Audiologic Outcomes of Cochlear Implantation in Inner Ear Malformations: A Comparative Analysis of Lateral Wall and Perimodiolar Electrode Arrays Nofrat Schwartz MD, Kevin D. Brown MD, PhD, Lisa R. Park AuD, CCC-A Department of Otolaryngology – Head and Neck Surgery and Neurosurgery University of North Carolina School of Medicine
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Audiologic Outcomes of Cochlear Implantation in Inner Ear … · 2019. 8. 12. · malformation on performance is controversial: • Eisenman et al (2001): all malformations ultimately
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Audiologic Outcomes of Cochlear Implantation in Inner Ear Malformations: A Comparative Analysis of Lateral Wall
and Perimodiolar Electrode ArraysNofrat Schwartz MD, Kevin D. Brown MD, PhD, Lisa R. Park AuD, CCC-ADepartment of Otolaryngology – Head and Neck Surgery and Neurosurgery
University of North Carolina School of Medicine
Disclosure
• Kevin Brown- Advisory board Med-El
• Lisa Park – Grant funded by Med- El
Dhanasingh A, et al 2019.
Cochlear Implantation in Inner Ear Malformations
• Cochlear implantation in children with inner ear malformations was found to be beneficial.
• The impact of the severity of the bony cochlear malformation on performance is controversial:
• Eisenman et al (2001): all malformations ultimately perform as well as their matched counterparts with normal cochlea
• Buchman et al (2004) and Farhood et al (2017): the various types of inner ear malformations have quite different prognosis for good auditory performance
Study Design
• Retrospective • Inclusion criteria:
• Children with inner ear malformations and implanted with a cochlear implant in our institute in the last 10 years .
• Recorded open set speech perception scores (CNC word scores) with at least one year of experience with their implant.
• Exclusion criteria: • Less than 1 year of listening experience with the cochlear implant• Children with additional disabilities that preclude spoken language
development • Suspected cochlear nerve deficiency.
Results• 109 ears with inner ear malformations fulfilled criteria.
• 46 ears were diagnosed with cochlear malformations• 6 hypoplastic cochlea• 7 IP-1 • 31 IP-2• 2 IP-3
• 50 Enlarged vestibular aqueduct• 13 Dysplatic vestibular system
hypoplastic IP-1 IP-2 IP-3
Dhanasingh A, et al 2019.
L. Sennaroğlu. 2016L. Sennaroğlu, Saatci I. 2002
Presenter
Presentation Notes
Mondini dysplasia—this right ear has a flattened and shortened cochlea that is 1.5 turn in length. There is a basal turn and scala communis. C, cochlea; V, vestibule. Hematoxylin and eosin, original magnification 16×. (b) Mondini dysplasia—there are 1.5 cochlear turns and a complete basal turn in this right ear. A defect of the interscalar septum can be seen between the 1st and 2nd turns (arrows). Y. Zheng et al.
Speech perception in different cochlear malformations
• IP2 malformations have the highest auditory performance after cochlear implantation (P=0.0058)
• IP1 and IP3 malformations, while gaining benefit from cochlear implantation, have significantly poorer auditory performance:
• IP1 vs IP2 - 54 vs 72 (P = 0.0046) • IP3 vs IP2 - 41 vs 72 (P = 0.0007)
CNC score in different cochlear malformation
Cochlear malformation type
CN
C s
core
hypoplas
tic IP1 IP2 IP30
20
40
60
80
100
Lateral Wall Vs PerimodiolarWhen choosing electrode…• Electrode length and cochlear
coverage • Atraumaticity of insertion• Fully banded or hemi-banded