International Consensus Statements on Intraoperative Testing for Cochlear Implantation Surgery.

OBJECTIVES: A wide variety of intraoperative tests are available in cochlear implantation. However, no consensus exists on which tests constitute the minimum necessary battery. We assembled an international panel of clinical experts to develop, refine, and vote upon a set of core consensus statements. DESIGN: A literature review was used to identify intraoperative tests currently used in the field and draft a set of provisional statements. For statement evaluation and refinement, we used a modified Delphi consensus panel structure. Multiple interactive rounds of voting, evaluation, and feedback were conducted to achieve convergence. RESULTS: Twenty-nine provisional statements were included in the original draft. In the first voting round, consensus was reached on 15 statements. Of the 14 statements that did not reach consensus, 12 were revised based on feedback provided by the expert practitioners, and 2 were eliminated. In the second voting round, 10 of the 12 revised statements reached a consensus. The two statements which did not achieve consensus were further revised and subjected to a third voting round. However, both statements failed to achieve consensus in the third round. In addition, during the final revision, one more statement was decided to be deleted due to overlap with another modified statement. CONCLUSIONS: A final core set of 24 consensus statements was generated, covering wide areas of intraoperative testing during CI surgery. These statements may provide utility as evidence-based guidelines to improve quality and achieve uniformity of surgical practice.

Application of anatomy-based spacing of electrode contacts for achieving a uniform semitonal resolution: A novel concept in cochlear implant electrode design.

Using anatomy-based fitting, we can determine the place-specific map with individualized center frequencies for each electrode contact that is a closer match to the natural pitch-place of the cochlea. The primary objective of this study is to evaluate the tonal presentation across the electrode array and to calculate the semitone difference between each adjacent pair of contacts according to their anatomy-based map. The secondary objective is to determine the distancing of the contacts that would result in an equal semitone difference with a uniform tonal presentation. A total of 167 ears were included in this retrospective study. The frequencies across the electrode arrays were found to be unequally presented. The semitonal condensations were higher in the apical inter-contact spaces compared to the basal inter-contact spaces, being 3.0-2.3 semitones/mm (Kruskal Wallis test, p < 0.000). The anatomy-based spacing of the electrode contacts was larger in the basal inter-contact spaces compared to the apical inter-contact spaces, ranging from 1.92 to 1.48 mm. In conclusion, the current electrode designs do not have uniform tonal representation throughout the electrode array. There is a more condensed tonal presentation in the apical electrodes than in the basal electrodes, resulting in a lower tonal resolution in the apical region.

A Good Practice Guide for Organizing the Scientific Program of International Conferences.

This paper provides a step-by-step guide for organizing the scientific program (OSP) of international conferences. Through informal discussions, a panel of experts organizing international conferences came up with this guide, which includes a flowchart, checklist, and detailed discussions of each step. Subsequently, additional specialists were invited to evaluate this synopsis and provide their input. All of the participants approved the final version after the outline was improved. This guide proposes the following six steps: 1) preparation, 2) recruitment, 3) building the agenda, 4) cross-checking the program, 5) reviewing and finalizing, and 6) in-conference refining. Thirteen items are specified across the six main steps in a detailed checklist. This OSP guide includes a flowchart and a checklist for providing a comprehensive manual for establishing, conducting, and organizing international scientific conferences. Understanding the procedures that are expected to be followed when holding a scientific conference enables the involved parties to organize and assign tasks to one another as well as create a schedule that allows them to finish their work on time. This guide can be used at any kind of scientific conference to describe an organized process, resulting in a professional and distinguished scientific program.

Hearing Improvement After Pain Related to Cochlear Implant Explantation: A Case Report.

This study aims to report a cochlear-implanted case who was explanted due to recalcitrant pain at the site of the device, despite various manage- ment trials. After explantation, this patient had an unexpected subjective and objective improvements in hearing. The patient reported improved hearing after explantation and was satisfied with using hearing aids. The audiological evaluation of the patient showed not only preserved hear- ing but also an unexpected hearing improvement. The medical records of the patient were reviewed to retrieve all the relevant data. This case illustrates how pain after cochlear implantation can be severe enough to discourage the patient from undergoing re-implantation. It also shows an unexpected hearing improvement after explantation. Although a human error in audiological evaluation can be the first and most simple possible explanation for this finding, the objective improvement of the patient is highly suggestive of a real hearing improvement. It can be hypothesized that the mechanical or electrical stimulation by the cochlear implant could have led to this hearing improvement.

Anatomy-Based Frequency Allocation in Cochlear Implantation: The Importance of Cochlear Coverage.

OBJECTIVES/HYPOTHESIS: This study aimed to compare the predicted anatomy-based frequency allocation of cochlear implant electrodes with the default standard frequencies. STUDY DESIGN: Retrospective study. METHODS: A retrospective analysis was performed using computed tomography (CT) images of patients who received cochlear implants at a tertiary referral center. Patients were excluded if they had any congenital or acquired cochlear anatomical anomalies. The CT images of the patients were uploaded to the surgical planning software. Two independent reviewers allocated the anatomical parameters of the cochlea. The software then used these parameters to calculate the frequency allocation for each electrode according to the type of electrode and the length of the organ of Corti (OC) in each patient. These anatomy-based frequency allocations were compared with the default frequency settings. MAIN OUTCOME MEASURE: Frequency-to-place mismatch in semitones. RESULTS: A total of 169 implanted ears in 102 patients were included in this study. The readings of the two reviewers were homogenous, with a Cronbach's alpha of 0.98. The mean anatomy-based frequency allocation was 487.3 ± 202.9 Hz in electrode 1; 9,298.6 ± 490.6 Hz in electrode 12. The anatomy-based frequency allocations were found to be significantly higher than the frequencies of the default frequencies for each corresponding electrode (one-sample t-test, P < .001). The frequency-to-place mismatch was negatively correlated with cochlear coverage and positively correlated with the cochlear duct length (Pearson correlation > 0.65, P < .003). CONCLUSIONS: The anatomy-based frequency allocation of each electrode is significantly different from the default frequency setting. This frequency-to-place mismatch was affected mainly by the cochlear coverage. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2224-2231, 2022.

Changes in the Area Adjacent to the Internal Receiver-Stimulator of Cochlear Implant: A Retrospective Study.

BACKGROUND: In some patients with cochlear implants, bony resorption at the internal receiver- stimulator site can be observed on postoperative computed tomography. Therefore, it is essential to elucidate the effects of the internal receiver-stimulator on the scalp and bony bed over time. OBJECTIVE: We aimed to evaluate how the internal receiver-stimulator of a cochlear implant device changed the thickness of the surrounding scalp and skull over time using computed tomography. METHODS: This retrospective study evaluated patients who underwent cochlear implantation and received two computed tomography scans postoperatively for different indications at a tertiary referral centre. The main outcomes were scalp thickness and bony bed depth. RESULTS: Fourteen ears were included in this study. There was very good inter-rater reliability among the two readers who evaluated the computed tomography of the included patients, with a Cronbach's alpha of 0.94. The mean scalp thickness over the internal receiver-stimulator was 6.02 (+/-2.4) mm in the first scan and decreased with no significant change to 5.62 mm (+/-1.64) in the second scan (p = 0.59, paired t-test). The mean depth of the bony bed increased significantly from 1.39 mm (+/-0.93) to 2.62 mm (+/-1.24) (p = 0.03). CONCLUSION: There was no change in the thickness of the scalp overlying the internal receiver-stimulator indicating that the scalp was more resistant than the bony skull to the tensile pressure exerted by the internal receiver-stimulator. In contrast, the bony bed depth of the internal receiver-stimulator increased over time. This can result in decreased internal receiver-stimulator protrusion and decreased risk of device displacement and migration.

Cochlear implantation in post-lingual adults: A 25-year experience at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia.

OBJECTIVES: To demonstrate the efficacy of cochlear implants (CI) in post-lingual adults, including surgical and auditory outcomes based on a 25-year experience at a tertiary referral hospital. METHODS: This study was a retrospective, descriptive chart review of post-lingual adults, aged ≥18 years, implanted at King Abdullah Ear Specialist Center (KAESC), Kingdom of Saudi Arabia (KSA), between September 1994 and March 2020. The study included 176 cochlear implantations performed in 144 patients. Data retrieval included patient demographics, clinical evaluation, operative details, postoperative course, and audiological evaluation parameters. The main outcome measures were surgical procedures, including techniques and complication rates, and audiological parameters as evaluated by pure tone audiometry average (PTA), speech reception threshold (SRT), and word recognition score (WRS). Student's t-test and Chi-square tests were used for statistical analysis and a p-value<0.05 was considered significant. RESULTS: Pure tone audiometry average, SRT, and WRS improved significantly after CI. Overall, major complications occurred in 3 patients. One patient underwent CI ex-planation for severe pain, and 2 had device malfunctioning. Other minor complaints were reported in 18% of the patients. CONCLUSION: Cochlear implants performed, in our institute, on post-lingual adults resulted in significant improvements in auditory performance, including PTA, SRT, and WRS values with low complication rates.

Caregivers' Willingness to Vaccinate Their Children Against COVID-19 in Saudi Arabia: A Cross-Sectional Survey.

Background In early 2021, vaccination against COVID-19 became one of the most important measures needed to control the pandemic. Objectives This study aimed to investigate the levels of acceptance and factors affecting the decisions among Saudi parents and caregivers of children under 12 for getting them vaccinated. Design and setting A cross-sectional survey of 1000 caregivers and parents was carried out from May 2021 to June 2021. The participants were from the eastern, central, southern, western, and northern provinces of Saudi Arabia. Materials and methods The data were collected and managed using Microsoft Excel (Microsoft® Corp., Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Of the 1000 respondents, 281 (28.1%) reported they would vaccinate their children, 346 (34.6%) rejected vaccination, and 373 (37.3%) were not sure. Most caregivers (24.1%; n = 241) reported protecting children as the principal reason for accepting vaccination. Regarding those rejecting the vaccine, the most common concern was that children might experience side effects (42.9%; n = 429). Limitations The acceptance of the COVID-19 vaccine is dynamic and changes with legislations and public awareness policies. Conclusions COVID-19 vaccine acceptance for children was low at the time of this study compared to the United Kingdom and United States. To achieve vaccination coverage that is adequate for herd immunity in Saudi Arabia, intense educational and awareness strategies are needed.

Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation.

PURPOSE: To compare the preoperative computed tomography (CT) parameters, including the thickness and density of the bone separating the upper basal turn of the cochlea (UBTC) and the labyrinthine segment of the facial nerve (LSFN), in patients with and without facial nerve stimulation (FNS) in post-cochlear implants (CI). METHODS: A retrospective case review of 1700 CI recipients in a tertiary referral center between January 2010 and January 2020 was performed; out of the 35 recipients who were found to have FNS, 29 were included in the study. The control group comprised the same number of randomly selected patients. CT parameters of the patients were measured independently by three fellowship-trained neuro-otologists blinded to the postoperative status of the patients. Thickness in axial and coronal views and density of the bone separating the UBTC and the LSFN were measured. RESULT: There was satisfactory agreement between the readings of the three reviewers. The distances (in mm) between the UBTC and LSFN obtained from the coronal (0.43 ± 0.24 vs. 0.63 ± 0.2) and axial (0.42 ± 0.25 vs. 0.6 ± 0.18) views were statistically lower in the FNS group (p = 0.001 and 0.005, respectively). The density (in HU) of the bony partition was also statistically lower in the FNS group (1038 ± 821 vs. 1409 ± 519; p = 0.029). CONCLUSION: Patients who experienced FNS postoperatively had significantly lower distance and bone density between the UBTC and the LSFN. This finding can help surgeons in preoperative planning in an attempt to decrease the occurrence of FNS.