When it comes to cochlear implant outcomes, not all electrode arrays are created equal. While patient-related factors often lie beyond our control, the design of the electrode array and surgical technique remain powerful levers for optimizing hearing performance. In a sweeping meta-analysis of 92 studies involving over 5,000 patients, Duckett et al.1 explore how electrode array design, particularly the distinction between pre-curved and straight arrays, can influence word recognition, hearing preservation, and overall audiologic outcomes. The findings challenge long-held assumptions and offer new insights into how modern design innovations are reshaping the cochlear implant landscape.
Key highlights are:
- Mean improvement of overall word recognition scores with pre-curved electrode arrays was 46.5%, which was statistically significantly superior (P=0.0009) to straight electrode arrays at 36.33% improvement
- No significant differences in relative change of PTA scores, LF-PTA scores, or functionally relevant hearing preservation rates between patients with pre-curved and straight electrode arrays.
The authors suggest that differences in outcomes between electrode types may be associated with their positioning relative to the modiolus. Pre-curved electrodes are designed to sit closer to this structure, which could influence factors such as channel interaction and current level requirements. The review also discusses the importance of minimizing intracochlear trauma, which is thought to support hearing preservation and protect neural structures. While some clinicians perceive straight electrodes as less traumatic, the authors note that modern perimodiolar designs have evolved significantly and differ from earlier, more rigid versions.
The transition from a stylet-based to a sheath-based deployment method in the Slim Modiolar electrode array has resulted in a reduction in overall array volume compared to earlier designs like the Contour Advance. This design evolution aimed to create a pre-curved electrode with a slimmer profile, potentially supporting structural preservation during insertion. In a large population study by Shaul et al.2, a 99.2% rate of scala tympani placement was reported, with no translocations and only one reported scala vestibuli insertion. These findings suggest that changes in electrode design may contribute to more consistent placement outcomes. The meta-analysis by Duckett et al.1 found no statistically significant differences in hearing preservation rates or threshold shifts between pre-curved and straight arrays, indicating that atraumatic insertions may be achievable with both types. However, a greater relative improvement in word recognition was observed in the pre-curved group.
This meta-analysis underscores a critical takeaway: with thoughtful design and atraumatic insertion techniques, pre-curved electrodes can deliver superior word recognition outcomes without compromising hearing preservation. As the field continues to evolve, understanding the nuances of electrode design is essential for clinicians aiming to deliver the best possible results for their patients. To dive deeper into the data and explore the full scope of findings, we encourage you to read the full study: Does cochlear implant electrode array design affect audiologic outcomes? A systematic review and meta-analysis (Acta Oto-Laryngologica).
To learn more about Cochlear’s electrode portfolio, please contact your local Cochlear representative or visit our website.
- Duckett, K. A., Kassir, M. F., Munhall, C. C., Schvartz-Leyzac, K. C., Nguyen, S. A., & Labadie, R. F. (2025). Does cochlear implant electrode array design affect audiologic outcomes? A systematic review and meta-analysis. Acta Oto-Laryngologica, 1–17. https://doi.org/10.1080/00016489.2025.2451074
- Slim, Modiolar Cochlear Implant Electrode: Melbourne Experience and Comparison With the Contour Perimodiolar Electrode. Otology & Neurotology. 1. 10.1097/MAO.0000000000002617. Shaul, Chanan & Weder, Stefan & Tari, Sylvia & Gérard, Jean-marc & O’Leary, Stephen & Briggs, Robert. (2020).
This blog is intended to serve as a resource for clinicians to help keep up to date with current clinical literature and is intended for professionals only. Clinical literature is based on research, which may include the experimental use of new or currently available products and technologies. Therefore, literature presented on this blog may represent use of Cochlear products that does not align with the intended use or indications approved by regulatory bodies, also known as off-label use. Cochlear does not condone any off-label use of its products, and it is not Cochlear’s intent to promote off-label use by providing this blog as a resource for healthcare professionals.
