The Dependency of Cochlear Lateral Wall Measurements on Observer and Imaging Type.

HYPOTHESIS: Assessment techniques for the cochlear spatial lateral wall are associated with inter-rater variability, but derived clinical recommendations nonetheless offer value for individualized electrode selection. BACKGROUND: Anatomical variations influence the location of cochlear implant electrodes inside the cochlea. Preoperative planning allows individualization of the electrode based on characterization of the bony lateral wall. METHODS: The study used publicly available digitized temporal bones based on microslicing and computed tomography. Four experienced observers assessed the lateral wall applying manual tracing, linear regression scaling and elliptic-circular approximation methods in all modalities. Radial and height differences were computed in 90-degree steps from the round window center to the apex. Total length, total angular length, and tonotopic frequencies were computed for each reconstruction. RESULTS: Differences were found most pronounced between assessment methods in vertical direction across observers and imaging modalities. One of the five anatomies was consistently found to be of shorter cochlear duct length with estimation techniques yielding more conservative results compared with manual tracings. CONCLUSIONS: Assessment techniques for the bony lateral wall yield method, observer, and image modality related deviations. Automation of the anatomical characterization may offer potential in minimizing inaccuracies. Nonetheless, observers were consistently able to detect a smaller inner ear demonstrating the ability of current methods to contribute to an optimized choice of electrodes based on individual patient anatomy.

Cochlear Implantation in Elderly Patients with Residual Hearing.

This retrospective study aimed to investigate the range of hearing levels in a cochlear implant (CI) elderly population receiving electric-acoustic-stimulation (EAS) or electric-stimulation (ES) alone. The investigation evaluates the degree of hearing preservation (HP) and the speech comprehension resulting from EAS or ES-only to identify audiometric factors that predict adequate EAS and ES use. We analyzed the pure tone audiometry and speech perception in quiet and noise preoperatively and 12-months after activation of 89 elderly adults (age of 65 years old or older), yielding in total 97 CIs. Thirty-two (33.1%) patients were potential EAS candidates preoperatively, of which 18 patients used EAS at the time of first fitting and the other 14 patients continued to use their residual hearing for EAS at 12-months. Post-treatment, patients with EAS system and ES-only users' with longer electrodes showed better results in monosyllable word scores in quiet than ES-only users with shorter electrodes. A similar trend was revealed for the speech recognition in noise. Patients with an EAS system benefit from maintaining their natural residual hearing. Nevertheless, strict preoperative patient selection is warranted particularly in elderly patients, in whom the hearing thresholds for EAS indication differ slightly from that in younger adults.

Computed Tomography Versus Dacryocystography for the Evaluation of the Nasolacrimal Duct-A Study With 72 Patients.

OBJECTIVES: In patients with epiphora, imaging of the nasolacrimal duct is essential not only for differential diagnosis, but also for preoperative planning. Advances in imaging technology and introduction of cone beam computed tomography (CB-CT) enable the combination of contrast agent-based imaging with a three dimensional tomography with low radiation exposure. However, the value of CT/CB-CT as an alternative to conventional dynamic dacryocystography (DCG) has not been evaluated yet. STUDY DESIGN: Retrospective study. METHODS: Conventional DCG was performed preoperatively in 72 consecutive patients treated for epiphora between 01/2013 and 04/2015 in our department. CB-CT or conventional CT was performed afterward with the contrast media still in place. Three separate experts (two radiologists and one otorhinolaryngologist) analyzed the radiographic images without any information about the respective clinical or surgical findings. The presence of further findings in the CT/CB-CT (eg, septal deviation, sinusitis) that were not detected in DCG and the overall visibility of the lacrimal duct system in both modalities were evaluated. RESULTS: Good delineations of bone, soft tissue, and contrast agent in the lacrimal system were achieved with both methods. No side effects were noted. Beside the pathology of the lacrimal duct, CT/CB-CT scans enabled the additional diagnosis of pathologies in the nose and the sinus system in 65.7% of the patients. Accordance in the identified level of obstruction between the two modalities was achieved in 71.4% of the patients. CONCLUSION: Thus, CT/CB-CT should be used in conjunction with contrast agent to reliably identify the level of obstruction as preoperative standard and can be used as diagnostic tool in addition to or even instead of conventional DCG. LEVEL OF EVIDENCE: 4.

Cochlear Implantation in Organ Transplant Recipients.

OBJECTIVE: Immunosuppressed individuals who have undergone organ transplants, especially children, pose particular challenges in terms of treatment. The aim of this study was to analyze the postoperative complication rate of organ transplant recipients who have also received a cochlear implant (CI). STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. INTERVENTION: The case series includes 13 kidney, liver, lung, and heart transplant patients. Age at treatment ranged from 2 to 71 years, with a total of 17 CIs. MAIN OUTCOME MEASURES: Postoperative complications were classified into major and minor, early (within 3 mo postoperatively) and late (>3 mo postoperatively). The results were compared with those for 13 1:1 matched pairs obtained and from our database and a healthy patient collective from our department. RESULTS: The global postoperative complication rate was 29.4%. The proportion of patients suffering major complications was 17.6%, with 17.6% having minor complications. Complications that occurred early accounted for 13.3%, and late for 26.7%. No adults, and 33.0% of children, showed any complications after cochlear implantation. The global complication rate (29.4%) was significantly increased compared with the matched pairs (0%, p = 0.013) and department data (13.8%, p = 0.006; Cramers v = 0.102). CONCLUSION: This study demonstrates that organ transplant recipients, and especially children, are at increased risk of postoperative complications after cochlear implantation in comparison with healthy CI recipients.

The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation.

OBJECTIVE: The aim of the study was to determine the degree of hearing preservation (HP) and its relation to electrode array length after cochlear implantation using different thin flexible electrode arrays (TFEA). STUDY DESIGN: Retrospective analysis. INTERVENTION: One hundred twenty adult patients with preoperative residual hearing received a cochlear implant with a TFEA: 46 received a TFEA20, 34 a TFEA24, and 40 a TFEA28 mm. MAIN OUTCOME MEASURES: Pure-tone audiometry (125-1500 Hz) was performed preoperatively, at initial fitting, and at 3, 6, and 12 months postoperatively. Median hearing loss (HL) was determined for each of the three array groups. The pre- to postoperative pure-tone average difference was scaled into three groups (≤15 dB, >15 to ≤30 dB, >30 dB) for array group. RESULTS: At initial fitting, median HL of 17.5 dB (TFEA20), 20 dB (TFEA24), and 24 dB (TFEA28) was observed. At 12 months, medial HL of 15 dB (TFEA20), 19.4 dB (TFEA24), and 32.5 dB (TFEA28) was observed. At initial fitting, a HL of ≤15 dB was achieved in 45.6% TFEA20 subjects, 29.4% TFEA24 subjects, and 15.0% TFEA28 subjects; compared with 48.8% TFEA20 subjects, 50.0% TFEA24 subjects, and 15.8% TFEA28 subjects at 12 months. CONCLUSION: HP is possible in the majority of subjects who are implanted with a TFEA20, 24, or 28. Using shorter arrays led to greater HP and lower median HL.