Hearing Preservation and Speech Outcomes in Pediatric Recipients of Cochlear Implants

Transcription

1 Hearing Preservation and Speech Outcomes in Pediatric Recipients of Cochlear Implants A. Morgan Selleck, M.D. 1, Lisa Park AuD 1, Baishakhi Choudhury 2, Holly Teagle AuD 1, Jennifer Woodard AuD 1, Kevin D. Brown 1 1 Department of Otolaryngology Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina 2 Department of Otolaryngology Head and Neck Surgery, New York University, New York, New York

2 Disclaimer The authors have no disclosures. 2

3 Hearing Preservation 3

4 Hearing Preservation 4

5 Questions Reliable Preservation? 5

6 Questions Reliable Preservation? Factors influencing preservation? 6

7 Questions Reliable Preservation? Factors influencing preservation? Improved Outcomes? 7

8 Study Details Retrospective, age 2-17, minimum of 70 db LFPTA» Main Group = 105 subjects» Lateral Wall Subset = 45 subjects Surgical technique: posterior tympanotomy, round window or cochleostomy insertion Device: AB, Cochlear or Med-El 8

9 Outcome Measurements Multivariate logistic regression» Compared change in LF PTA to: Pre-operative LF PTA Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence or Absence of EVA 9

10 Outcome Measurements Multivariate logistic regression» Compared change in LF PTA to: Pre-operative LF PTA Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence or Absence of EVA Hearing Preservation Rate» 68% (71/105) 10

11 Multivariate Logistic Regression Variable P-value Preoperative low frequency pure tone average Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence/Absence of EVA

12 Multivariate Logistic Regression Variable P-value Preoperative low frequency pure tone average Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence/Absence of EVA

13 Multivariate Logistic Regression Variable P-value Preoperative low frequency pure tone average Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence/Absence of EVA

14 Multivariate Logistic Regression Variable P-value Preoperative low frequency pure tone average Time from Surgery Side (Right or Left) Progressive or Stable Hearing Loss Lateral wall or Perimodiolar Electrode Presence/Absence of EVA

15 Hearing Preservation Rates by Device Type 15

16 Hearing Preservation Rates by Device Type 16

17 LW Subset Patient Group 3/16/18 17

18 Hearing Preservation Rates in LW Subset HP rate with LFPTA <90 db HP rate with HL <80dB at 250 Hz 18

19 Depth of Insertion in LW Subset

20 LW Subset Acoustic Benefit - Word Scores CNC % CI CI + Hybrid/EAS 0 Pre-Op Time (months) 19.7 point improvement 20

21 LW Subset Acoustic Benefit - Sentences in Quiet BabyBio % CI CI + Hybrid/EAS point improvement Time (months) 21

22 LW Subset - Acoustic Benefit - Sentences in Noise BabyBio + 5dB% CI CI + Hybrid/EAS point improvement Time (months) 22

23 Key Points Consistent Hearing Preservation 23

24 Key Points Consistent Hearing Preservation Factors Influencing Preservation include: 24

25 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative low frequency hearing 25

26 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative low frequency hearing» Lateral wall electrodes 26

27 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative low frequency hearing» Lateral wall electrodes» EVA approached significance 27

28 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative low frequency hearing» Lateral wall electrodes» EVA approached significance» Progressive hearing loss substantial effect with 422/522 28

29 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative low frequency hearing» Lateral wall electrodes» EVA approached significance» Progressive hearing loss substantial effect with 422/522 High levels of preservation possible with longer electrodes 29

30 Key Points Consistent Hearing Preservation Factors Influencing Preservation include» Pre-operative residual hearing» Lateral wall electrodes» EVA approached significance» Progressive hearing loss substantial effect with 422/522 High levels of preservation possible with longer electrodes Improved speech perception outcomes with hybrid/eas 30

31 Thank you Electric-Acoustic Stimulation: Long-Term Outcomes