Audiologic Outcomes of Cochlear Implantation in Inner Ear Malformations: A Comparative Analysis of Lateral Wall

and Perimodiolar Electrode ArraysNofrat Schwartz MD, Kevin D. Brown MD, PhD, Lisa R. Park AuD, CCC-ADepartment of Otolaryngology – Head and Neck Surgery and Neurosurgery

University of North Carolina School of Medicine

Disclosure

• Kevin Brown- Advisory board Med-El

• Lisa Park – Grant funded by Med- El

Dhanasingh A, et al 2019.

Cochlear Implantation in Inner Ear Malformations

• Cochlear implantation in children with inner ear malformations was found to be beneficial.

• The impact of the severity of the bony cochlear malformation on performance is controversial:

• Eisenman et al (2001): all malformations ultimately perform as well as their matched counterparts with normal cochlea

• Buchman et al (2004) and Farhood et al (2017): the various types of inner ear malformations have quite different prognosis for good auditory performance

Study Design

• Retrospective • Inclusion criteria:

• Children with inner ear malformations and implanted with a cochlear implant in our institute in the last 10 years .

• Recorded open set speech perception scores (CNC word scores) with at least one year of experience with their implant.

• Exclusion criteria: • Less than 1 year of listening experience with the cochlear implant• Children with additional disabilities that preclude spoken language

development • Suspected cochlear nerve deficiency.

Results• 109 ears with inner ear malformations fulfilled criteria.

• 46 ears were diagnosed with cochlear malformations• 6 hypoplastic cochlea• 7 IP-1 • 31 IP-2• 2 IP-3

• 50 Enlarged vestibular aqueduct• 13 Dysplatic vestibular system

hypoplastic IP-1 IP-2 IP-3

Dhanasingh A, et al 2019.

L. Sennaroğlu. 2016L. Sennaroğlu, Saatci I. 2002

Speech perception in different cochlear malformations

• IP2 malformations have the highest auditory performance after cochlear implantation (P=0.0058)

• IP1 and IP3 malformations, while gaining benefit from cochlear implantation, have significantly poorer auditory performance:

• IP1 vs IP2 - 54 vs 72 (P = 0.0046) • IP3 vs IP2 - 41 vs 72 (P = 0.0007)

CNC score in different cochlear malformation

Cochlear malformation type

CN

C s

core

hypoplas

tic IP1 IP2 IP30

20

40

60

80

100

Lateral Wall Vs PerimodiolarWhen choosing electrode…• Electrode length and cochlear

coverage • Atraumaticity of insertion• Fully banded or hemi-banded

electrodes• Suitability for round window or

cochleostomy insertion

Patient CharacteristicsLateral Wall electrode Perimodiolar Electrode

Total number 26 20Type of cochlear malformation: Hypoplastic

3 3

IP1 7 0IP2 14 17IP3 2 0

Average age of implantation 5.8 7.84Bilateral Malformation 96% 100%Full Insertion 73% 95%Gusher 34.6% 35%

Speech Perception Outcome • No statistical significance outcome difference when comparing

electrode type (P = 0.09).

IP2

CNC

wor

d sc

ore%

Lateral

Wall

Perimodiolar

0

20

40

60

80

100

Conclusion• Cochlear implantation is beneficial for

cochlear malformations• IP2, the most prevalent cochlear

malformation, demonstrates the best auditory outcomes, and reaches those similar to normal cochlea.

• No statistical significance difference in outcome when comparing electrode type.

UNC Cochlear Implant TeamPhysicians• Kevin Brown, MD, PhD• Matthew Dedmon, MD, PhD• Lauren Kilpatrick, MD• Brendan O’Connell, MD• Harold Pillsbury, MD• Carlton Zdanski, MD

Adult Audiologists• English King, AuD• Andrea Bucker, AuD• Ellen Deres, AuD• Sarah McCarthy, AuD• Kristen Quinones, AuD• Allison Young, AuD

Research• Emily Buss, PhD• Margaret Dillon, AuD• Douglas Fitzpatrick, PhD• John Grose, PhD• Lisa Park, AuD• Meredith Rooth, AuD

NIH T-32 Research Fellow• Michael Canfarotta, MD

Research Assistants• Kaylene King, BA• Margaret Richter, BA

Pediatric Audiologists• Elizabeth Preston, AuD• Melissa Auchter, AuD• Erika Gagnon, AuD• Jennifer Woodard, AuD

Speech-Language Pathologists• Hannah Eskridge, MSP• Maegan Evans, PhD• Sandra Hancock, MS• Lillian Henderson, MSP• Christine Kramer, MS• Erin Thompson, MS

Neurotology Fellow• Nofrat Schwartz, MD

Thank you

16th International Conference on Cochlear Implants and Other Implantable Technologies

March 18-21, 2020

www.ci2020orlando.org#CI2020International