.

Magnetic Resonance Imaging in Patients With Hearing Implants - Follow-up on Prevalence and Complications.

OBJECTIVE: To examine the number of magnetic resonance imaging (MRI) examinations performed in patients with hearing implants and to quantify side effects or complications related to this procedure. STUDY DESIGN: Questionnaire. SETTING: Tertiary referral center, academic hospital. PATIENTS: One thousand four hundred sixty-onepatients with an implanted hearing system. INTERVENTION: Patients were asked to complete a questionnaire either during a visit to the clinic (304) or by mail contact (1,157) between February 2018 and March 2019. MAIN OUTCOME MEASURES: Number of examinations by means of MRI per patient and number of side effects or complications. RESULTS: A total of 711 questionnaires were returned. After excluding nonvalid information on the questionnaire, 12.8% of patients were identified who had undergone an MRI after having received their hearing implant. Within this group of 91 patients, the most common precaution undertaken was a head bandage (69%). Side effects were mainly pain (37%), followed by anxiety (15%) and tinnitus (9%). The MRI had to be aborted in 14% and dislocation of the magnet occurred in 7% of examinations. CONCLUSIONS: Our data indicate that patients undergoing hearing implant surgery need better information about the limitations and requirements of MRI. The occurrence of side effects is likely as only half of the patients in our study group were completely free of symptoms. Dislocation of the implant magnet was observed in several cases, hence patients and physicians need to be educated about this potential complication.

Radiohistologic Comparison Study of Temporal Bone Specimens After Cochlear Implant Electrode Array Insertion: Is Cone-Beam CT Superior to MDCT?

OBJECTIVE. The purpose of this article is to evaluate subjective image quality and diagnostic accuracy to determine cochlear implant (CI) electrode position in a temporal bone (TB) specimen on cone-beam CT (CBCT) versus MDCT. MATERIALS AND METHODS. In this retrospective study, two radiologists independently reviewed CBCT (96-kV and 120-kV settings) and MDCT images of 20 TB specimens after electrode implantation. Qualitative evaluation of bone structures of the otic capsule, inner and outer cochlear wall, osseous spiral lamina, electrode position relative to the osseous spiral lamina, visualization of single electrode contacts on the array, metal artifacts, and overall image quality was performed using a five-point scale. Intracochlear electrode position was subsequently correlated with histologic examination. RESULTS. Radiologic assessment of bone structures of the otic capsule, the cochlear wall (except the outer part), osseous spiral lamina, electrode position, visualization of single electrode contacts on the array, metal artifacts, and overall image quality were significantly higher in CBCT compared with MDCT (maximum p = .04). No significant differences were found between CBCT at 96 kV and 120 kV (minimum p = .21). The intracochlear electrode position with histologic correlation was correctly diagnosed in 100% and 97.5% of specimens on 120-kV and 96-kV CBCT, respectively, whereas 77.5% were correctly assessed using MDCT. CONCLUSION. The data suggest that CBCT shows a higher diagnostic accuracy in TB specimen imaging after CI compared with MDCT, in particular to determine the intracochlear localization of the implant.

Comparison of bandaging techniques to prevent cochlear implant magnet displacement following MRI.

INTRODUCTION: For cochlear implants (CI) with removable magnets, a pressure bandage usually is recommended during MR imaging to avoid magnet dislocation. Nevertheless, this complication is regularly observed despite applying a pressure bandage. The aim of this study was to compare various bandaging techniques to avoid magnet displacement. MATERIALS AND METHODS: As an experimental model a force measuring stand was developed and validated, on which the process of magnet dislocation could be simulated on a cochlear implant. In a test series with six combinations of cohesive and elastic bandages with different counter pressure elements (CPE), the forces required to induce magnet dislocation against the resistance of a compression bandage was determined. In addition, the inter- and intraindividual variability of the compression bandages was measured for ten different users. RESULTS: The cohesive bandage had the lowest average holding force of 10.70 N. The elastic bandage developed more than four times the retention force of the cohesive bandage (44.88 N, p < 0.01). By adding a CPE, these values could be increased highly significantly up to factor 3. The optimum combination in terms of fixation force against magnet dislocation was an elastic bandage plus a cylindrical CPE (76.60 N). The data showed a high interindividual variability. CONCLUSION: Even though most CI manufacturers now offer 3T-conditional implants, a pressure bandage will have to be applied to thousands of patients with previous implant generations to prevent magnet dislocation. We examined for the first time force measurements to compare different bandaging techniques by detecting the holding force of the CI magnet. We were able to identify an optimized combination of a bandage and a CPE to immobilize the CI magnet. However, our data also demonstrated a significant scatter amongst different examiners. Although our data provide valuable data for potential clinical application, future development of the dressing technique is required for human use.

Cochlear implant magnet dislocation after MRI: surgical management and outcome.

PURPOSE: An increasing number of cochlear implant (CI) users is examined by magnetic resonance imaging which may cause the displacement of the implant magnet. This complication prevents the usage of the external processor and has to be treated surgically in most cases. The purpose of this study is to analyze the results of the surgical intervention and the consequences for the CI recipients. METHODS: The retrospective study was conducted at a tertiary referral center. From the patient care records between October 2014 and July 2018, 9 cases were reviewed that had undergone MRI after cochlear implantation and had experienced magnet displacement. RESULTS: Nine patients from 9 to 74 years of age were identified with MRI-induced magnet displacement. Implants of different manufacturers were affected (8 × Cochlear®, 1 Advanced Bionics®) but did not include the latest 3 T MR conditional product generation. The patients reported pain, swelling, redness above the implant and/or a noticeably dislocated magnet. One-third of the MRI examination were conducted in external radiological sites without any precautions such as a compression bandage. Surgical magnet repositioning was successful in all but one case with postoperative implant infection and consecutive explantation. In total, the patient was unable to use his CI for 420 days (1.2 years) after the MRI examination. The remaining eight patients averaged 29 days between MRI-related magnet dislocation and CI re-activation. CONCLUSIONS: The present study shows that in the majority of cases a surgical magnet reposition is possible without complications, and thus the time of nonuse of the CI is usually low. Nevertheless, there is a risk that in individual cases significant medical, functional, social and economic consequences for patients may occur. The presented data demonstrate that the indication to perform MRI scans in CI users needs to be further critically considered. An attentive, critical assessment of an MRI indication by both the initiating physician (usually not an ENT specialist) and the performing radiologist is mandatory.

Evaluation of a bone groove geometry for fixation of a cochlear implant electrode.

PURPOSE: Electrode migration is a rare, but relevant complication in cochlear implant (CI) surgery. An effective countermeasure is to create a bone groove in the facial recess to secure the electrode lead. We use this method routinely since 2013, but still experienced sporadic electrode migration events most likely due to an improper surgical execution. The aim of this study was to determine the optimum groove geometry. METHODS: Grooves of defined geometry were created in specimens of fresh porcine femur compacta by use of a CNC milling machine. Electrode dummies were fixed in the groove and then exposed to tensile stress. Force measurements were carried out to examine the effect of groove diameter and opening width on the holding force. The mechanical impact on the electrode cable during insertion into the groove was recorded and the electrode lead was examined under microscopic magnification to assess potential structural damage. RESULTS: Optimum groove geometry (diameter 1.10 mm, opening width 0.90 mm) ensured an average holding force of 830 mN which is equivalent to the established fixation by use of a titanium clip. None of the microscopic inspections revealed any morphological deterioration of the electrode lead. CONCLUSION: The fixation of a CI electrode in a bone groove in the facial recess appears to be effective and safe. Furthermore, this method does not require additional costs or foreign material. The optimum geometry defined in this study helped us to refine our surgical standard produce and to generate more consistent results.

A new adhesive bone conduction hearing system as a treatment option for transient hearing loss after middle ear surgery.

OBJECTIVE: The objective of this prospective, single-subject, repeated measures study was to evaluate the audiological benefit and patient satisfaction with an adhesive, pressure-free bone conduction hearing system (ADHEAR; MED-EL, Innsbruck, Austria) in patients who underwent middle ear surgery with transient hearing loss due to auditory canal tamponade. METHODS: Eleven adult subjects suffering from transient conductive hearing loss were enrolled in the study and followed up to 3 weeks after middle ear surgery. Bone and air conduction thresholds were measured pre and postoperatively to evaluate eligibility for enrollment. Postoperative unaided and aided sound-field thresholds, as well as speech tests in quiet and noise were compared to confirm hearing improvement with the hearing system. To determine patient satisfaction, the SSQ12 and a system-specific quality of life questionnaire was administered to all subjects. RESULTS: Speech perception for monosyllables in quiet improved by 46%, with statistical significance for the ADHEAR system compared to the unaided condition after one week. The functional hearing gain improved by 19 dB. Speech perception in noise with the device was - 6.7 dB SNR on average, with a statistically significant improvement of 2.7 dB SNR. The results of the questionnaire showed a high level of patient satisfaction and subjective hearing improvement. No serious skin reactions or other severe complications occurred. CONCLUSION: As long as the auditory canal is blocked due to tamponade, patients benefit from hearing rehabilitation. This adhesive hearing system is a safe and effective device to treat transient conductive hearing loss and may considerably improve treatment for patients even with short-term hearing loss.

The Effect of a Bone Groove Against Cochlear Implant Electrode Migration.

HYPOTHESIS: The risk of electrode migration in cochlear implant (CI) surgery can be reduced by securing the electrode lead in a bone groove in the chorda-facial angle. BACKGROUND: Electrode migration is an important complication in CI surgery, which affects hearing performance, may induce pain and facial nerve stimulation, and requires surgical revision. A potential method to secure the electrode is to use a bone groove created in the facial recess to fixate the electrode lead. This surgical measure is a standard procedure for lateral wall electrodes (LWE) in our clinic since 2013. METHODS: Retrospective analysis of consecutive CI cases of a tertiary referral center from 2006 to 2016 and comparison of incidence rates between group A (without bone groove, years 2006-2012) and group B (with bone groove fixation, years 2013-2016). Clinical cases were reviewed with respect to electrode type, migration length, time interval to migration, and findings during revision surgery. RESULTS: Seventeen cases of electrode migration were found in a total of 1,603 cochlear implantations. Only LWE designs were affected by migration. The cumulative incidence for LWE in group B (0.5%) was significantly lower than in group A (3.7%, p < 0.01). The two migration cases in group B revealed insufficient geometric design of the bone grooves. Only one patient experienced a remigration after revision surgery. CONCLUSION: The fixation in a bone groove in the chorda-facial angle is an effective measure against migration of LWE. Proper surgical execution is mandatory to ensure a tight and enduring fit.

Objective, audiological and quality of life measures with the CI532 slim modiolar electrode.

OBJECTIVES: To report on electrode array measurements for the Nucleus® CI532 Slim Modiolar Electrode device including: ECAP thresholds, electrode impedances, and psychophysical comfort levels, as well as speech perception results pre- and post-operatively and standardized evaluations of quality of life. METHODS: Forty-four subjects were implanted with the CI532. Electrically evoked compound action potential (ECAP) thresholds and impedances were measured using automatic Neural Response Telemetry intra-operatively, at activation and at six months post implant. Pre- and post-operative measures of words in quiet and sentences in noise were made in multiple languages. Quality of life was assessed using The Speech Spatial Qualities questionnaire (SSQ) and Glasgow Benefit Inventory (GBI). RESULTS: Intra-operative ECAP thresholds were recorded successfully from 90% of electrodes tested. ECAP thresholds varied across the array and a post-hoc Dunn's test showed that median thresholds for electrodes E1-E13 were significantly greater than those for E17-E22 (all P < 0.001). Impedances increased significantly between surgery and activation. Speech recognition scores for words in quiet and sentences in noise showed a significant improvement for the group at six months, when using the cochlear implant, compared with pre-operative performance (P < 0.001). There was a significant increase compared to pre-operative ratings for all sections of the SSQ at six months post activation (P < 0.001). The GBI gave scores significantly above zero for the 'general' subscale and total score. CONCLUSION: Objective ECAP and impedance measures for this new electrode array were as expected and similar to results reported for other array types. Speech perception and quality of life improved significantly following implantation. (Registered as NCT02392403 on ClinicalTrials.gov PRS).

Incidence for Tip Foldover During Cochlear Implantation.

OBJECTIVE: Incidence and clinical presentation of tip foldover during cochlear implantation (CI). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral university hospital. PATIENTS: One thousand three hundred twenty CI recipients who underwent postoperative Stenvers view, digital computed tomography (CT), or digital volume tomography (DVT). MAIN OUTCOME MEASURE: Tip foldover rates were evaluated with regard to perimodiolar (PM), lateral wall (LW), and mid-scalar (MS) electrode carriers; the electrode insertion angle was estimated and postoperative complications and the necessity for revisions were described. RESULTS: One thousand three hundred twenty CI recipients (1,722 ears) had detailed surgery reports and postoperative imaging available for review. Tip foldover occurred in 15 ears (0.87%) with the highest rate (1.67%) for PM electrodes. In three patients tip foldover was accompanied by costimulation of the facial nerve and one patient reported vertigo. Eleven patients underwent revision surgery. In two of them revision was performed in the same surgical intervention due to abnormality in spread of excitation measurement. In four patients no revision was conducted due to uncompromised aided speech perception. CONCLUSION: In a large academic center with experienced surgeons, tip foldover verified by CT/DVT arose at a rate of 0.87%. PM electrode carriers inherited the highest risk for this electrode malposition. Revision surgery was feasible in these cases.

Hearing Preservation Outcomes After Cochlear Implantation Depending on the Angle of Insertion: Indication for Electric or Electric-Acoustic Stimulation.

OBJECTIVE: This study reviewed outcomes of hearing preservation (HP) surgery depending on the angle of insertion (AOI) in a cochlear implant (CI) patient population who used electric stimulation (ES) or combined electric-acoustic stimulation (EAS). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral university hospital. PATIENTS: Ninety-one patients with different degrees of preoperative low-frequency residual hearing who underwent HP surgery with a free-fitting lateral-wall electrode array (MED-EL Flex) with lengths ranging from 20.0 to 31.5 mm. INTERVENTION: Cochlear implantation using HP surgery technique and subsequent fitting with CI speech processor for ES, or combined CI and hearing aid speech processor for EAS. MAIN OUTCOME MEASURES: Individual AOI were estimated using modified Stenvers' projection. Freiburg monosyllable test in quiet (free-field presentation at 65 dB SPL) and pure-tone averages for low frequencies (125, 250, and 500 Hz; PTAlow) were evaluated during a follow-up period of 12 months after implantation. RESULTS: Estimated AOIs showed bimodal distribution: shallow insertion (SI) with mean AOI of 377 degrees and deep insertion (DI) with mean AOI of 608 degrees. Speech test scores after 12 months were comparable between AOI groups, however, they were significantly different between stimulation types with better scores for EAS. Only ES showed a positive correlation (r = 0.293) between speech test score and AOI. When HP was possible, both SI and DI showed significant postoperative PTAlow shifts with mean of 17.8 and 21.6 dB, respectively. These were comparable between AOI groups and no significant shifts were observed in follow-up intervals. Audiometric indication for HP and subsequent EAS is proposed up to 65 dB HL at 500 Hz, and up to 87 dB HL for HP. CONCLUSIONS: CI candidates can benefit from HP surgery with deep insertion when only using ES due to insufficient residual hearing. Conversely, candidates with preoperative threshold up to 65 dB HL at 500 Hz could perform significantly better with EAS which requires shallow insertion.