Update on Cochlear Implantation

Educational Objectives

The goal of this program is to improve diagnosis and treatment of otologic disorders. After hearing and assimilating this program, the clinician will be better able to:

1. Select appropriate patients for implantation with hybrid cochlear implants.

Summary

Overview: 25% of individuals 65 to 74 yr of age and 50% of those >75 yr of age have disabling hearing loss; only 30% of patients with severe hearing loss treated; 1 million people in United States have severe to profound hearing loss but most do not receive cochlear implants (CIs); compared with earlier implantations, CIs now being placed in patients with more residual hearing; children currently may be implanted at 1 yr of age; bilateral CIs offer better hearing, perception of direction of sound, and quality of sound; Medicare criteria for CI include limited benefit from amplification (scoring ≤40% correct in best-aided condition); most centers use implantation criterion of ≤50% correct, with ≤60% correct in contralateral ear; AzBio sentence test more difficult than Hearing In Noise Test (HINT) and increases number of eligible patients; adding noise to test increases difficulty; placing CI compromises natural hearing, so procedure should be carefully considered if patient benefitting from hearing aid

Surgical management: preservation of hearing — current practices include “soft surgery” in which residual natural hearing at low frequencies preserved; technique — perilymph should not be suctioned; round window insertion preferred over cochleostomy; when cochleostomy required, endosteum should not be violated; implant inserted through small opening in endosteum without damaging cochlea; intraoperative steroids recommended; slowly inserting electrode helps to preserve low-frequency hearing and protect cochlea; hybrid implants — feature CI for high-frequency and hearing aid for low-frequency hearing; hybrid has shorter, more flexible electrodes that may be difficult to insert; patients with loss of low-frequency hearing may have good outcomes with shorter electrode, but long-term result unclear (hearing loss progressive in most patients); indication for hybrid implant good low-frequency hearing (≥60 dB) and poor high-frequency hearing

Other considerations: contralateral ear — hearing should be same or better than in implanted ear; magnetic resonance imaging (MRI) — magnet must be surgically removed before imaging patient with CI; modified magnet (MED-EL CI) compatible with MRI when magnet ≤3.0 T used; tinnitus — most, but not all, patients improve after CI; single-sided deafness — patients derive little benefit from implant

Readings

Nguyen S et al: Outcomes review of modern hearing preservation technique in cochlear implant. Auris Nasus Larynx 2016 Oct;43(5):485-8; Rah YC et al: Dizziness and vestibular function before and after cochlear implantation. Eur Arch Otorhinolaryngol 2016 Nov;273(11):3615-3621; Roemer A et al: Biohybrid cochlear implants in human neurosensory restoration. Stem Cell Res Ther 2016 Oct 7;7(1):148; Sladen DP et al: Early outcomes after cochlear implantation for adults and children with unilateral hearing loss. Laryngoscope 2016 Oct 12.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Bigelow was recorded at 2016 Annual Scientific Meeting, presented by Pennsylvania Academy of Otolaryngology — Head and Neck Surgery, and held June 17-18, 2016, in Bedford, PA. To learn about meetings of the Pennsylvania Academy of Otolaryngology — Head and Neck Surgery, please visit otopa.org. The Audio Digest Foundation thanks the speakers and the sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OT492403

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.