Cochlear Implants
by Wade Colburn

Journal Club – Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode

July 14, 2020
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By Wade Colburn, Biomedical Engineer and Product Manager – Implants, Cochlear Americas

Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode1

Chanan Shaul, Stefan Weder, Sylvia Tari, Jean-Marc Gerard, Stephen J. O’Leary, and Robert J. Briggs

Otol Neurotol. 2020;41(5):639-643

In today’s busy clinical environment, clinicians who value research-based practice often struggle to keep up with current literature. To help, we offer a Cochlear ProNews feature where rotating guest authors present a current journal article summary.

The latest Journal Club explores a recent study from The Royal Victorian Eye and Ear Hospital, Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode. This article highlights the center’s experience with Slim Modiolar and compares this to experiences with Contour Advance®.

What did the study investigate?

Goals of the study:

  1. Describe the tip fold-over rate, scalar localization and speech perception outcomes of the Slim Modiolar Electrode
  2. Compare Slim Modiolar performance and scalar localization to a retrospective matched group experiences of Contour Advance patients

Why is this important? 

Electrode variations, such as lateral wall and perimodiolar electrodes, are often a topic of conversation in the cochlear implant industry. As this article states, there is evidence suggesting perimodiolar electrodes have lower electrical stimulation thresholds, demonstrate less spread of excitation and demonstrate a more focused stimulation, resulting in optimal speech performance.1

Despite these benefits, there is a belief that perimodiolar electrodes are more prone to translocate, and thus cause more damage to the structure of the cochlea. This study looks at the results of Slim Modiolar, Cochlear’s latest perimodiolar offering, and compares it to the historical results of the Contour Advance electrode. This article represents a larger case study with Slim Modiolar, demonstrating the optimized design regarding the placement of the electrode close to the modiolus and within scala tympani.   

How did they do it? 

Here is the need-to-know: 

  • Conducted prospective observational study with retrospective comparative analysis
    • Contained 125 Slim Modiolar adult recipients and 69 Slim Modiolar pediatric recipients
    • Compared to retrospective review of Contour Advance patients, which were previously reported in a 2018 article by the same research group2
  • Collected demographic data on all adult patients
  • Repeated speech perception testing three and 12 months postoperatively using Consonant Vowel Consonant (CVC) evaluation
  • Matched comparator of performance with no significant differences regarding age, duration of deafness and preoperative phoneme scores
  • Reported extended round window cochleostomy in all Slim Modiolar patients

Results1

The paper reported that eight adult patients had a tip fold-over (4.1%).  Six cases were revealed with an intraoperative x-ray and five were corrected in the OR. Cone Beam CT (CBCT) scans were performed in 120 of 125 patients with 119 (99.1%) cases showing complete scala tympani insertion and one patient with a complete scala vestibuli insertion.

Slim Modiolar results were compared to a series of patients previously reported with Contour Advance, showing 58 of 79 patients (73%) with scala tympani location.2 Of the 120 patients with CBCT, 98 had postlingual deafness and were evaluated at three months. 95 patients had scores at 12 months.

No significant differences were found in recipients that had a tip fold-over compared to those with single insertions. Slim Modiolar patients had an average three month post-operative phoneme of 64.2, as compared to 71.6 at 12 months post-op. 

Table 2 below highlights the comparison between matched groups, which were matched with no significant differences regarding age, duration of deafness and preoperative phoneme scores. 

This study highlighted a significant difference between Contour Advance and Slim Modiolar electrodes, which could be due to scalar localization. However, there is an opportunity to compare to a more controlled group. Nonetheless, the article highlights multiple articles that have reported on the Slim Modiolar electrode and the associated results. Ultimately the study concludes, “Slim Modiolar electrode provides reliable scala tympani position” with a relatively low tip fold-over rate.

Results of this study indicate that there are many advantages to a perimodiolar array, specifically Slim Modiolar, including closer proximity to the modiolus and decreased translocation rates. There continues to be a growing body of evidence surrounding Slim Modiolar.

Learn more about perimodiolar electrodes by accessing the publication and stay tuned for the next edition of Journal Club!

Wade Colburn

About our guest author: Wade Colburn is the Product Manager, Cochlear Implants at Cochlear Americas. Wade is responsible for managing the lifecycle of products, including managing supporting current products and bringing new ones to the market. Wade is a biomedical engineer from North Carolina State University with extensive experience within otolaryngology prior to joining Cochlear.

References:

  1. Shaul C, Weder S, Tari S, Gerard JM, O’Leary SJ, Briggs RJ. Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode. Otol Neurotol. 2020;41(5):639-643. doi:10.1097/MAO.0000000000002617
  2. Shaul C, Dragovic AS, Stringer AK, O’Leary SJ, Briggs RJ. Scalar localisation of peri-modiolar electrodes and speech perception outcomes. J Laryngol Otol 2018;1–7. https://doi.org/10.1017/S0022215118001871
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Cochlear™ Nucleus® implant candidacy and indications for adult and pediatric patients

August 29, 2018

Cochlear™ Nucleus® implant (CI) candidacy and indications are important when counseling both adult and pediatric patients. In adults, cochlear implants can significantly improve hearing performance and quality of life.1 This can have a positive effect on the patients’ overall physical and mental health as well by reducing anxiety and stress.2

For pediatric patients, a cochlear implant is vital to giving children access to sound for proper speech and language development.3

Below you will find U.S. FDA indications regarding Nucleus cochlear implant candidacy for both adults and children. As well as Nucleus Hybrid™ System* candidacy.

Adult CI Candidacy4

For those over the age of 18 the criteria include:

Those who have bilateral, pre, peri or postlinguistic sensorineural hearing impairment.

Those with a moderate to profound hearing loss in the low frequencies and profound (≥90 dB HL) hearing loss in the mid to high speech frequencies. Also,the candidate must obtain limited benefit from appropriate hearing aids. Limited benefit from amplification is defined by test scores of 50% correct or less in the ear to be implanted (60% or less in the best-aided listening condition) on recorded tests of open set sentence recognition.

Adult Hybrid Candidacy

The Cochlear Nucleus® Hybrid System is made up of the Nucleus Hybrid L24 implant and the Nucleus sound processor combining acoustic amplification for the low frequencies with electric stimulation for the high frequencies. The Nucleus Hybrid System is indicated for unilateral use in patients age 18 years and older who have residual low frequency hearing sensitivity and severe to profound high-frequency sensorineural hearing loss, and who obtain limited benefit from appropriately fitted bilateral hearing aids.

Candidates range from normal to moderate hearing loss in the low frequencies (thresholds better than 60 dB HL up to and including 500 Hz). Severe to profound mid to high-frequency hearing loss (threshold average of 2000, 3000, and 4000 Hz ≥75 dB HL) in the ear to be implanted.

The CNC word recognition score for the ear to be implanted must be between 10% and 60%, inclusively, in the ear to be implanted in the preoperative aided condition. The contralateral ear’s CNC score criteria are equal to or better than that of the ear to be implanted, but not better than 80% correct. Moderately severe to profound mid- to high frequency hearing loss (threshold average of 2000, 3000, and 4000 Hz ≥ 60 dB HL) in the contralateral ear.

CI and Hybrid candidacy graphs

Pediatric CI Candidacy4

The cochlear implant system for those 12 to 24 months of age who have bilateral profound sensorineural deafness and demonstrate limited benefit from appropriate binaural hearing aids.

Children 2 years of age or older may demonstrate severe to profound hearing loss bilaterally.

In younger children, limited benefit is defined as lack of progress in the development of simple auditory skills in conjunction with appropriate amplification and participation in intensive aural habilitation over a three to six month period. It is recommended that limited benefit be quantified on a measure such as the Meaningful Auditory Integration Scale or the Early Speech Perception test.

In older children, limited benefit is defined as ≤ 30% correct on the open set Multisyllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT), depending upon the child’s cognitive and linguistic skills. A three to six month hearing aid trial is recommended for children without previous aided experience.

CI Contraindications4

A Cochlear Nucleus cochlear implant is not suitable for individuals with the following conditions:

  • Deafness due to lesions of the acoustic nerve or central auditory pathway
  • Active middle ear infections
  • Absence of cochlear development
  • Tympanic membrane perforation in the presence of active middle ear disease

Visit our website for more information regarding cochlear implant candidacy and Hybrid candidacy.

References:
  1. Gaylor, BA. Raman, G. Chung, M. Cochlear Implantation in Adults. JAMA Otolaryngol Head Neck Surg. 2013 Mar;139(3):265-72.
  2. Manrique-Huarte R et al (2016) Treatment for hearing loss among the elderly: Auditory outcomes and impact on quality of life. Audiol Neurootol, 21 Suppl 1:29-35
  3. Novak MA, Firszt JB, Rotz LA, et al. Cochlear implants in infants and toddlers. Ann Otol Rhino Laryngol Suppl 2000;185:46-49
  4. Cochlear™ Nucleus® CI532 cochlear implant with Slim Modiolar electrode Physician’s Guide. March 2016.
* The Acoustic Component should only be used when behavioral audiometric thresholds can be obtained and the recipient can provide feedback regarding sound quality.
**The Hybrid L24 Implant is approved in the US for adults ages 18 and older.
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