Faculty Bibliography

OBJECTIVE:To evaluate the impact of prolonged unaided duration of deafness (DoD) on speech perception outcomes following cochlear implantation in adults. METHODS:A retrospective review was performed of adult cochlear implant recipients at a single high-volume center between 2012 and 2023. Patients with ≥ 5 years of documented unaided deafness meeting cochlear implant (CI) criteria were stratified into three groups (5-9, 10-19, and ≥ 20 years DoD). The primary outcome was CNC word recognition scores at 3 and 12 months post-operatively. RESULTS:Forty-one patients met inclusion criteria. At 3 months, patients with ≥ 20 years DoD demonstrated lower CNC word recognition scores compared with shorter duration groups. No significant differences were observed between groups at 12 months. Patients without measurable pre-operative hearing thresholds were more likely to be device non-users or fail to achieve open-set speech perception. CONCLUSION/CONCLUSIONS:Patients demonstrated meaningful speech perception outcomes across a range of deafness durations, though longer DoD was associated with slower early improvement. Absence of measurable pre-operative hearing thresholds may identify a subgroup at higher risk for limited functional benefit and should be considered during pre-operative counseling.

OBJECTIVE:To evaluate cochlear implant (CI) speech perception and usage outcomes in patients after prolonged unilateral deafness. METHODS:Retrospective cohort study at five tertiary academic centers of adult patients with prolonged (> 10 years) unilateral severe to profound hearing loss who underwent cochlear implantation. Main outcome measures included post-operative word recognition scores (WRSs) and average daily usage of CI. RESULTS:A total of 68 patients were analyzed with a median duration of unilateral deafness of 17 years (IQR, 12-35 years). The mean individual average daily CI usage was 8.4 h (SD, 4.5 h) at ≤ 1 year after implantation and 7.1 h (SD, 5.0 h) at > 1 year. The majority of patients (54.5%, 30 patients) had an absolute increase in WRS of ≥ 20% after implantation and 32.7% (18 patients) had an absolute increase of ≥ 50%. Univariate analysis comparing pre- and post-operative speech recognition in patients who completed the same test revealed a clinically and statistically significant improvement, with a mean change of 28.4% (SD 31.6%; p < 0.001) at their latest audiogram. In the analysis excluding those without post-operative data, duration of deafness was not predictive of post-CI WRS on multivariable analysis. CONCLUSIONS:Most patients with prolonged unilateral auditory deprivation in our study benefited from a CI. Although the duration of auditory deprivation was found to be inconsistently associated with poorer CI speech perception performance, our findings support individualized CI candidacy assessment and suggest that prolonged deafness alone should not be used as an absolute exclusion criterion for cochlear implantation.

OBJECTIVES/UNASSIGNED:To better understand the implications of tumor size on auditory brainstem implant (ABI) categories of auditory performance (CAP) score to facilitate more precise patient counselling. DESIGN/UNASSIGNED:Single-center retrospective chart review. SETTING/UNASSIGNED:Tertiary referral center. PARTICIPANTS/UNASSIGNED:Patients > 18 years old with neurofibromatosis type 2 who underwent ABI placement between the years 2009 and 2023 were included. Patients with prior surgical resection were excluded to reduce the potential of previous cochlear nucleus trauma confounding results. MAIN OUTCOME MEASURES/UNASSIGNED:Ipsilateral tumor volume was measured from the preoperative MRI, and the primary endpoint was the 1-year CAP score. RESULTS/UNASSIGNED: = 0.010). CONCLUSION/UNASSIGNED:Increased tumor size has a negative correlation with ultimate ABI performance. There were patients in this study with larger tumor sizes who still benefited from ABI placement. While larger tumor size should not be a contraindication for ABI placement, understanding the role tumor size can have on performance variation can serve to improve tumor management strategies and preoperative counselling.

OBJECTIVES/UNASSIGNED:To develop and study a novel means of imaging auditory brainstem implant (ABI) paddle placement utilizing postoperative MRI images to determine correlation between ABI performance and ideal paddle placement properties. DESIGN/UNASSIGNED:Single-center retrospective review and image analysis. SETTING/UNASSIGNED:Tertiary referral center. PARTICIPANTS/UNASSIGNED:Patients >18 years old who received an ABI from 2009 to 2023 and had subsequent MRI and auditory performance testing completed. MAIN OUTCOME MEASURES/UNASSIGNED:ABI paddle angulation and insertion depth measure, in addition to categories of auditory performance (CAP) score. RESULTS/UNASSIGNED: = 0.049) once patients with large tumor burden were excluded. Insertion depth and axial angulation showed a negative correlation, in which higher insertion depth was associated with a decrease in axial angulation value, although not statistically significant. CONCLUSION/UNASSIGNED:We present a novel means of measuring ABI paddle placement utilizing MRI to improve the objectivity of paddle placements assessments. Multicenter collaboration to increase the number of patients studied with this new measurement scheme will be required before stronger measurement associations can be determined.

OBJECTIVE:To describe a novel surgical technique utilizing the placement of an apical ground electrode to facilitate intracochlear current modulation in patients with cochlear ossification and incomplete electrode array insertion. PATIENTS/METHODS:Patients with incomplete standard electrode array insertion due to cochlear ossification. INTERVENTION/METHODS:Standard cochlear implant (CI) electrode array insertion, in addition to the placement of the extracochlear ground electrode into the cochlear apex to enable current steering through areas of cochlear ossification and towards the cochlear apex. MAIN OUTCOME MEASURES/METHODS:Procedural safety and patient-reported perceptual differences between programming configurations utilizing the apical ground. RESULTS:Placement of an apical ground electrode was safe and feasible in 3 patients with complex ossified cochlea and was able to augment sound perception, and improve performance, after adjustments to device programming. CONCLUSIONS:Apical ground electrode placement represents a technically achievable adjunct in selected patients with ossified cochlea and incomplete electrode array insertion. This approach may expand the functional stimulation field utilizing intracochlear current modulation to improve patient performance.

OBJECTIVE:We sought to apply a previously developed transimpedance (TIM) heatmap pattern classification scheme in patients with no known risk factors for cochlear anomalies, in addition to patients implanted in the revision setting, to better understand the incidence of pattern variants, and potential clinical implications. STUDY DESIGN/METHODS:Single-center retrospective review. SETTING/METHODS:Tertiary referral centre. PATIENTS/METHODS:Patients older than 6 months of age who underwent cochlear implantation between June 2020 and June 2024 with normal gross cochlear anatomy and no concern for fibrosis that had intraoperative TIM testing completed. Patients undergoing revision implantation were also included as a separate cohort. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURES/METHODS:The number of patients with normal and variant TIM patterns was evaluated for each cohort. TIM patterns were subsequently compared with the electrode position found on intraoperative x-ray. RESULTS:There were 321 ears that underwent implantation and subsequent intraoperative TIM assessment meeting inclusion criteria. Of these, 310 (96.6%) were in the primary surgery setting, and 11 (3.4%) were in the revision surgical setting. In the primary surgical setting, 86.4% (n=268) of the implants demonstrated a normal TIM heatmap. Compared with the primary surgical setting, where only 45.5% (n=5) of revision surgery TIM heatmaps were interpreted as normal. One patient in the revision setting had a newly identified "double X" pattern corresponding to a normal electrode position on x-ray. CONCLUSIONS:There is a decreased incidence of previously developed TIM heatmap pattern variants in CI recipients with normal gross cochlear anatomy.

UNLABELLED:<p>Introduction: Cochlear implantation has demonstrated benefit for restoring hearing in patients with Ménière's disease. We sought to examine disease and management factors that may influence postoperative speech performance and vertigo control. METHODS:A single-center retrospective chart review between 2010 and 2023 of patients with Ménière's disease receiving a cochlear implant (CI). The primary outcome was 1-year postoperative word recognition score on Consonant-Nucleus-Consonant (CNC) testing. Postoperative vertigo control was assessed as a secondary outcome. Variables including concurrent labyrinthectomy, pre- and postoperative Ménière's disease symptoms and treatments, duration of deafness, and hearing loss laterality were analyzed. RESULTS:Twenty-five patients were identified over the study period. Of those, 9 (36%) also underwent labyrinthectomy; 6 (67%) were performed simultaneously with CI and 3 (33%) received a CI following surgical ablation. There was a statistically significant (p = 0.03) higher rate of bilateral Ménière's disease in the CI-only cohort (n = 9, 56%), compared to the cochlear implant and labyrinthectomy (CI + L) cohort (n = 1, 11%). There was also a higher rate of preoperative uncontrolled vertigo (n = 5, 56%) in the CI + L cohort compared to the CI-only cohort (n = 3, 20%), although this did not reach statistical significance (p = 0.08). The average pre- and postoperative CNC score for the CI + L cohort was 3.6 (SD 5.9) and 36.7 (SD 17.5), respectively, and 7.1 (SD 10.1) and 62.1 (SD 14.3) for the CI-only group. There was a statistically significant difference noted at most recent CNC follow-up testing (p = 0.01) between the CI + L and CI-only group. CONCLUSION/CONCLUSIONS:Patients with Ménière's disease meeting CI candidacy criteria may undergo CI safely and achieve speech performance benefit. A trend toward worse performance in patients who undergo concurrent labyrinthectomy with CI compared to CI alone was seen which warrants further study. </p>.

OBJECTIVE:To better understand the distance relationship of the stapes to the round window, to assist in intraoperative round window identification. STUDY DESIGN/METHODS:Retrospective review of CT temporal bone imaging and multiplanar image reformat analysis. SETTING/METHODS:Tertiary referral center. PATIENTS/METHODS:Patients above 18 years of age who underwent cochlear implantation between January 2020 and April 2025 and had preoperative computed tomography (CT) imaging of the temporal bone. Patients were excluded if they had prior surgical procedures that could distort the stapes superstructure (eg, stapedectomy) or if image quality/resolution precluded adequate visualization of the stapes crus. INTERVENTION/METHODS:None. MAIN OUTCOME MEASURE/METHODS:Prediction accuracy of the stapes intercrural width to locate the level of the round window. RESULTS:There were 102 ears that were studied, including 51 (50%) left and 51 (50%) right ears. The average measured intercrural width was 2.1 mm (SD: 0.17 mm). The maximum intercrural distance was found to be 2.6 mm, and the minimum distance was 1.7 mm. In all 102 (100%) ears, the intercrural distance of the stapes accurately predicted the level of the RW on image analysis. CONCLUSION/CONCLUSIONS:The stapes intercrural width can be utilized as an accurate predictor of the round window level and is a simple and intuitive intraoperative tool surgeons can utilize to safely gain access to the cochlea.

OBJECTIVE/UNASSIGNED:We sought to consolidate the anatomical findings from radiologic research and prior surgical literature to develop a stepwise surgical approach utilizing cadaveric specimens which can serve to improve the accuracy and scalability of surgical apical cochleostomies in the future. METHODS/UNASSIGNED:Cadaveric temporal bone dissections, with subsequent image documentation and distance measurements to confirm surgical accuracy. RESULTS/UNASSIGNED:All four temporal bones (100%) that were drilled utilizing the newly developed surgical approach had an accurately placed apical cochleostomy. No inadvertent entry into the middle turn of the cochlea occurred. There was no violation of the labyrinthine facial nerve, or carotid artery. CONCLUSIONS/UNASSIGNED:Preliminary findings are promising for the described steps to achieve a substantial improvement in apical cochleostomy accuracy, with reduced trauma compared to historically taught techniques.

OBJECTIVE:Observe if metal artifact reduction (MAR) techniques applied to magnetic resonance imaging (MRI) performed on patients with cochlear implants (CI) or auditory brainstem implants (ABI) improves image quality. STUDY DESIGN/METHODS:Retrospective review. SETTING/METHODS:Tertiary care center. PATIENTS/METHODS:Patients with auditory implants who underwent clinical MRI before and after the application of MAR techniques previously described. INTERVENTIONS/METHODS:From September 2022 to March 2023, patients who underwent brain or internal auditory canal (IAC) MRI with and without MAR were identified. Sequences included T1 and T2 weighted with turbo-spin-echo (TSE) correction and fluid-attenuation inversion recovery (FLAIR). Images were analyzed for visualization of intracranial structures by two neuroradiologists. MAIN OUTCOME MEASURES/METHODS:Visibility of 14 structures graded on a four-point Likert scale. Average scores per structure and sequence were compared using paired two-tailed t-tests and change in mode score. RESULTS:Ten patients underwent pre- and post-MAR MRI. Six had a unilateral CI, three had a unilateral ABI, and one had an ABI and CI. Three patients had four devices with the internal magnet removed for both scans. All structures had significantly improved visibility on post-MAR scan except ipsilateral parietal and occipital lobes and contralateral inner ear. Mode score increased from 2 to 4 for the ipsilateral occipital lobe and from 3 to 4 for the ipsilateral semicircular canals, brainstem, and cerebellar peduncles. Significant improvement was seen in all sequences except for ipsilateral structures on T1w axial precontrast and contralateral structures on T1w coronal postcontrast. ABIs did not improve as much as CIs because they scored better on the pre-MAR scan. CONCLUSIONS:MAR techniques improve image quality for patients with MRI-compatible implants with magnets. Benefits may be more evident in CIs than ABIs.