Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations
Abstract
:1. Introduction
2. Materials and Methods
- (a)
- Relevant history, including demographic characteristics and the time-course of symptoms that led to RCI (specifically the duration between Pri-CI and symptoms onset as well as between symptoms onset and RCI).
- (b)
- Reports of medical follow-up and surgical procedures, including imaging [computed tomography (CT), magnetic resonance imaging (MRI) or plain film Stenver’s view].
- (c)
- RCI indication. A comprehensive case-by-case review by a panel of two senior audiologists and two neurotologists was performed to determine the following RCI indications: (a) Device-related indications—Soft failure was defined according to the 2005 consensus guidelines [13] and included cases with decreased or unexpected poor performance, non-auditory aversive symptoms, and intermittent function. In all of the soft failure cases, medical, imaging, programing, and hardware issues have been ruled out. Hard failure was determined according to the absence of communication between the internal and external hardware. (b) Non-device-related indications—Medical failure included cases with suspected biofilm infection, allergic response, neuralgia and chronic middle ear condition. Patients with severe congenital inner ear malformations (i.e., common cavity, hypoplastic nerve, others) were included in the medical indication group as well. Following a thorough case-by-case review, our assumption was that these patients’ medical status (reflected in severe inner ear anomalies) was the main reason for the symptoms (i.e., poor speech perception, extracochlear manifestations) that ultimately led to reimplantation. Surgical failure included malposition or inadequate electrode insertion, electrode migration or protrusion, and device extrusion. Trauma included implants that failed immediately after an event of head trauma.
- (d)
- Speech perception was evaluated by means of an open-set monosyllabic word recognition test [Hebrew Arthur Boothroyd [24]; HAB] scored for correct words and phonemes. When the HAB test could not be administered due to young age, poor cognitive-linguistic skills or limited speech perception ability, speech reception threshold (SRT) was used. Both tests were administered in a quiet listening condition. First, we compared between speech perception scores measured before RCI (i.e., most recent measurement prior to appearance of symptoms), to those obtained 6 months or more after RCI. The difference score was calculated and subsequently the performance in each case was classified as unchanged, declined, or improved. The clinically significant criterion was defined as a change of >10% in HAB phoneme scores. Phoneme score, rather than word score, was selected as it was found to be less dependent on linguistic abilities, showed reduced variability and was therefore considered a more valid measure [25,26,27]. Analysis of HAB results of 90 adult CI recipients from our CI program (not included in the current study) revealed that between-lists phoneme score variability did not exceed 10%. Accordingly, the selected criterion for post RCI change was set to >10%. When phoneme scores were unobtainable, a change of ≥10 dB in SRT was used.
3. Results
3.1. Demographics, RCI Rates and Time-Course
3.2. RCI Indications
3.3. Audiologic Outcomes
3.4. Surgical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total | Children | Adults | |
---|---|---|---|
Number of (%) | |||
RCIs | 172 | 134 (76%) | 38 (24%) |
patients | 145 | 115 (79%) | 30 (21%) |
Gender (% †) | |||
female | 69 (48%) | 50 (43.5%) | 19 (63%) |
male | 76 (52%) | 65 (56.5%) | 11 (37%) |
Side (% ‡) | |||
right | 80 (46.5%) | 56 (42%) | 24 (63%) |
left | 92 (53.5%) | 78 (58%) | 14 (37%) |
Age at primary CI (years) | |||
M ± SD | 12.5 ± 16.9 | 4.7 ± 3.8 | 39.9 ± 16.6 |
median (range) | 4.5 (9 months-76.8) | 3.3 (9 months-17.8) | 34.7 (18.5–76.8) |
Approach of primary CI (% ‡) | |||
SMA | 115 (67%) | 89 (66.4%) | 26 (68.4%) |
PTA | 57 (33%) | 45 (33.6%) | 12 (32.6%) |
Hearing loss etiology (% †) | |||
Genetic | 57 (39.3%) | 53 (46.1%) | 4 (13.3%) |
unknown | 48 (33.1%) | 35 (30.4%) | 13 (43.3%) |
inner ear malformation | 10 (6.9%) | 8 (7%) | 2 (6.7%) |
intrauterine infection | 8 (7%) | 1 (3.3%) | |
neonatal complication | 7 (4.8%) | 6 (5.2%) | 1 (3.3%) |
meningitis | 3 (2.1%) | 3 (2.6%) | 0 (0%) |
other | 11 (7.6%) | 2 (1.7%) | 9 (30%) |
Time-Course (Months) | Total | Children | Adults | Statistical Analysis Mann–Whitney Test |
---|---|---|---|---|
Pri-CI to RCI | ||||
M ± SD | 80 ± 70.5 | 80 ± 65.4 | 83 ± 86.8 | U(172) = 2396 p-value = 0.58 |
range | 1–248 | 0.5–346 | ||
Pri-CI to onset of symptoms | ||||
M ± SD | 54 ± 62.1 | 56.5 ± 60.2 | 45 ± 68.2 | U(170) = 1923 p-value = 0.03 * effect size r = −0.17 |
range | 0–219 | 0–285 | ||
Onset of symptoms to RCI | ||||
M ± SD | 26 ± 40.7 | 23.5 ± 35.8 | 38 ± 53.7 | U(170) = 2000 p-value = 0.06 |
range | 0.5–240 | 0.5–234 |
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Sagiv, D.; Yaar-Soffer, Y.; Yakir, Z.; Henkin, Y.; Shapira, Y. Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations. J. Clin. Med. 2021, 10, 3215. https://doi.org/10.3390/jcm10153215
Sagiv D, Yaar-Soffer Y, Yakir Z, Henkin Y, Shapira Y. Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations. Journal of Clinical Medicine. 2021; 10(15):3215. https://doi.org/10.3390/jcm10153215
Chicago/Turabian StyleSagiv, Doron, Yifat Yaar-Soffer, Ziva Yakir, Yael Henkin, and Yisgav Shapira. 2021. "Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations" Journal of Clinical Medicine 10, no. 15: 3215. https://doi.org/10.3390/jcm10153215