Kyle Allen MD MPH Tampa Bay Hearing and Balance Center November 9 2018 Florida Combined Otolaryngology Meeting Disclosures Med El Surgical Advisory Board Advanced Bionics Consultant Research Agreement ID: 795729
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Slide1
Cochlear Implants: What’s New?
Kyle Allen MD, MPHTampa Bay Hearing and Balance CenterNovember 9, 2018Florida Combined Otolaryngology Meeting
Slide2Disclosures
Med El Surgical Advisory BoardAdvanced BionicsConsultantResearch AgreementWill discuss off-label use of cochlear implants
Slide3Cochlear Implants
Revolutionized treatment of severe-profound hearing lossAs of 2015United States Recipients58,000 Adults38,000 Children
Slide4Cochlear Implant Candidacy
Open-set sentence recognition (best-aided condition)FDA<60%Medicare<40%78% of cochlear implant surgeons implant off-label
Carlson et al. Otology & Neurotology: Jan 2018
Slide5Kitchen Table Test
Unable to follow the conversation with eyes closed
Slide6Pre-Operative Imaging
May not be required in all casesPresbycusisCT vs MRI
Slide7Pre-operative Imaging
CTAdvantagesDetailed view of osseous anatomyMay identify unexpected findings5% result in change in management (Gaskell et al. 2018, Otol
Neurotol
)
Disadvantages
Does not detect early labyrinthitis ossificans
Poor visualization of cochlear nerve
Radiation exposure
Slide8Pre-Operative Imaging
MRIAdvantagesExcellent visualization of cochlear nerves and cochlear anatomyEarly detection of labyrinthitis ossificansAble to assess presence of vestibular schwannoma
9% abnormal findings (2% vestibular schwannoma)
(Jiang et al.
Otol
Neurotol
2014)
Disadvantages
Poor representation of osseous anatomyExpensive
Slide9Anterior Sigmoid Sinus
Slide10Retrofacial Approach to Round Window
Slide11Cochlear Implants in Single-Sided Deafness
Currently not FDA approved in the United StatesHowever, unilaterally worse implantees have existed for yearsBimodal usersApproved options only address head-shadow effect
Slide12Cochlear Implants in Single-Sided Deafness
Cochlear implants can:Reduce tinnitusImprove localizationImprove hearing in noiseModest results
Doge et al. 2017.
Otol
&
Neurotol
Systematic review demonstrated tinnitus reduction in all included studies (10)
-van
Zon
et al. 2015.
Otol
&
Neurotol
Doge et al. 2017.
Otol
&
Neurotol
Slide13Electroacoustic Stimulation
Available from all manufacturersAdvantagesImproved speech discrimination in noiseImproved music appreciationImproved quality of sound
Slide14Structure Preservation
Electrode Design“Soft” surgeryPerioperative medications
Slide15Trends in Electrode Design
Focus on structure preservationSlimmerIncreased flexibilityDesigned for reduced traumaAvoidance of scalar translocation
Slide16Soft Surgery
Surgical techniques to reduce cochlear trauma
Slow insertion
Round window vs cochleostomy
Dramatic hearing differences are not demonstrated
Richard et al. 2012
Otol
&
Neurotol
.
Supported by 2014 meta-analysis
Santa Maria et al. 2014
Otol
&
Neurotol
Slide17Steroid Administration
Perioperative SteroidsAnimal studies demonstrate less fibrosisPre-opImproved spiral ganglion preservation
Post-op
Decreased fibrosis with 7 day course
Smaller threshold shift
Chang et al. 2017
Otol
&
Neurotol
Kuthbutheen et al. 2015 Hear Res
1 week
4 weeks
12 weeks
Slide18Steroids
PerioperativeSanta Maria 2014 Meta-analysisNo benefit of post-op steroidsTampa Bay Hearing and Balance CenterEvaluatedInsertion technique
Intraoperative steroid application
Electrode type
Perioperative steroid
Slide19Steroids
Intraoperative SteroidsNo benefit per meta-analysisPre-incision intratympanic injectionIntravenous steroidMinimal benefitTopical steroid (preservation at 2 kHz)
Slide20MRI Compatibility
All Devices now MRI ConditionalCochlear CorpMagnet in place1.5TRequires headwrapMagnet removed
3T
Slide21Newer Magnet Technology
Med ElSynchronyMagnet rotates within housing3T MRI headwrap optionalHead position restriction
Advanced Bionics
3D
4 rotatable magnet rods
Magnet realigns in 3 planes
Slide22Hearing Aid Compatibility
Cochlear Resound Hearing AidsNo intervening deviceAdvanced BionicsPhonak Hearing AidsNo intervening Device
Med El
Interfaces with any telecoil hearing aid
Requires Quatro loop
Roger Pen
Slide23Rechargeable Batteries
Available in all 3 companies
Slide24Single Unit Processors
Cochlear KansoDirectional microphonesBluetooth capabilitiesMed El Rondo
Slide25Hearing in Noise
Med ElLow frequency stimulation“Fine structure preservation”Advanced BionicsMultiple microphone architecture“Clear Voice”/”Ultrazoom”
Cochlear
“Smart Sound
iQ
” – Auto scene analysis
“Forward focus”
Slide26Thank you!