Search

Objectives: Traditional first-time activation of the cochlear implant (CI) remained the same throughout the years without empirical evidence for the time required after surgery. First activation usually takes place 2-6 weeks after the CI surgery (ASHA, 2015; FDA, 2017). In our early fitting (EF) studies, we evaluated: the effect of EF on the healing process of the wound, the effect of EF on the evolution of electrical stimulation, the difference between EF vs traditional fitting and how early can we get. Material and methods: Participants:100 patients fitted on the next day of surgery and 100 patients fitted 3-4 weeks post CI. 9 patient with 11 implants also received same-day fitting following surgery under local anesthesia to evaluate the feasibility of same-day fitting. All implanted with standard MED-EL Concerto. For comparison, electrode impedance telemetry (EIT), MCL and THR were obtained for both groups of patients: On day of surgery, four weeks post-op, 6 months post-op and 1 year post-op. For same-day fitting, a comparison was made between EIT, MCL and THR during same-day fitting, the next day fitting, one week after and 6-weeks after. Results: -A significant difference between early fitting and late fitting for Thresholds was found for E1, E2, E3 and E4 (all p<0.001) at 1-year testing -No statistically significant differences between early fitting and late fitting were found for impedances at all tested intervals. -No statistically significant differences between early fitting and late fitting were found for MCLs at 1-year testing. -Statistically significant difference between same-day and second day and between second day and 1 week post-op for THR levels in the apical and basal regions. Conclusion: -Next day fitting feasible and has no adverse effects. -Same day fitting must be followed by next day fitting. -Early stimulation might hinder fibrosis formation within the cochlea [ABSTRACT FROM AUTHOR]

Objective : "Electrode migration is an underrecognized complication of cochlear implant (CI) surgery." Connell et al. (2008).Rader et al. (2016) examined electrode migration and suggested a flowchart for clinical management of suspected electrode migration where the investigation would start after loss of sound-quality or decreased speech perception despite not finding a significant change in speech perception scores. Extra-cochlear electrodes might be present without noticeable decrement in speech perception since migration might occur gradually and effects on sound quality might go unnoticed. This study examined the audiological indications of the presence of extra-cochlear electrodes (EE)s which are not usually examined in routine clinical practice with radiological confirmation in case of suspicion. Methods and materials :150 CI device for 122 uni- or bilaterally recipients implanted between 1995 and 2015 went under evaluation for the presence of (EE)s during routine CI clinical programming sessions. 23 adults and 99 implanted as children, Devices included: 90 Cochlea; 40 AB; 8 Med-El and 7 Oticon-Neurelec. All devices were evaluated for a set of possible audiological indications of EEs which included impedance telemetry, T & M/C/MCL levels, Electric compound action potential (ECAP)s and performance with the CI. Radiological confirmation was done in the presence of any suspicion. Results : 18 (12.5%) CI recipients had EEs which were previously undetected based on routine clinical practice with an average of 2.7 extra-cochlear electrodes (± 1.7) per recipient. Pain was reported by two out of 18 CI recipients only. The most prevalent indications of EEs were elevated or absent ECAPs, elevated T levels at the basal end, limited DR/ abnormal loudness growth at the basal end and fluctuating impedances. Conclusion : Present clinical practice must be modified to uncover any hidden extra-cochlear electrodes to improve out-come. [ABSTRACT FROM AUTHOR]