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.

A novel radiological software prototype for automatically detecting the inner ear and classifying normal from malformed anatomy.

BACKGROUND: To develop an effective radiological software prototype that could read Digital Imaging and Communications in Medicine (DICOM) files, crop the inner ear automatically based on head computed tomography (CT), and classify normal and inner ear malformation (IEM). METHODS: A retrospective analysis was conducted on 2053 patients from 3 hospitals. We extracted 1200 inner ear CTs for importing, cropping, and training, testing, and validating an artificial intelligence (AI) model. Automated cropping algorithms based on CTs were developed to precisely isolate the inner ear volume. Additionally, a simple graphical user interface (GUI) was implemented for user interaction. Using cropped CTs as input, a deep learning convolutional neural network (DL CNN) with 5-fold cross-validation was used to classify inner ear anatomy as normal or abnormal. Five specific IEM types (cochlear hypoplasia, ossification, incomplete partition types I and III, and common cavity) were included, with data equally distributed between classes. Both the cropping tool and the AI model were extensively validated. RESULTS: The newly developed DICOM viewer/software successfully achieved its objectives: reading CT files, automatically cropping inner ear volumes, and classifying them as normal or malformed. The cropping tool demonstrated an average accuracy of 92.25%. The DL CNN model achieved an area under the curve (AUC) of 0.86 (95% confidence interval: 0.81-0.91). Performance metrics for the AI model were: accuracy (0.812), precision (0.791), recall (0.8), and F1-score (0.766). CONCLUSION: This study successfully developed and validated a fully automated workflow for classifying normal versus abnormal inner ear anatomy using a combination of advanced image processing and deep learning techniques. The tool exhibited good diagnostic accuracy, suggesting its potential application in risk stratification. However, it is crucial to emphasize the need for supervision by qualified medical professionals when utilizing this tool for clinical decision-making.

Enhancing cochlear duct length estimation by incorporating second-turn parameters.

Estimating insertion depth, cochlear duct length (CDL), and other inner ear parameters is vital to optimizing cochlear implantation outcomes. Most current formulas use only the basal turn dimensions for CDL prediction. In this study, we investigated the importance of the second turn parameters in estimating CDL. Two experienced neuro-otologists blindly used segmentation software to measure (in mm) cochlear parameters, including basal turn diameter (A), basal turn width (B), second-turn diameter (A2), second-turn width (B2), CDL, first-turn length, and second-turn length (STL). These readings were taken from 33 computed tomography (CT) images of temporal bones from anatomically normal ears. We constructed regression models using A, B, A2, and B2 values fitted to CDL, two-turn length, and five-fold cross-validation to ensure model validity. CDL, A value, and STL were longer in males than in females. The mean B2/A2 ratio was 0.91 ± 0.06. Adding A2 and B2 values improved CDL prediction accuracy to 86.11%. Therefore, we propose a new formula for more accurate CDL estimation using A, B, A2, and B2 values. In conclusion, the findings of this study revealed a notable improvement in the prediction of two-turn length (2TL), and CDL by clinically appreciable margins upon adding A2 and B2 values to the prediction formulas.

Cochlear Implantation: The Volumetric Measurement of Vestibular Aqueduct and Gusher Prediction.

This study aimed to validate the role of 3D segmentation in measuring the volume of the vestibular aqueduct (VAD), and the inner ear, and to study the correlation between VAD volume and VAD linear measurements at the midpoint and operculum. The correlation with other cochlear metrics was also studied. We retrospectively recruited 21 children (42 ears) diagnosed with Mondini dysplasia (MD) plus enlarged vestibular aqueduct (EVA) from 2009 to 2021 and who underwent cochlear implantation (CI). Patients' sociodemographic data were collected, and linear cochlear metrics were measured using Otoplan. Vestibular aqueduct width and vestibular aqueduct and inner ear volumes were measured by two independent neuro-otologists using 3D segmentation software (version 4.11.20210226) and high-resolution CT. We also conducted a regression analysis to determine the association between these variables and CT VAD and inner ear volumes. Among the 33 cochlear implanted ears, 13 ears had a gusher (39.4%). Regarding CT inner ear volume, we found that gender, age, A-value, and VAD at the operculum were statistically significant (p-Value = 0.003, <0.001, 0.031, and 0.027, respectively) by regression analysis. Moreover, we found that Age, H value, VAD at the midpoint, and VAD at the operculum were significant predictors of CT VAD volume (p-Value < 0.04). Finally, gender (OR: 0.092; 95%CI: 0.009-0.982; p-Value = 0.048) and VAD at the midpoint (OR: 0.106; 95%CI: 0.015-0.735; p-Value = 0.023) were significant predictors of gusher risk. Patients' gusher risk was significantly differentiated by gender and VAD width at the midpoint.

Cochlear implantation: Predicting the scala tympani volume of the pediatric recipients.

OBJECTIVES: The main aim of this study was to estimate the volume of the Scala Tympani (ST) of our pediatric cochlear implant (CI) recipients from the computed tomography (CT) images. Then, to study the association between ST volume and both demographic characteristics and cochlear parameters. METHODS: A retrospective study on the CT scans of pediatric CI patients at a tertiary referral CI center. Congenital or acquired cochlear defects were excluded. Two reviewers, with the same level of experience, blindly measured the main cochlear parameters and studied its anatomy. Then, the interrater reliability was tested to measure any differences between the two readings. After that, the ST volume of the included patients was calculated and analyzed. Furthermore, the correlations between the main cochlear parameters and ST volume were studied to propose a formula for estimating the ST volume from the cochlear duct length (CDL). RESULTS: The mean predicted ST volume among our pediatric CI recipients was 38.51 ± 5.54 µl (range; 24.47-52.57 µl). The statistical analysis revealed that all cochlear parameters (A, B, H, and CDL values) could be significant predictors of the ST volume (p=<0.0001). CONCLUSION: The main cochlear parameters along with the CDL are positively linked to the ST volume. There are considerable differences in cochlear size and scala tympani volume among our pediatric population. These findings confirm the importance of pre-operative planning for proper electrode array selection.

Cochlear Implantation: The Variation in Cochlear Height.

This study aimed to identify the association between different cochlear metrics, including the basal turn diameter (A-value), the basal turn width (B-value), and the height of the cochlea (H-value). We also reported an association between H-value and hearing outcomes with cochlear implants (CI). This is a retrospective study that included all patients who underwent CI procedures between 2012 and 2018 at a tertiary center and have; preoperative high-resolution computed tomography (CT), normal cochlea, postoperative follow-up duration of at least 2 years, scores of the category auditory performance II (CAP-II), and speech intelligibility rating (SIR) scales. A total of 65 ears implanted with CI in 46 patients (24 boys and 20 girls; mean age of 7 (±10) years) fulfilled the inclusion criteria. We found significant positive correlations between A vs B, A vs H, and B vs H (P-value = 0.008, 0.018, and 0.0039, respectively). We also found a significant positive relationship between A, B, and H values and cochlear duct length (CDL) (P-value < 0.0001, 0.008, and 0.018, respectively). Finally, the H-value was significantly correlated with the SIR (P-value = 0.027). However, its correlation with the CAP score was not statistically significant (P-value = 0.62). Cochlear height significantly correlated with CDL and the other cochlear parameters. The variation in cochlear height can also affect speech outcomes in patients undergoing CI. Therefore, the H-value together with the other cochlear metrics should be adequately assessed preoperatively in CI patients.

Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results.

OBJECTIVE: To estimate the incidence of brain abnormalities in a cohort of prelingually deaf children and whether these abnormalities can impact the hearing outcomes of patients eligible for cochlear implantation (CI). METHODS: We performed a retrospective review of consecutive medical charts of prelingually deaf children under 12 years of age who underwent brain magnetic resonance imaging (MRI) during their preoperative workup for CI surgery. We used the category of auditory performance (CAP) test and the speech intelligibility rating (SIR) test to assess the hearing and speech performance of the children, respectively. RESULTS: The MRIs of 285 patients, 174 boys and 111 girls with a mean age of 36.4 (±16) months, were evaluated for this study. We identified 31 patients with abnormal findings (10.88%): (17/31) (54.8%) had MRI brain abnormalities, (9/31) (29%) had inner ear anomalies, and (5/31) (16.1%) had both inner ear and brain abnormalities. The most frequent inner ear anomaly was an enlarged vestibular aqueduct, while white matter lesions were the most common brain abnormality. The CAP and SIR mean score of patients with inner ear anomalies was slightly, but not significantly, higher than those of patients with brain abnormalities. CONCLUSION: CAP and SIR scores were not significantly different in children with brain abnormalities than inner ear anomalies. These patients can still benefit from CI to improve their overall hearing and speech performance.

Cochlear implantation in adults and pediatrics with enlarged vestibular aqueduct: a systematic review on the surgical findings and patients' performance.

PURPOSE: Cochlear implantation (CI) has been considered a safe and effective management option for patients with severe to profound hearing loss. Patients with enlarged vestibular aqueduct (EVA) could be challenging with some variations in surgical approaches, intraoperative surgical notes, and clinical outcomes. This study aimed to  review the surgical and clinical outcomes of cochlear implantation among patients with EVA. MATERIALS AND METHODS: A systematic literature search was carried out in five major databases. All original studies reporting cochlear implantation in patients with EVA were included for qualitative data synthesis. The risk of bias was independently assessed through the National Intuitional of Health tool. The review protocol was registered in PROSPERO (reference number: CRD42021225900). RESULTS: A total of 34 studies with 4035 subjects were included. Of them, 853 (21.14%) had EVA and underwent CI. Mondini malformation was the most frequently associated anomaly (n = 78, 11.1%). Unilateral implantation was performed in 258 cases while bilateral in 119 subjects. Postoperative complications included CSF/perilymph gusher (n = 112), CSF oozing (n = 18), and partial electrode insertion (n = 6). Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue was the most frequently reported approach to manage CSF/perilymph gusher (n = 67, 56.7%) while packing was performed in six patients. CONCLUSION: Patients with EVA demonstrated audiometric and speech performance improvement after CI. However, many patients had intra- or postoperative complications. Further research is needed as the outcomes may be affected by associated temporal bone pathology, the timing of implant, and hearing condition.

Cochlear implantation among patients with otosclerosis: a systematic review of clinical characteristics and outcomes.

PURPOSE: There have been considerable advancements in cochlear implants in different clinical scenarios; however, their use in patients with otosclerosis remains challenging. This review aimed to investigate the surgical and clinical outcomes of cochlear implantation in patients with otosclerosis. METHODS: An electronic literature search was performed using four main databases through February 2021 to identify original studies of cochlear implantation in patients with otosclerosis for inclusion in this systematic review. The study protocol was registered with the Prospectively Registered Systematic Reviews and Meta-analyses (reference number: CRD42021234753). RESULTS: A total of 23 studies including 3162 patients were enrolled. Of these patients, only 392 had otosclerosis and underwent cochlear implantation. The duration of deafness was reported in only eight studies, extending up to 50 years. Far-advanced otosclerosis was observed in 153 patients. A total of 56 patients used hearing aids. Stapedectomy and stapedotomy were performed in 118 and 63 patients, respectively. In three studies, the temporary success of stapedectomy and stapedotomy was 6 (43%) and 5 (71%) patients, respectively. Computed tomography was used as a preoperative assessment tool in most studies (n = 14, 60.9%). Incomplete implant insertion occurred in 17 patients, while facial nerve stimulation occurred in 36 patients after implantation. CONCLUSION: Cochlear implantation is a relatively safe modality that can provide promising audiological outcomes in patients with otosclerosis. However, several factors, including cochlear ossification, duration of deafness, and previous operations, can affect its outcomes. Further studies with a larger sample population are recommended.

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.

Validation of LittlEARS® Early Speech Production Questionnaire in Arabic-speaking children with normal hearing.

OBJECTIVES: To validate an Arabic version of the LittlEARS® Early Speech Production Questionnaire (LEESPQ), which assesses the early development of speech and language in infants between 0 and 18 months, in Arabic-speaking children with normal hearing in Saudi Arabia. METHODS: This is a cross-sectional study conducted in the city of Riyadh, Saudi Arabia between September and December 2020. Parents completed the LEESPQ regarding their child's speech production development. To assess the ability of normal hearing children aged 0-18 months in developing speech and language production, a norm curve has been generated based on the standardized values that were calculated from the Arabic normal-hearing data set. RESULTS: A total of 198 questionnaires were analyzed. The total score on the LEESPQ correlated with age, gender, and bilingualism. A norm curve for early speech production in children with normal hearing was created. CONCLUSION: The Arabic version of LEESPQ appears to be a valid questionnaire that can be used in the assessment of early language and speech development of Arabic-speaking children with normal hearing in the age range of 0-18 months. The Arabic version of the LEESPQ might also be a useful tool to detect developmental delays and hearing disorders in young children.

Clinical Approaches To External Auditory Canal Hemangiomas: A Systematic Review.

OBJECTIVES: Hemangioma is a common soft tissue tumor that can be categorized mainly into cavernous, capillary, and venous subtypes. It usually develops in the head and neck and rarely in the external auditory canal (EAC). METHODS: A systematic review of patients with capillary hemangioma of the EAC was performed. A computerized systematic search was conducted in PubMed, Scopus, and Web of Science to extract relevant studies for a qualitative review. RESULTS: A total of 38 patients were included in the systematic review, and half of them were men. Hearing loss was the most common presenting feature (n = 19; 50%), followed by aural fullness (n = 15; 39.4%). Cavernous hemangioma was the predominant type (n = 22, 57.8%). Endaural and transcanal surgical approaches were the most frequent, with ten (26.3%) and nine (23.6%) cases, respectively. Most of the patients (n = 31; 81.5%) had no recurrence. CONCLUSIONS: Hemangioma of the EAC may not be uncommon as healthcare professionals may expect. Hearing loss, aural fullness, and tinnitus are possible symptoms, but many patients remain asymptomatic. Surgical excision is the main effective management option, and complete resolution is the most prevalent outcome. Computed tomography assists in the diagnosis, but histopathological examination after resection is mandatory for the definitive diagnosis.

A novel cochlear measurement that predicts inner-ear malformation.

The A-value used in cochlear duct length (CDL) estimation does not take malformed cochleae into consideration. The objective was to determine the A-value reported in the literature, to assess the accuracy of the A-value measurement and to evaluate a novel cochlear measurement in distinguishing malformed cochlea. High resolution Computer Tomography images in the oblique coronal plane/cochlear view of 74 human temporal bones were analyzed. The A-value and novel C-value measurement were evaluated as predictors of inner ear malformation type. The proximity of the facial nerve to the basal turn was evaluated subjectively. 26 publications report on the A-value; but they do not distinguish normal vs. malformed cochleae. The A-values of the normal cochleae compared to the cochleae with cochlear hypoplasia, incomplete partition (IP) type I, -type II, and -type III were significantly different. The A-value does not predict the C-value. The C-values of the normal cochleae compared to the cochleae with IP type I and IP type III were significantly different. The proximity of the facial nerve to the basal turn did not relate to the type of malformation. The A-value is different in normal vs. malformed cochleae. The novel C-value could be used to predict malformed anatomy, although it does not distinguish all malformation types.

Clinical profile and management of revision cochlear implant surgeries.

OBJECTIVES: To discuss our experience with managing cochlear implant cases that required revision surgery. METHODS: A retrospective case series study including data from 922 cochlear implant patients at an academic tertiary center was evaluated retrospectively. All patients who underwent revision cochlear implant (CI) surgery between January 2011 and July 2017 were included. The following data were collected: patient demographic data, details on the first implant, reasons for the revision, duration from initial implantation to revision, type of device, and management. RESULTS: Out of 922 CI patients, 37 (4%) underwent revision surgery, comprising 33 children and 4 adults. The most common reason for revision surgery, at 28/37 cases (75.6%), was device failure. Surgical and medical aetiologies were responsible for 9/37 (24.3%) revisions. The mean duration from the initial implantation to the revision surgery was 29 months. CONCLUSION: Revision CI surgery is not uncommon after initial implantation. Cochlear implant programs must implement long-term follow-up processes for CI users. Whenever a patient's rehabilitated performance regresses, the cause should be investigated to determine whether subsequent reimplantation is necessary.

Auditory Performance and Subjective Satisfaction with the ADHEAR System.

BACKGROUND: The ADHEAR device, a new nonsurgical bone conduction hearing device, has been developed for patients with conductive hearing loss. OBJECTIVES: This study aims to assess the impact of the ADHEAR device on the audiological performance and satisfaction level in subjects with conductive hearing loss. METHODS: Twelve patients with conductive hearing loss were included. All patients received the device for 3 months. The audiological outcomes were determined using basic audiological assessments, including pure tone audiometry and sound field measurements of pure tone and speech audiometry with the contralateral ear occluded with a specific earplug. Additionally, the patients were subjectively evaluated using (1) the Speech, Spatial, and Qualities Questionnaire (SSQ), and (2) the custom-made ADHEAR questionnaire. RESULTS: Analysis of the measured audiological outcomes revealed an average improvement in pure tone thresholds (functional gain) of 23 (± 4.4) dB HL when the ADHEAR system was used compared to the unaided condition in the sound field. Moreover, speech reception thresholds improved by an average of 23 (± 15.3) dB SPL in the aided condition with plugged contralateral ear. Additionally, when using ADHEAR in the sound field, subjects' speech recognition scores improved by 32% (± 17.7) in quiet and 21% (± 15.1) in the presence of interfering noise. The average SSQ questionnaire scores improved from 3.9 at the study initiation to 6.6 after 3 months of device usage. ADHEAR custom questionnaire assessments revealed high satisfaction and acceptance of the device with no pain or skin irritation. CONCLUSION: During the study period, this new adhesive system yielded improved audiological outcomes with high patient satisfaction and acceptance and no reported skin irritation or pain.

Diagnostic Value of 3D Segmentation in Understanding the Anatomy of Human Inner Ear Including Malformation Types.

OBJECTIVE: To understand the anatomical and dimensional variations of the human inner ear using 3-dimensional (3D) segmentation within the Middle East population. DESIGN: Retrospective study. SETTING: King Abdullah Ear Specialist Center (KAESC) Riyadh, Saudi Arabia. PARTICIPANT: Forty computed tomography (CT) images of patients with sensorineural hearing loss who underwent cochlear implant (CI) were taken for analysis. MAIN OUTCOME MEASURES: Three-dimensional images showing the anatomical variations of the inner ear including various pathological conditions, cochlear parameters including basal turn diameter ("A" value), "B" value which is perpendicular to "A" value, cochlear height, length, and width of the internal auditory canal (IAC), intercochlear spacing, and electrode angular insertion depth (AID). RESULTS: Out of 40 CT image data sets, 12 had normal inner-ear anatomy (NA), 4 with enlarged vestibular aqueduct syndrome (EVAS), 8 with only 2 turns of the cochlea (2TL), 7 with incomplete partition (IP) type II, 5 with cochlear hypoplasia, 1 with common cavity, and 3 with abnormal IAC. Taking the NA, EVAS, 2TL, and the IP type II cases altogether, age of the patient had no correlation with the "A" value; however, the "A" value had a linear correlation with the "B" value. The age of the patient had an increasing logarithmic correlation with the IAC length and the intercochlear spacing. The "A" value did not have any meaningful correlation with the cochlear height. Three data sets showed asymmetric inner-ear malformation types on either side of the ears. All these 40 cases were implanted with various CI electrode array variants and the corresponding postoperative plain film X-ray images showing the electrode AID are given separately in figures. CONCLUSIONS: Three-dimensional segmentation of the inner ear from the temporal bone CT is a valuable clinical and training tool for surgeons and radiologists especially in difficult cases which will certainly help to understand the overall anatomical and dimensional variations.

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.

Systematic Review of Postcochlear Implant Electrode Migration: What Is Known?

BACKGROUND AND OBJECTIVES: Electrode migration after cochlear implantation (CI) is a rare complication that accounts for 1to 15% of all revision surgery. This study is a systematic review of the literature for investigating the knowledge and approaches to the incidence of electrode migration after CI. METHODS: A systematic electronic search of the literature was carried out using PubMed, Cochrane, Virtual Health Library, Scopus and Web of Science (ISI). All original articles that reported electrode migration after CI surgery were included. The Newcastle-Ottawa Scale and CARE checklist were utilized for the assessment of the risk of bias. Descriptive data analysis was performed using SPSS software. RESULTS: A total of 26 studies including 4,316 patients were included. Out of them, 289 patients had electrode migration following CI. To diagnose electrode migration, traditional computed tomography scan was used in 13 studies, while cone-beam computed tomography was applied in three studies. In addition, electrode migration was detected during intraoperative exploration in eight studies. The most common presenting symptom was change in sound/poor performance (n = 43) followed by pain sensation (n = 15) and facial nerve stimulation (n = 10). Cholesteatoma was the most common associated pathology (n = 10) followed by infection (n = 9) and ossification of the basal turn of the cochlea (n = 8). CONCLUSION: Electrode migration is a major complication of CI and could be more common than previously thought. As it may occur with or without clinical complaints, long-term follow-up through routine radiological scanning is recommended. Further studies are warranted to identify the underlying mechanism of electrode extrusion and the appropriate fixation method.

Audiologic Outcome of Cochlear Implantation in Children With Cochlear Nerve Deficiency.

OBJECTIVE/HYPOTHESIS: The aim of this study was to investigate cochlear implantation (CI) outcome in children with nerve deficiency. STUDY DESIGN: Retrospective chart review. METHODS: A total of seven children with prelingual profound deficiency (hypoplasia or aplasia) were included. A control group of 10 CI children with no cochlear nerve anomalies was also included. In addition to implant stimulation levels, children's performance on pure-tone audiometry, speech reception measure, and auditory and speech skills ratings were compared across groups. Additionally, pre- and postoperative audiologic results were evaluated for the group with nerve deficiency. RESULTS: In general, children with nerve deficiency performed poorer than those without nerve deficiency on all tested measures. Stimulation levels were considerably higher and more variable than the control group. Results further showed that performance was dependent on the diameter of the internal auditory canal. CONCLUSION: Overall, cochlear implantation outcome in children with auditory nerve deficiency is poorer and extremely more variable than those without nerve deficiency. However, three of the patients had a noticeable improvement in auditory performance postimplantation suggesting that CI is a viable option in this population but expected benefit can be dependent on the status of the cochlear nerve.

Influence of family environment on the outcomes of cochlear implantation in pediatric recipients.

OBJECTIVES: To determine whether family environment and demographic factors such as family income and education produce any significant difference in postoperative performance of cochlear implant (CI) patients. METHODS: In this study, 49 participants who received cochlear implant devices at King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia before the age 5 years were included. Data were collected between July 2019 and August 2019. Postoperative performance was assessed by speech intelligibility rating (SIR) and categories of auditory performance (CAP) scales. Family environment was assessed with family environment scale (FES) survey. Data of demography, average income, and maternal and paternal education were obtained through review of patient's medical files. The data obtained were analyzed using Statistical Package for Social Sciences for Mac, version 23 (IBM Corp, Armonk, NY, USA). RESULTS: A significant difference between the organization categories of FES (p less than 0.05) was observed in terms of postoperative CAP scores, while a significant effect of the expressiveness category on both postoperative CAP and SIR scores (p less than 0.05) was observed. The scores on both CAP and SIR scales were significantly affected by maternal education, and the scores on SIR scale were positively correlated with paternal education. CONCLUSION: This study suggests that post-procedural performance of auditory perception and speech intelligibility in CI patients is significantly related to the family environment as well as the education levels of the parents.