Long-term Hearing Preservation Outcomes after Cochlear Implantation for Electric-Acoustic Stimulation

Transcription

1 Long-term Hearing Preservation Outcomes after Cochlear Implantation for Electric-Acoustic Stimulation Youssef Adel, Silke Helbig, Tobias Weissgerber, Uwe Baumann University Hospital Frankfurt Audiological Acoustics Department of Otorhinolaryngology Head: Prof. Timo Stöver Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

2 Disclosure Sponsorship to attend CI 2016 by MED-EL Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

3 Introduction ski-slope hearing loss acoustic stimulation frequency [khz] hearing loss [db HL] HA CI electric stimulation Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

4 Introduction EAS benefit is established à Requirement: residual hearing! Electric-Acoustic Stimulation Reduced trauma using shorter, more flexible electrode arrays insertion angle hearing preservation (HP) cochlear coverage Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

5 Methods Electrode Arrays + STANDARD + MEDIUM Source: MED-EL, Innsbruck, Austria Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

6 Methods Patient Groups Group A Group B Focus Long-term HP outcomes Focus Effects of insertion angle Criteria Preoperative residual hearing Fulfilled indication of EAS Criteria Preoperative residual hearing No long-term deafness > 1 year CI/EAS experience Measures Pure-tone thresholds for freqs. 125, 250, 500 Hz (PTAlow) Freiburg monosyllable test score Measures Pure-tone thresholds for freqs. 125, 250, 500 Hz (PTAlow) Freiburg monosyllable test score Intervals pre-, post-op (up to 3 months) 12 months > 2 years (up to 11 years) Intervals pre-, post-op (up to 3 months) 6 months 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

7 Methods Patient Groups Group A n = 69 (75 ears) Group B n = 55 (58 ears) Count [n] Count [n] Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

8 Group A (Long-term) Frequency Frequenz [khz] 0,063 0,125 0,25 0,5 0,75 1 1, Hearing Hörverlust loss [db HL] HL] n = 75 pre-op n = 70 post-op n = months n = 40 >24 months = long-term Source: Helbig et al. 2016, in press Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

9 Group A: Total Hearing Loss Electrode carrier group 47.83% (n = 23) 9.62% (n = 52) Count [n] NB: Total hearing loss cases were excluded from further HP analysis. post-op 12 months long-term Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

10 Group A: PTAlow n = 38 *** * NB: Only complete data sets were included. Statistic: one-way ANOVA, Tukey s post-hoc test. pre-op post-op 12 months long-term Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

11 Group A: PTAlow n = 39 R 2 = weak correlation trend: 1.6 db / year NB: Only complete data sets were included. Time after implantation [months] Source: Helbig et al. 2016, in press Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

12 Group A: Monosyllable Test ipsilateral best-aided *** *** Freiburg monosyllable test score [% correct] NB: Only complete data sets were included. n = 32 Statistic: Student s t-test for paired samples. pre-op 12 months pre-op 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

13 Group B (Insertion Angle) Frequenz Frequency [khz] [khz] 0,063 0,125 0,25 0,5 0,75 1 1, Hörverlust [db HL] Hearing loss [db HL] n = 58 n = 30 n = 27 n = 28 pre-op post-op 6 months 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

14 Group B: Total Hearing Loss Electrode carriers 8,33% (n = 12) 43,48% (n = 46) Count [n] post-op 6 months 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

15 Group B: PTAlow n = 16 *** NB: Only complete data sets were included. Statistic: one-way ANOVA, Tukey s post-hoc test. pre-op post-op 6 months 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

16 Group B: PTAlow n = 14 n = 11 n = 11 n = 10 n = 13 n = 11 EAS user? No Yes 60 db HL as possible indication? NB: Only complete data sets were included. post-op 6 months 12 months Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

17 Group B: Insertion Angle n = 5 n = 7 n = 23 n = 23 insertion angle [ ] Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

18 Group B: PTAlow ~ Insertion Angle time interval post-op 6 months 12 months R² = insertion angle [ ] Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

19 Group B: Monosyllable Test ~ Insertion Angle Freiburg monosyllable test score [% correct] R² = R² = 0.24 slope: 14% per 100 EAS user? No Yes n = 47 n = 11 insertion angle [ ] Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

20 Conclusion Group A Long-term HP possible in a subset of patients with residual hearing when using shorter, more flexible electrode carriers Group B Patients with poor HP (using only CI) can benefit from deeper insertion à Shallow insertion preferred for potential EAS users 1.6 db shift / year? à Deeper insertion preferred when residual hearing is insufficient PTAlow at 60 db HL? There s a need to disentangle short-term and long-term CI effects on HP. Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA

21 Acknowledgments Tobias Weissgerber Silke Helbig Uwe Baumann Thank you for your attention! This work was supported by Rader und Baumann DGA-Tutorial Sonderversorgungen - Elektroakustische Stimulation DGA