Stimulation Crosstalk Between Cochlear And Vestibular Spaces During Cochlear Electrical Stimulation.

OBJECTIVES: Possible beneficial "crosstalk" during cochlear implant stimulation on otolith end organs has been hypothesized. The aim of this case-control study is to analyze the effect of electrical cochlear stimulation on the vestibule (otolith end-organ), when using a cochleo-vestibular implant, comparing vestibular stimulation (VI) and cochlear stimulation (CI). METHODS: Four patients with bilateral vestibulopathy were included. A double electrode array research implant was implanted in all cases. Dynamic Gait Index (DGI), VOR gain measured by using vestibular head impulse test (vHIT), acoustic cervical myogenic responses (cVEMP) recordings, and electrical cVEMP were used in all cases. Trans-impedance Matrix (TIM) analysis was used to evaluate the current flow from the cochlea to the vestibule. RESULTS: While patients did not have any clinical vestibular improvement with the CI stimulation alone, gait metrics of the patients revealed improvement when the vestibular electrode was stimulated. The average improvement in the DGI was 38% when the vestibular implant was activated, returning to the normal range in all cases. Our findings suggest that any current flow from the cochlear space to the otolith organs was insufficient for effective cross-stimulation. The functional results correlated with the data obtained in TIM analysis, confirming that there is no current flow from the cochlea to the vestibule. CONCLUSION: The only way to produce effective electrical otolith end-organ stimulation, demonstrated with this research implant, is by direct electrical stimulation of the otolith end organs. No effective cross-stimulation was found from cochlear electrode stimulation. LEVEL OF EVIDENCE: 4 Laryngoscope, 2023.

Recent Advances in the Diagnosis and Treatment of Vestibular Disorders.

Vestibular medicine "embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum and supratentorial cerebral networks, to many disorders beyond these structures" [...].

Strategies for the implementation of the living guidelines for cochlear implantation in adults.

Introduction: Clinical guidelines for cochlear implants (CI) exist in several countries, however, they lack consistency and often do not encompass the full user journey. This study aims to explore the barriers and facilitators for implementing global Living Guidelines for cochlear implantation in adults with severe, profound or moderate sloping to profound sensorineural hearing loss (SPSNHL) as well as identify guideline implementation (GI) tools that may support uptake. Methods: A convenience sample of Task Force members were recruited for semi-structured interviews. Interview transcripts were thematically analysed to group country-specific barriers, facilitators and GI tools into three levels: health care provider (HCP), consumer and structural. Once identified, barriers and facilitators were classified into four themes related to awareness, economic, guideline or other. Results: Interviews were conducted with 38 Task Force members, representing 20 countries. Lack of CI and hearing loss awareness was a major barrier at the HCP (85% of countries), consumer (80%) and structural (20%) levels. Economic and guideline barriers followed at the HCP (35%; 25%), consumer (45%; 0%) and structural (55%; 30%) levels, respectively. Facilitators focused on raising awareness of hearing loss and CIs as well as guideline related initiates at the HCP (80%; 70%), consumer (70%; 10%) and structural (25%; 70%) levels. GI tools including education, economic evaluations, quick reference resources and social media can help improve awareness and uptake. Conclusion: Awareness is the primary barrier to implementing Living Guidelines globally for adults with SPSNHL. Endorsement from key professional bodies and using the best available evidence can enhance uptake.

COVID-19 era: Hearing handicaps behind face mask use in hearing aid users.

BACKGROUND: The aim of this study was to assess the effect on speech perception and lack of hearing devices gain with surgical masks worn in hearing aid users. METHODS: This prospective cohort study enrolled consecutive patients between November 2020 and February 2021 in a tertiary care medical center from Spain. Fifty-five subjects have been included, 10 as control group, with normal hearing, and 45 patients with sensory-neural hearing loss and hearing aid users, ranging in age between 31 and 83 years old, and were recruited randomized in 4 months. Appropriate test was done previously to check adequate functioning from devices and suitable adaptation. Control group had no hearing impairment neither otologic disease. RESULTS: Disyllabic test in quiet get worse with face mask with a significant difference and stronger impact in noisy background. Age made no difference. Adding lipreading speech perception improved by 95.1 % for younger subjects (<50 years of age) and 91.2% for older subjects (>50 years of age). In the control sample, there was no differences in any condition. CONCLUSION: Despite advantages of wearing mask in preventing coronavirus disease 2019 spread, we must consider that they have also drawbacks for some groups like hearing aid users. In this research, we have not observed high frequencies perception decrease with surgical masks worn, but there was reduction in speech perception, most notably in hearing aids wearers in noisy environment.

Dynamic Visual Acuity Results in Otolith Electrical Stimulation in Bilateral Vestibular Dysfunction.

(1) Background. Patients with bilateral vestibular disease (BVD) experience oscillopsia with a detriment to visual acuity (VA). This VA is driven mainly by the VOR that has two components: rotational and translational. VA can be tested by using dynamic visual acuity (DVA) on a treadmill because both systems are activated. The aim of this study is to compare VA before and after chronic electrical stimulation of the otolith organ. (2) Materials and Method. Five patients suffering from bilateral vestibular dysfunction (BVD), previously implanted with a new vestibular implant prototype, were included in this study with the aim to check VA with and without vestibular implant use (W and W/O) in static, 2 km/h and 4 km/h walking situations. DVAtreadmill was measured on a treadmill with a dynamic illegible E (DIE) test in static and dynamic conditions (while walking on the treadmill at 2 and 4 km/h). The DVA score was registered in a logarithm of the minimum angle of resolution (LogMAR) for each speed. In addition, every patient completed the oscillopsia severity questionnaire (OSQ) and video head impulse test (vHIT) before and after activation of the vestibular implant. (3) Results. The analysis shows a significant difference in OSQ scores and DVA with an improvement in dynamic conditions. Organized corrective saccades during the use of a vestibular implant with no changes in gain were also detected in the video head impulse tests (vHIT). (4) Conclusion. The vestibular implant with otolithic stimulation offers changes in the response of DVA, which makes this paper one of the first to address the possible restoration of it. It is not possible to rule out other contributing factors (presence of covert saccades, somatosensory system, …). More work seems necessary to understand the neurophysiological basis of these findings, but this implant is added as a therapeutic alternative for the improvement of oscillopsia.

Assessing the Placement of the Cochlear Slim Perimodiolar Electrode Array by Trans Impedance Matrix Analysis: A Temporal Bone Study.

New cochlear implant (CI) electrode arrays provide softer insertion dynamics; however, due to their high flexibility, the possibilities of fold-overs or intraoperative displacements must be taken into account. The position of each individual electrode can only be determined by using high-resolution computed tomography or cone-beam CT. The trans-impedance matrix test (TIM) is an electrophysiological method based on electric field imaging that can provide images of electrode position and electrode folding. OBJECTIVE: In this experimental research, we evaluated the result of TIM as a method of monitoring cochlear insertion for a precurved slim modiolar electrode array in fresh human temporal bones by analyzing the transimpedance matrix patterns and their correlation with electrode position using high-resolution computed tomography. MATERIAL AND METHODS: Sixteen slim modiolar electrode arrays were inserted into eight fresh Human Temporal Bones. Eight electrodes were inserted according to the correct methodology of insertion, and eight were intentionally folded over. After all insertions, a trans-impedance matrix analysis and a Cone Beam CT (CBCT) were performed in each temporal bone. RESULTS: If we correlated the TIM patterns with the radiological electrode position, we observed that better electrode intracochlear positions indicated more "homogeneous" TIM patterns (intracochlear voltage dropped monotonically as the distance between stimulation and recording contact increased, both toward the apex and toward the base). A correlation where fold-over was detected in the TIM results was found in all eight temporal bone radiological findings. CONCLUSIONS: Trans-Impedance Matrix patterns were correlated with the radiological CI electrode position. When a tip fold-over appeared, a matrix with a secondary ridge in addition to the primary ridge was observed in all cases. TIM can be an effective method in the control of electrode positioning.

A phenomenological computational model of the evoked action potential fitted to human cochlear implant responses.

There is a growing interest in biomedical engineering in developing procedures that provide accurate simulations of the neural response to electrical stimulus produced by implants. Moreover, recent research focuses on models that take into account individual patient characteristics. We present a phenomenological computational model that is customized with the patient's data provided by the electrically evoked compound action potential (ECAP) for simulating the neural response to electrical stimulus produced by the electrodes of cochlear implants (CIs). The model links the input currents of the electrodes to the simulated ECAP. Potentials and currents are calculated by solving the quasi-static approximation of the Maxwell equations with the finite element method (FEM). In ECAPs recording, an active electrode generates a current that elicits action potentials in the surrounding auditory nerve fibers (ANFs). The sum of these action potentials is registered by other nearby electrode. Our computational model emulates this phenomenon introducing a set of line current sources replacing the ANFs by a set of virtual neurons (VNs). To fit the ECAP amplitudes we assign a suitable weight to each VN related with the probability of an ANF to be excited. This probability is expressed by a cumulative beta distribution parameterized by two shape parameters that are calculated by means of a differential evolution algorithm (DE). Being the weights function of the current density, any change in the design of the CI affecting the current density produces changes in the weights and, therefore, in the simulated ECAP, which confers to our model a predictive capacity. The results of the validation with ECAP data from two patients are presented, achieving a satisfactory fit of the experimental data with those provided by the proposed computational model.

Tinnitus suppression with electrical stimulation in adults: long-term follow-up.

Objectives: To investigate the long-term effects of cochlear implants as a treatment for patients with severe to profound neurosensory loss associated with severe tinnitus. Methods: Prospective study in 17 adult patients with severe to profound sensorineural hearing loss associated with severe tinnitus, indicated with a Tinnitus Handicap Inventory (THI) score ≥ 58%, and hyperacusis. Measures were made on hearing, tinnitus, hyperacusis and quality of life up to 5 years after activation of the sound processor of the cochlear implant. It was evaluated by using the disyllabic test, THI, visual analogue scale and Glasgow Benefit Inventory questionnaire. Results: 60 months after cochlear implantation, improvements in loudness and discomfort of tinnitus, speech discrimination and hyperacusis were observed. Subjects perceive an important subjective benefit upon receiving the cochlear implant. Conclusions: Cochlear implants can be used as treatment for patients with severe to profound sensorineural hearing loss associated with severe tinnitus and hyperacusis with long-term benefits on quality of life and lasting relief of tinnitus.

Development and Content Validity of the Bilateral Vestibulopathy Questionnaire.

Background: To date, the burden and severity of the full spectrum of bilateral vestibulopathy (BVP) symptoms has not yet been measured in a standardized manner. Since therapeutic interventions aiming to improve BVP symptoms are emerging, the need for a new standardized assessment tool that encompasses the specific aspects of BVP arises. Therefore, the aim of this study was to develop a multi-item Patient Reported Outcome Measure (PROM) that captures the clinically important symptoms of BVP and assesses its impact on daily life. Methods: The development of the Bilateral Vestibulopathy Questionnaire (BVQ) consisted of two phases: (I) initial item generation and (II) face and content validity testing. Items were derived from a literature review and individual semi-structured interviews focusing on the full spectrum of reported BVP symptoms (I). Subsequently (IIa), individual patient interviews were conducted using "thinking aloud" and concurrent verbal probing techniques to assess the comprehensibility of the instructions, questions and response options, and the relevance, missing domains, or missing items. Interviews continued until saturation of input was reached. Finally, international experts with experience in the field of the physical, emotional, and cognitive symptoms of BVP participated in an online focus group to assess the relevance and comprehensiveness of the BVQ (IIb). Results: The BVQ consisted of two sections. The first section included 50 items scored on a six-point Likert scale arranged into seven constructs (i.e., imbalance, oscillopsia, other physical symptoms, cognitive symptoms, emotional symptoms, limitations and behavioral changes and social life). The second section consisted of four items, scored on a visual analog scale from 0 to 100, to inquire about limitations in daily life, perceived health and expectations regarding future recovery. Interviews with BVP patients [n = 8, 50% female, mean age 56 years (range 24-88 years)] and the expert meeting confirmed face and content validity of the developed BVQ. Conclusion: The BVQ, which was developed to assess the spectrum of BVP symptoms and its impact on daily life, proved to have good face and content validity. It can be used to characterize current self-reported symptoms and disability and to evaluate symptom burden before and after therapeutic interventions in future research and clinical practice.

Evaluation of a Transimpedance Matrix Algorithm to Detect Anomalous Cochlear Implant Electrode Position.

INTRODUCTION: Transimpedance measurements from cochlear implant electrodes have the potential to identify anomalous electrode array placement, such as tip fold-over (TFO) or fold-back, basal electrode kinking, or buckling. Analysing transimpedance may thus replace intraoperative or post-operative radiological imaging to detect any potential misplacements. A transimpedance algorithm was previously developed to detect deviations from a normal electrode position with the aim of intraoperatively detecting TFO. The algorithm had been calibrated on 35 forced, tip folded electrode arrays in six temporal bones to determine the threshold criterion required to achieve a sensitivity of 100%. Our primary objective here was to estimate the specificity of this TFO algorithm in patients, in a prospective study, for a series of electrode arrays shown to be normally inserted by post-operative imaging. METHODS: Intracochlear voltages were intraoperatively recorded for 157 ears, using Cochlear's Custom Sound™ EP 5 electrophysiological software (Cochlear Ltd., Sydney, NSW, Australia), for both Nucleus® CI512 and CI532 electrode arrays. The algorithm analysed the recorded 22 × 22 transimpedance matrix (TIM) and results were displayed as a heatmap intraoperatively, only visible to the technician in the operating theatre. After all clinical data were collected, the algorithm was evaluated on the bench. The algorithm measures the transimpedance gradients and corresponding phase angles (θ) throughout the TIM and calculates the gradient phase range. If this was greater than the predetermined threshold, the algorithm classified the electrode array insertion as having a TFO. RESULTS: Five ears had no intraoperative TIM and four anomalous matrices were identified from heatmaps and removed from the specificity analysis. Using the 148 remaining data sets (n = 103 CI532 and n = 45 CI512), the algorithm had an average specificity of 98.6% (95.80%-99.75%). CONCLUSION: The algorithm was found to be an effective screening tool for the identification of TFOs. Its specificity was within acceptable levels and resulted in a positive predictive value of 76%, with an estimated incidence of fold-over of 4% in perimodiolar arrays. This would mean 3 out of 4 cases flagged as a fold-over would be correctly identified by the algorithm, with the other being a false positive. The measurements were applied easily in theatre allowing it to be used as a routine clinical tool for confirming correct electrode placement.

Cochlear Implants in Single-Sided Deafness. Comparison Between Children and Adult Populations With Post-lingually Acquired Severe to Profound Hearing Loss.

Objective: To determine audiological and clinical results of cochlear implantation (CI) comparing two populations with single-sided deafness (SSD): post-lingually deaf children between 6 and 12 years of age, and post-lingually deaf adults, in order to evaluate the effect of CI in different age groups. Design: Retrospective case review. Setting: Tertiary clinic. Patients and Method: Twenty-three children and twenty-one adult patients that were candidates for CI with single-side deafness were included. In all cases we evaluate: Speech perception thresholds; disyllabic words test (65 dB SPL) were performed in the modalities S0-SCI-SNH and Auditory Lateralization Test. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire was also used. All results were obtained after 12 months of CI activation. Results: In children, the most common etiology was idiopathic sensory-neural hearing loss. They showed positive results in the Auditory Lateralization Test. In the Speech Test, word recognition in noise improved from 2% preoperatively to 61.1% at a mean follow-up of 1 year (S0 condition) in children [test with signal in CI side 60% and signal normal hearing side (plugged) 31%]. The processor was used for >12 h in all cases. With respect to the SSQ questionnaire, parents were more satisfied within the postoperative period than within the preoperative period. For adults, the most common etiology was idiopathic sudden sensorineural hearing loss (SNHL). Positive results in the Auditory Lateralization Test were found. With respect to the Speech Test in quiet conditions: Word recognition in noise improved from 5.7% preoperatively to 71.8% at a mean follow-up of 1 year [test with signal in CI side 68% and signal normal hearing side (plugged) 41%]. The processor was used for >12 h. In the SSQ questionnaire, the post-operative results showed a beneficial effect of the CI. No adverse events were reported during the study period. No differences were found between children and adults in all tests in this study. Conclusions: Cochlear implantation in post-lingually deaf adults and children with SSD can achieve a speech perception outcome comparable with CI in conventional candidates. Improvements in spatial hearing were also observed. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.

Analysis of Neural Interface When Using Modiolar Electrode Stimulation. Radiological Evaluation, Trans-Impedance Matrix Analysis and Effect on Listening Effort in Cochlear Implantation.

BACKGROUND: The proximity of the electrode to the modiolar wall may be of interest to investigate the effect of pitch discrimination. This research establishes the relation between these factors and whether perimodiolar positions may provide benefits regarding improved electrode discrimination. METHODS: A prospective randomized study including 24 post-lingual deaf adults was performed. A psychoacoustic study was done by using a psychoacoustic research platform. Radiological study, and a cone-beam computed tomography was used to assess post cochlear implantation electrodes' position. Trans-impedance matrix (TIM) analysis was performed after cochlear implant insertion in all cases, and pupillometry test was also performed. RESULTS: 12 patients received a slim perimodiolar electrode array, and 12 patients received a straight electrode array. Although all the patients showed similar speech test results after 12 months follow-up, those implanted with a perimodiolar electrode obtained better scores in electrode discrimination test and pupillometry test, and showed more homogenous TIM patterns. CONCLUSIONS: The better positioning of the electrode array seams to provide a better hearing resolution and less listening effort trans-impedance matrix seems to be a useful tool to analyze positioning of the perimodiolar array.

Differences in Vestibular-Evoked Myogenic Potential Responses by Using Cochlear Implant and Otolith Organ Direct Stimulation.

Objective: Several studies have demonstrated the possibility to obtain vestibular potentials elicited with electrical stimulation from cochlear and vestibular implants. The objective of this study is to analyze the vestibular-evoked myogenic potentials (VEMPs) obtained from patients implanted with cochlear and vestibulo-cochlear implant. Material and Methods: We compared two groups: in the first group, four cochlear implant (CI) recipients with present acoustic cVEMPs before CI surgery were included. In the second group, three patients with bilaterally absent cVEMPs and bilateral vestibular dysfunction were selected. The latter group received a unilateral cochleo-vestibular implant. We analyze the electrically elicited cVEMPs in all patients after stimulation with cochlear and vestibular electrode array stimulation. Results: We present the results obtained post-operatively in both groups. All patients (100%) with direct electrical vestibular stimulation via the vestibular electrode array had present cVEMPs. The P1 and N1 latencies were 11.33-13.6 ms and 18.3-21 ms, respectively. In CI patients, electrical cVEMPs were present only in one of the four subjects (25%) with cochlear implant ("cross") stimulation, and P1 and N1 latencies were 9.67 and 16.33, respectively. In these patients, the responses present shorter latencies than those observed acoustically. Conclusions: Electrically evoked cVEMPs can be present after cochlear and vestibular stimulation and suggest stimulation of vestibular elements, although clinical effect must be further studied.

[Macrolides as a possible cause of hearing loss in childhood]. / Macrólidos como posible causa de hipoacusia en la infancia.

INTRODUCTION: Idiopathic sudden hearing loss (SHL) is a relatively frequent entity in the adult population with unk nown cause in most cases. There are few studies in pediatric age and its diagnosis and management are a challenge for health professionals. OBJECTIVE: To relate macrolide therapy as a causal agent of sudden hearing loss in pediatric patients. CLINICAL CASE: 3-year-old girl with no relevant pathological history, with normal neonatal hearing screening and age-appropriate language development. She consulted due to an upper airway infectious process, treated on an outpatient basis with azithromycin for 3 days. One week later, she developed bilateral hearing loss, confirmed with Brainstem Auditory Evoked Potentials (BAEP), and started treatment with oral methylprednisolone and intratympanic corticosteroids. During treatment, imaging, laboratory, and genetic studies were performed, ruling out other causes of SHL, so the recent use of macrolides was considered as a possible diagnosis. As no clinical improvement was observed 6 weeks after the treatment, confirmed by the absence of response in the steady-state auditory evoked potentials and BAEP, simultaneous bilateral cochlear implant surgery was carried out. Four years after surgery, the patient showed good speech-language develop ment and adequate school performance. CONCLUSIONS: Ototoxicity is a cause that must be considered in the case of SHL in childhood. A multidisciplinary approach will allow effective treatment in these patients, in which early management with an adequate hearing aid will restore hearing and achieve adequate speech development and linguistic competence.

The Superiority of the Otolith System.

BACKGROUND: The peripheral vestibular end organ is considered to consist of semi-circular canals (SCC) for detection of angular accelerations and the otoliths for detection of linear accelerations. However, otoliths being phylogenetically the oldest part of the vestibular sensory organs are involved in detection of all motions. SUMMARY: This study elaborates on this property of the otolith organ, as this concept can be of importance for the currently designed vestibular implant devices. Key Message: The analysis of the evolution of the inner ear and examination of clinical examples shows the robustness of the otolith system and inhibition capacity of the SCC. The otolith system must be considered superior to the SCC system as illustrated by evolution, clinical evidence, and physical principles.

Chronic Electrical Stimulation of the Otolith Organ: Preliminary Results in Humans with Bilateral Vestibulopathy and Sensorineural Hearing Loss.

INTRODUCTION: Bilateral vestibulopathy is an important cause of imbalance that is misdiagnosed. The clinical management of patients with bilateral vestibular loss remains difficult as there is no clear evidence for an effective treatment. In this paper, we try to analyze the effect of chronic electrical stimulation and adaptation to electrical stimulation of the vestibular system in humans when stimulating the otolith organ with a constant pulse train to mitigate imbalance due to bilateral vestibular dysfunction (BVD). METHODS: We included 2 patients in our study with BVD according to Criteria Consensus of the Classification Committee of the Bárány Society. Both cases were implanted by using a full-band straight electrode to stimulate the otoliths organs and simultaneously for the cochlear stimulation we use a perimodiolar electrode. RESULTS: In both cases Vestibular and clinical test (video head impulse test, videonistagmography cervical vestibular evoked myogenic potentials, cVEMP and oVEMP), subjective visual vertical test, computerized dynamic posturography, dynamic gait index, Time UP and Go test and dizziness handicap index) were performed. Posture and gait metrics reveal important improvement if compare with preoperartive situation. Oscillopsia, unsteadiness, independence and quality of life improved to almost normal situation. DISCUSSION/CONCLUSION: Prosthetic implantation of the otolith organ in humans is technically feasible. Electrical stimulation might have potential effects on balance and this is stable after 1 year follow-up. This research provides new possibilities for the development of vestibular implants to improve gravito-inertial acceleration sensation, in this case by the otoliths stimulation.

Evaluation of Intracochlear Position of a Slim Modiolar Electrode Array, by Using Different Radiological Analyses.

INTRODUCTION: The radiological analysis following a cochlear implantation offers insight into the audiological outcomes of cochlear implant recipients. The wrapping factor (WF) is the most common radiological analysis measuring the modiolar position and depth of insertion of an electrode array. New measurements like the intracochlear position index (ICPI) or the homogeneity factor (HF) can offer more accurate information regarding the electrode's intracochlear position. We have also studied a new method to calculate the WF, by normalizing it with a new methodology (WFn). OBJECTIVES: To analyze and compare the results of the WF, ICPI, HF, and WFn obtained using a cone beam computer tomography (CBCT) with the histological analysis on temporal bone. MATERIAL: A perimodiolar electrode array (Nucleus Slim CI532) was inserted in three temporal bones. A perfect insertion was performed in the first temporal bone, according to the correct specifications. In the second specimen, a slightly over-inserted electrode was analyzed and in the third specimen a completely over-inserted electrode array was studied. METHOD: A CBCT was performed following the implantations and then, a histological analysis with slices perpendicular to the cochlea axis (modiolus). Each measurement was made 10 times by 10 experts (radiologist and otologist) with a total amount of 600 measurements (100 for each data, 3 CBCT and 3 histology). A t test statistical analysis was performed to compare the measurements between CBCT and histology. RESULTS: It was observed that the ICPI and the HF correctly identify the three different insertions. Regarding the WF no significant difference in the two over-inserted specimens was found. The ICPI was the only measurement that shows no statistical difference between the CBCT and the histology, so it was considered the most accurate method. Finally, the WF shows a statistical difference between the CBCT and the histology in all cases, indicating the poor value of the radiological method. The WFn analysis includes the modiolar wall length in the measurement. This improves the final result as it reduces the error induced by the size of the cochlea. CONCLUSION: The ICPI and the HF provide better radiological information than the WF, regarding the intracochlear position of the electrode array. The most relevant difference is that the ICPI, HF, and WFn include modiolar and lateral wall dimensions, thereby using the diameter of the cochlear duct for the analysis.

Intraoperative Intracochlear Electrocochleography and Residual Hearing Preservation Outcomes When Using Two Types of Slim Electrode Arrays in Cochlear Implantation.

OBJECTIVES: To report residual hearing preservation outcomes in patients with low frequency hearing, after cochlear implant (CI) electrode insertion with two types of electrode arrays: one straight and other perimodiolar, when using intraoperative intracochlear electrocochleography (ECochG) during (CI) electrode insertion. STUDY DESIGN: Prospective, randomized study. SETTING: Tertiary referral otology center. PATIENTS: Fifteen patients ranging from 33 to 54 years old (mean 51.19). They had been diagnosed with a bilateral, profound sensorineural hearing loss and treated with a unilateral cochlear implant: eight of them with the CI532 and seven of them with the CI522 (Cochlear Ltd, Sydney, Australia). INTERVENTION: Pure-tone audiometry was performed preoperatively and at 1 and 6 months postoperatively. Interoperatively, intracochlear ECochG was performed using the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in real time by the audiologist-surgeon team during their CI electrode insertion. The different ECoch patterns of the insertion track were recorded and analyzed. RESULTS: In 12 cases ECochG responses were successfully recorded. In three cases no ECochG responses could be recorded with no residual hearing observed postoperatively in two of them. With respect to the first harmonic amplitude changes, we found: four cases with an overall increase in amplitude measured from the beginning of insertion until completion, all of them showed residual hearing (<15 dB HL) at 6 months postoperation. Three cases with an increasing amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion, in two cases dropping of residual hearing (15-30 dB HL) were observed after 6 months postoperation and, in one case, complete residual hearing was observed at 6 months postoperatively. And finally five cases presented amplitudes at the start of insertion with modifications of amplitude during the insertion dynamic, with increasing and descending in amplitude range during the whole insertion, two of them showed residual hearing at 6 months postoperation and three cases a drop of residual hearing (15-30 dB HL) was observed after 6 months postoperation. No statistical differences between CI532 and CI522 electrodes were found. Data of the ECochG responses are also presented (p value ≥ 0.05). CONCLUSION: ECochG is a useful tool to evaluate the residual hearing in CI patients with straight and perimodiolar cochlear implant. More studies are needed to fully understand the relationship between ECochG and the presence of residual hearing, cochlear trauma, and functional outcomes.

Guía clínica sobre implantes de conducción de vía ósea / Clinical guideline on bone conduction implants

Introducción y objetivos: En la última década se han producido numerosos y relevantes avances en el tratamiento de la hipoacusia transmisiva y mixta que han desembocado en una ampliación de las indicaciones de los implantes de conducción de vía ósea y la aparición de nuevos dispositivos. La Comisión Científica de Audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), junto con las comisiones de Otología y Otoneurología, ha llevado a cabo una revisión del estado actual de los implantes de vía ósea con la finalidad de ofrecer a los especialistas de Otorrinolaringología, a los profesionales de la sanidad, a las autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes de conducción de vía ósea. Métodos: Esta guía clínica sobre implantes de conducción ósea contiene información sobre los siguientes temas: 1) definición y descripción de los implantes auditivos de vía ósea; 2) indicaciones actuales y emergentes de los implantes de vía ósea; compatibilidad y resonancia magnética, y 3) requisitos organizativos para un programa de implantes de vía ósea. Resultado y conclusiones: La finalidad de esta guía es describir los diferentes sistemas de conducción ósea, sus particularidades e indicaciones, con el objeto de aportar unas coordenadas que ayuden a todos estos agentes en las tomas de decisiones que deban asumir en los diferentes ámbitos de responsabilidad en los que están enmarcados en sus áreas de trabajo

Introduction and goals: During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. Methods: This clinical guideline on bone-conduction implants contains information on the following: 1) Definition and description of bone-conduction devices; 2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; 3) Organization requirements for a bone-conduction implant programme. Results and conclusions: The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas

Single-sided deafness and cochlear implantation in congenital and acquired hearing loss in children.

OBJECTIVE: To determine the audiological and clinical results of cochlear implantation in children below the age of 12 years old with congenital and acquired single-sided deafness. DESIGN: Observational, descriptive, transversal study. MAIN OUTCOME MEASURES: Speech reception thresholds, Cortical responses, Auditory Lateralization Test and SSQ questionnaire. PARTICIPANTS: Children < 12 implanted for congenital or acquired SSD. RESULTS: All the children with congenital SSD showed positive cortical responses. Positive results were obtained in the Auditory Lateralization Test for the following modalities: 0º, 45º and 90º. With respect to the Speech Test, the children with acquired SSD showed the following results: 92% and 100% in recognition and 48% and 68% (Azimuth modalities), Signal CI side 52% and 68% and Signal normal hearing side 44% - 60% (p < 0.05). In both group the processor was used for 6-12 hours. With respect to the SSQ questionnaire results, the parents were more satisfied within the post-operative period than within the pre-operative period (P<0.001). CONCLUSIONS: Cochlear implant provides children with congenital SSD with significant audiological and subjective benefits. Children with congenital SSD and implanted after a longer period may not have an important benefit (binaural) although other bilateral effects can be achieved. Children with post-lingual unilateral deafness and after a short period of hearing deprivation probably integrated the normal acoustic hearing with the cochlear implant electrical signal and showed binaural benefits.