Audiologic Outcomes of Cochlear Implantation in Inner Ear Malformations: A Comparative Analysis of Lateral Wall
and Perimodiolar Electrode ArraysNofrat Schwartz MD, Kevin D. Brown MD, PhD, Lisa R. Park AuD, CCC-ADepartment of Otolaryngology – Head and Neck Surgery and Neurosurgery
University of North Carolina School of Medicine
Disclosure
• Kevin Brown- Advisory board Med-El
• Lisa Park – Grant funded by Med- El
Dhanasingh A, et al 2019.
Cochlear Implantation in Inner Ear Malformations
• Cochlear implantation in children with inner ear malformations was found to be beneficial.
• The impact of the severity of the bony cochlear malformation on performance is controversial:
• Eisenman et al (2001): all malformations ultimately perform as well as their matched counterparts with normal cochlea
• Buchman et al (2004) and Farhood et al (2017): the various types of inner ear malformations have quite different prognosis for good auditory performance
Study Design
• Retrospective • Inclusion criteria:
• Children with inner ear malformations and implanted with a cochlear implant in our institute in the last 10 years .
• Recorded open set speech perception scores (CNC word scores) with at least one year of experience with their implant.
• Exclusion criteria: • Less than 1 year of listening experience with the cochlear implant• Children with additional disabilities that preclude spoken language
development • Suspected cochlear nerve deficiency.
Results• 109 ears with inner ear malformations fulfilled criteria.
• 46 ears were diagnosed with cochlear malformations• 6 hypoplastic cochlea• 7 IP-1 • 31 IP-2• 2 IP-3
• 50 Enlarged vestibular aqueduct• 13 Dysplatic vestibular system
hypoplastic IP-1 IP-2 IP-3
Dhanasingh A, et al 2019.
L. Sennaroğlu. 2016L. Sennaroğlu, Saatci I. 2002
Speech perception in different cochlear malformations
• IP2 malformations have the highest auditory performance after cochlear implantation (P=0.0058)
• IP1 and IP3 malformations, while gaining benefit from cochlear implantation, have significantly poorer auditory performance:
• IP1 vs IP2 - 54 vs 72 (P = 0.0046) • IP3 vs IP2 - 41 vs 72 (P = 0.0007)
CNC score in different cochlear malformation
Cochlear malformation type
CN
C s
core
hypoplas
tic IP1 IP2 IP30
20
40
60
80
100
Lateral Wall Vs PerimodiolarWhen choosing electrode…• Electrode length and cochlear
coverage • Atraumaticity of insertion• Fully banded or hemi-banded
electrodes• Suitability for round window or
cochleostomy insertion
Patient CharacteristicsLateral Wall electrode Perimodiolar Electrode
Total number 26 20Type of cochlear malformation: Hypoplastic
3 3
IP1 7 0IP2 14 17IP3 2 0
Average age of implantation 5.8 7.84Bilateral Malformation 96% 100%Full Insertion 73% 95%Gusher 34.6% 35%
Speech Perception Outcome • No statistical significance outcome difference when comparing
electrode type (P = 0.09).
IP2
CNC
wor
d sc
ore%
Lateral
Wall
Perimodiolar
0
20
40
60
80
100
Conclusion• Cochlear implantation is beneficial for
cochlear malformations• IP2, the most prevalent cochlear
malformation, demonstrates the best auditory outcomes, and reaches those similar to normal cochlea.
• No statistical significance difference in outcome when comparing electrode type.
UNC Cochlear Implant TeamPhysicians• Kevin Brown, MD, PhD• Matthew Dedmon, MD, PhD• Lauren Kilpatrick, MD• Brendan O’Connell, MD• Harold Pillsbury, MD• Carlton Zdanski, MD
Adult Audiologists• English King, AuD• Andrea Bucker, AuD• Ellen Deres, AuD• Sarah McCarthy, AuD• Kristen Quinones, AuD• Allison Young, AuD
Research• Emily Buss, PhD• Margaret Dillon, AuD• Douglas Fitzpatrick, PhD• John Grose, PhD• Lisa Park, AuD• Meredith Rooth, AuD
NIH T-32 Research Fellow• Michael Canfarotta, MD
Research Assistants• Kaylene King, BA• Margaret Richter, BA
Pediatric Audiologists• Elizabeth Preston, AuD• Melissa Auchter, AuD• Erika Gagnon, AuD• Jennifer Woodard, AuD
Speech-Language Pathologists• Hannah Eskridge, MSP• Maegan Evans, PhD• Sandra Hancock, MS• Lillian Henderson, MSP• Christine Kramer, MS• Erin Thompson, MS
Neurotology Fellow• Nofrat Schwartz, MD
Thank you
16th International Conference on Cochlear Implants and Other Implantable Technologies
March 18-21, 2020
www.ci2020orlando.org#CI2020International