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Cochlear Implants: What’s New? Cochlear Implants: What’s New?

Cochlear Implants: What’s New? - PowerPoint Presentation

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Cochlear Implants: What’s New? - PPT Presentation

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

hearing cochlear otol neurotol cochlear hearing neurotol otol amp implants 2014 med steroid mri implant meta pre operative imaging

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Presentation Transcript

Slide1

Cochlear Implants: What’s New?

Kyle Allen MD, MPHTampa Bay Hearing and Balance CenterNovember 9, 2018Florida Combined Otolaryngology Meeting

Slide2

Disclosures

Med El Surgical Advisory BoardAdvanced BionicsConsultantResearch AgreementWill discuss off-label use of cochlear implants

Slide3

Cochlear Implants

Revolutionized treatment of severe-profound hearing lossAs of 2015United States Recipients58,000 Adults38,000 Children

Slide4

Cochlear 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

Slide5

Kitchen Table Test

Unable to follow the conversation with eyes closed

Slide6

Pre-Operative Imaging

May not be required in all casesPresbycusisCT vs MRI

Slide7

Pre-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

Slide8

Pre-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

Slide9

Anterior Sigmoid Sinus

Slide10

Retrofacial Approach to Round Window

Slide11

Cochlear 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

Slide12

Cochlear 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

Slide13

Electroacoustic Stimulation

Available from all manufacturersAdvantagesImproved speech discrimination in noiseImproved music appreciationImproved quality of sound

Slide14

Structure Preservation

Electrode Design“Soft” surgeryPerioperative medications

Slide15

Trends in Electrode Design

Focus on structure preservationSlimmerIncreased flexibilityDesigned for reduced traumaAvoidance of scalar translocation

Slide16

Soft 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

Slide17

Steroid 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

Slide18

Steroids

PerioperativeSanta Maria 2014 Meta-analysisNo benefit of post-op steroidsTampa Bay Hearing and Balance CenterEvaluatedInsertion technique

Intraoperative steroid application

Electrode type

Perioperative steroid

Slide19

Steroids

Intraoperative SteroidsNo benefit per meta-analysisPre-incision intratympanic injectionIntravenous steroidMinimal benefitTopical steroid (preservation at 2 kHz)

Slide20

MRI Compatibility

All Devices now MRI ConditionalCochlear CorpMagnet in place1.5TRequires headwrapMagnet removed

3T

Slide21

Newer Magnet Technology

Med ElSynchronyMagnet rotates within housing3T MRI headwrap optionalHead position restriction

Advanced Bionics

3D

4 rotatable magnet rods

Magnet realigns in 3 planes

Slide22

Hearing 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

Slide23

Rechargeable Batteries

Available in all 3 companies

Slide24

Single Unit Processors

Cochlear KansoDirectional microphonesBluetooth capabilitiesMed El Rondo

Slide25

Hearing 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”

Slide26

Thank you!