Indications and outcomes of cochlear implant reimplantation surgery for legacy internal devices

Transcription

1 Indications and outcomes of cochlear implant reimplantation surgery for legacy internal devices Meredith A. Holcomb, AuD Clinical Director CI Program, Assistant Professor

2 Authors Meredith Holcomb, AuD Jane Burton, AuD Elizabeth Camposeo, AuD Ted Meyer, MD, PhD Ted McRackan, MD

3 Disclosures Meredith Holcomb Advanced Bionics - Consultant: Audiology Advisory Council Cochlear Americas - Consultant Institute for Cochlear Implant Training - Consultant: Instructor American Cochlear Implant Alliance - Board of Directors Ted McRackan K12 award through the South Carolina Clinical & Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina (NIH/ NCATS UL1TR001450) Doris Duke Foundation.

4 Introduction Cochlear Implant Reimplantation (CIR) surgery Surgical and medical complications are minimal 1 Audiological outcomes are generally very good 1-7 Previous authors acknowledge technological upgrade as a possible reason for CIR 2-4 Patients will require variable time to adapt to their new device and achieve these stable or improved scores 8

5 Introduction AB Clarion 1.2 internal device External processor compatibility: ü Harmony ü PSP X Naida X Neptune Differences: Microphone technology Signal processing Current steering Battery life Waterproof ability Accessories MRI compatibility

6 Objective To determine indications, surgical efficacy, and audiologic outcomes of cochlear implant reimplantation for individuals with Advanced Bionics Clarion C1.2 internal devices, including those reimplanted as a means of technology upgrade.

7 Study Design, Subjects, Methods Study Design: Retrospective review and pre- vs. post- intervention analysis of patients initially implanted with AB C1.2 internal device and reimplanted with AB HiRes90k Advantage HiFocus Mid Scala internal device. Subjects: Seven patients (7 ears) 5 females, 2 males Mean age of first CI = 3.8 years (range: ) Mean age at reimplantation = 18.8 years (range: ) Methods: Demographic data and pre- and post- cochlear implant reimplantation speech perception scores were collected.

8 Results - Primary motivation for CIR: technology upgrade (6/7), soft failure (1/7) - No surgical complications reported - Full insertion (6/7), two electrodes extra-cochlear (1/7) - Speech perception improvements post-cir: - Words - Phonemes - Sentences in noise - Due to the small sample size no significant differences were found (all p>0.05)

9 Mean Speech Recognition Scores Pre- and Post-CIR 100% 80% Percent Correct Score 60% 40% Pre Post 20% 0% CNC Words CNC Phonemes HINT Q AzBio Q AzBio +10SNR

10 CNC Words Pre- and Post-CIR Percent Correct 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CNC Words Subject # Pre Post

11 CNC Phonemes Pre- and Post- CIR Percent Correct 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CNC Phonemes Subject # Pre Post

12 HINT/AzBio Sentences Quiet Pre- and Post-CIR 100% 90% 80% HINT/AzBio Quiet Percent Correct 70% 60% 50% 40% 30% 20% 10% 0% Subject # Pre Post

13 AzBio +10 Pre- and Post-CIR Percent Correct 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% AzBio Subject # Pre Post

14 Conclusions Post-CI reimplantation audiological benefit was stable or improved compared to pre-ci reimplantation performance in all patients. Patients with AB CI.2 internal devices should be considered for reimplantation to optimize their overall performance with a cochlear implant. Patient should be counseled cautiously.

15 References 1. Donatelli Lassig, A. Zwolan, T. A., & Telian, S. A. (2005). Cochlear implant failures and revision. Otol Neurotol, 26, Cullen, R. D., Fayad, J. N., Luxford, W. M., & Buchman, C. A. (2008). Revision cochlear implant surgery in children. Otol Neurotol, 29, Sterkers, F., Merklen, F., Piron, J. P., Vieu, A., Venail, F., Uziel, A., & Mondain, M. (2015). Outcomes after cochlear reimplantation in children. Int J Pediatr Otorhinolaryngol, 79, Blanchard, M., Thierry, B., Glynn, F., De Lamaze, A., Garabedien, E. N., & Loundon, N. (2015). Cochlear implant failure and revision surgery in pediatric population. Annals of Otol, Rhinol, & Laryngol, 124(3), Marlowe, A. L., Chinnici, J. E., Rivas, A., Niparko, J. K., & Francis, H. W. (2010). Revision cochlear implant surgery in children: the Johns Hopkins experience. Otol Neurotol, 31(1), van der Marel, K. S., Briaire, J. J., Verbist, B. M., Joemai, R. M. S., Boermans, P. B. M., Peek, F. A. W., & Frijns, J. H. M. (2011). Cochlear reimplantation with same device: surgical and audiologic results. The Laryngoscope, 121, Sunde, J., Webb, J. B., Moore, P. C., Gluth, M. B., & Dornhoffer, J. L. (2013). Cochlear implant failure, revision, and reimplantation. Otol Neurotol, 34, Waltzman, S., Roland, J. T., Waltzman, M., Shapiro, W., Lalwani, A., Cohen, N. (2004). Cochlear reimplantation in children: soft signs, symptoms and results. Cochlear Implants International, 5(4),