Speech Performance Following Intraoperative Correction of Cochlear Implant Electrode Array Tip Fold-Overs

Saturday, September 28, 2024

9:36 AM – 9:42 AM EDT

Location: MBCC, 231

Disclosure(s):

Miriam R. Smetak, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jordan J. Varghese, MD MSCI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Cameron C. Wick, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Craig A. Buchman, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pre-curved electrode arrays can be associated with an increased rate of tip fold-over, necessitating removal and reinsertion which may result in additional trauma. The degree to which an intraoperative correction of tip fold-over affects speech perception, outcomes, and hearing preservation has not been previously reported.

Methods: This was a retrospective review of CI recipients receiving a Slim Modiolar Electrode from 2016 to 2023. Demographics and operative details were recorded. Low-frequency pure tone average (LFPTA) was defined as the average of thresholds at 125, 250, and 500 Hz. Hearing preservation was defined as LFPTA < 60dB at activation. Consonant-nucleus-consonant (CNC) word recognition scores and AzBio scores both in quiet and in +10dB signal to noise ratio (SNR) were collected preoperatively and at 3 and 6 months postoperatively.

Results: From 663 CI recipients, there were 35 patients (5.3%) with intraoperative identification and correction of tip fold-over. There was no significant difference in 3-month CNC scores between those with fold-overs (44.9%, SD 20.9%) and those without (46.2%, SD 21%; p = 0.82). Similarly, there was no difference in AzBio in quiet (53.1%, SD 21.7% vs 60.8%, SD 28%; p = 0.30) or in AzBio +10dB SNR (19.1%, SD 23.7% vs 31.5%, SD 27.2%; p = 0.15). This remained consistent at 6 months for CNC scores (42.7%, SD 22.1% vs 52.7%, SD 24.8%; p = 0.22), AzBio in quiet (51.2%, SD 26.2% vs 59.5%, SD 24.7%, p= 0.35) and AzBio +10dB SNR (23.3%, SD 21.2% vs 36.7%, SD 26%; p = 0.21). Of 10 hearing preservation candidates that experienced tip fold-over, 5 (50%) had preserved hearing at activation.

Conclusions: Pre-curved electrode arrays have shown great promise in improving speech performance for CI recipients. While tip fold-over remains a clinical concern, speech performance does not appear to be negatively affected if the fold-over is identified and corrected.

Presenting Author(s)

Miriam R. Smetak, MD

Fellow, Otology, Neurotology & Lateral Skull Base Surgery
Washington University in St Louis
Saint Louis, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Matthew A. Shew, MD

Assistant Professor
Washington University in St. Louis
St. Louis, MO, United States

Disclosure information not submitted.
Jordan J. Varghese, MD

Resident Physician & Post-Doctoral Fellow
Washington University in St. Louis
Saint Louis, Missouri, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Cameron C. Wick, MD

Associate Professor
Washington University
St. Louis, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Nedim Durakovic, MD

Assistant Professor
Washington University in St. Louis
Saint Louis, MO, United States

Disclosure information not submitted.
Craig A. Buchman, MD

Lindburg Professor and Head, Otolaryngology - Head & Neck Surgery
Washington University in St. Louis
St. Louis, MO, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

JH

Jacques A. Herzog, MD

Chief Division of Otology and Neurotology, Professor
Washington University School of Medicine
Creve Couer, MO, United States

Disclosure information not submitted.