Cochlear Implants
by Zach Pollack

Counseling on Cochlear™ Electrodes

September 10, 2024
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  • Approximately 5 mins to read
  • CochlearElectrodes.com learning objectives:
    • Learn about the significance of electrode selection in cochlear implants
    • Understand the differences between perimodiolar and lateral wall electrodes
    • Understand how to use the electrode model to learn about insertion approaches and educate candidates on electrode types

At Cochlear, we believe that technology is at the center of what gives each patient the opportunity to reach their full potential in hearing and in life. Cochlear is committed to partnering with you to understand and support your expertise to deliver the best possible care for your patients.

One important aspect of a cochlear implant that can have a significant impact on performance outcomes is the type of electrode selected. Cochlear is the only manufacturer with a full suite of electrodes to ensure that you have the optimal electrode for whatever a patient’s individual needs might be.

Understanding the differences between perimodiolar and lateral wall electrodes is critical to selecting the appropriate array for each patient. Therefore, we’ve created CochlearElectrodes.com to be your Cochlear™ Nucleus® implant information center, with content focusing on electrodes, receiver stimulators, innovation timelines, reliability information, surgical resources and more.

One new tool that can be utilized for counseling is our electrode interactive 3D insertion model. Complete with pop up guides and insights, this model can help you or your patients better understand the differences in Cochlear’s electrodes to select the right device for that patient.

For Surgeons, this insertion model can be used to learn about:

  • Various insertion approaches and considerations for each electrode array
  • Key insertion steps and instruments needed
  • Design intention of the electrode arrays
  • Comparison of size and insertion position across arrays

For Audiologists, this insertion model can be used to:

  • Assist with counseling the differences between perimodiolar and lateral wall electrodes
  • Guide discussions on why a surgeon might chose one array over another
  • Visual aid to explain basic cochlea anatomy
  • Brochure to easily locate insertion model and can send candidates home with a reference to the insertion model

For Candidates, this model can:

  • Educate on the differences between perimodiolar and lateral wall electrodes
  • Reduce fear of surgery by better understanding what happens in the OR
  • Explain the differences between electrodes
  • Self-paced learning- can review information after counseling appointment

The decision to move forward with a cochlear implant has quite a few factors: multiple manufacturers, implant type, electrode type, sound processor technology, and so much more. Cochlear has built this model with the intention of aiding the education about our electrode portfolio to help counsel patients to the device that is right for them.

Ask your local rep about our CochlearElectrodes.com handout to have easy access to this interactive model in the clinic. You can keep the half-page brochure on hand or send candidates home with the brochure to explore electrodes on their own for self-paced learning.

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Visit www.CochlearElectrodes.com for more information about Cochlear’s implant portfolio.

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Cedric Pritchett

Research spotlight with Dr. Pritchett: Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation

October 18, 2021

Hear from Dr. Pritchett on the recent publication of Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation:

What inspired you to research this topic?

In the state of Florida we have a rich depth of diversity in culture, ethnicity and language. Nearly 40% of the children with hearing loss in our program have parents whose primary language is Spanish. We were desirous of understanding whether in this diversity, disparities existed.

What surprised you the most? What insights from this study were the most compelling to you and your team?

I was most surprised to learn heritage from African descent was the most predictive factor in delay to early implantation. Black children were less likely than White or Hispanic children to be implanted by two years of age (and even less so for one year of age). Demonstrating in the state of Florida, it is not unexpected for implantation of children with public insurance to occur later than children with commercial insurance; however, I did not expect to find racial background was more important than insurance status. In our study we discovered a Black child with commercial insurance was less likely to be implanted early than a White child of any insurance status—commercial, public, or self-pay, or a Hispanic child of commercial status; and with nearly the same likelihood as a Hispanic child with public insurance. In other words, the only children who were less likely to be implanted later than a Black child with commercial insurance were Black children with public insurance.

Have the findings from this study changed your team’s approach to managing children with severe to profound hearing loss? If so, how?

Realizing the existence of unequal odds for early implantation in our patient population has informed, but not changed our practice. Our team remains dedicated and intentional in our approach to provide timely access to sound in general, and cochlear implantation in particular for our children with hearing loss.

Your study references the importance of a multidisciplinary team. Can you tell us a little bit about how your team is structured? What has made your team successful?

Recently we reviewed our program’s outcomes measuring time to implantation based on several factors including race, insurance status and preferred spoken language of our patients’ caregivers. We were pleased to see such times were similar comparing the different categories within these variables. Our team has included a neurotologist, pediatric otolaryngologist, two implant audiologists, two speech pathologists/auditory verbal therapist, a pediatric nurse practitioner, a registered nurse, a licensed clinical social worker, an implant coordinator and clinical assistant. We have been very fortunate to have the presence of a dedicated social worker and several members of our team who are fluently bilingual (Spanish), including one implant audiologist and at one point both speech pathologists. These assets in our program have provided crucial insight into our families’ needs and perspectives, and then supported our program’s band width to address them.

Any key takeaways that professionals should know?

We recognize our children are the future, but this is especially worth emphasizing in the context of children with hearing loss disabilities/disadvantages. We understand children are typically dependent participants in the care they receive. Pediatric care is best delivered in a multidisciplinary team. A team involving clinicians and therapists, but also educators and family members. Our teams should be prepared to investigate at the least, and ideally mitigate the underlying challenges to optimal care our children-patients encounter.

Read more on this topic here!

Citation:

Liu X, Rosa-Lugo LI, Cosby JL, Pritchett CV. Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg. 2021 Mar;164(3):667-674. doi: 10.1177/0194599820953381. Epub 2020 Sep 15. PMID: 32930656.

About the author:

Dr. Pritchett is a Pediatric Otolaryngologist- Head & Neck Surgeon with Nemours Children’s Health System at the Nemours Children’s Hospital in Orlando, FL.  His scope of practice includes a range of pediatric otolaryngology conditions with particular interest in pediatric otology and hearing loss. He is a cochlear implant surgeon, presently serves as Medical Director of both the Nemours Children’s Hospital’s Cochlear Implant Program and Section of Audiology, and is an affiliated Associate Professor in Otolaryngology at the University of Central Florida’s College of Medicine. Dr Pritchett received his Medical Degree and Master’s in Public Health from The Ohio State University in Columbus, OH. Residency in Otolaryngology-Head & Neck Surgery was completed at the University of Michigan, in Ann Arbor, MI, and fellowship in Pediatric Otolaryngology at Northwestern University’s Ann & Robert Lurie Children’s Hospital of Chicago. Dr. Pritchett is a member several professional societies including the Academy of Otolaryngology – Head and Neck Surgery, and is a fellow of the American Society of Pediatric Otolaryngology, and the American Academy of Pediatrics. He has served as a reviewer for several journals, including the Laryngoscope, Otolaryngology-Head and Neck Surgery, and International Journal of Pediatric Otorhinolaryngology. He is the author of a number of articles and enjoys sharing his knowledge with training healthcare professionals from all backgrounds. He has been married for over 20 years, and has two wonderful daughters. He enjoys traveling, reading, is attempting to become a photographer, and looking to become more involved in mission work.

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Journal Club: Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays

February 10, 2020

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

Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays

JT Holder, RJ Yawn, AM Nassiri, RT Dwyer, A Rivas, RF Labadie, RH Gifford

Otology Neurotology (2019) 40(9): 1160 – 1666

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 ProNews Blog monthly feature – Journal Club!  Each month, rotating guest authors will present a current journal article summary.

This month’s Journal Club explores a recent 2019 study from Vanderbilt University, Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays. Researchers analyzed the two primary types of electrode arrays within the marketplace: lateral wall or straight array and pre-curved or perimodiolar.  Very seldomly are the array types compared using matched groups.

Historical studies have suggested the benefits of placing the electrode closer to the nerve, but often did not contain a comparison group.  This article explores the comparison between pre-curved and lateral wall electrode design and demonstrates the superiority of pre-curved.

What did the study investigate?

Goals of the study:

  1. Better understand how electrode type affects programming parameters and patient outcomes to choose the best device for an individual
  2. Compare a newer generation precurved electrode with a straight electrode utilizing matched groups

Why is this important? 

In the cochlear implant industry there are multiple electrode variants and choices between manufacturers. With that comes various evidence showing how implant technology, surgical technique and placement of the device can impact the outcome. Specifically, the authors call out that electrode design, intrascalar location, surgical approach and atraumatic insertion technique could impact performance.  Various studies in the marketplace highlight the benefits of both lateral wall and precurved electrode types, but few draw a direct comparison using matched groups.

Straight arrays have a history of atraumatic insertions and greater potential for structural preservation, while precurved arrays have the outcome benefit of stimulation specificity.1 Due to recent changes in electrode design, this study aimed to compare a new perimodiolar array to a straight array. Authors hypothesized that the arrays would show similar hearing preservation rates, while the perimodiolar array would show better speech understanding scores and preferable programming parameters due to the lower electrode-to-modiolus distance.

How did they do it? 

Here is your need-to-know: 

  • 29 precurved array patients
    • 17 male/ 12 female
  • 29 straight array patients
    • 19 male/ 10 female
  • Retrospectively reviewed aggregate clinical database and matched CI532 electrode recipients with CI422/CI522 recipients, controlling age and preoperative hearing thresholds
  • Standard cochlear implantations via round window (RW), extended round window (ERW) and cochleostomy (C)
    • CI422/CI522 Group: RW=23, ERW=3 and C=3
    • CI532 Group: RW=18, ERW=5, C=6
  • Speech recognition scores (CNC Word Recognition, AzBio Sentence Recognition in quiet, AzBio Sentence Recognition in +5 dB SNR), residual acoustic hearing thresholds (LFPTA at 125, 250, 500 Hz) and quality of life questionnaire data (Speech Spatial Qualities -SSQ) were obtained for patients both pre-operatively and post-operatively (6 months).
  • Programming software parameters (pulse duration, maxima and datalogging) were also analyzed
  • Matching controlled for age, preoperative LFPTA, preoperative CNC scores and daily processor usage

Results1

Age, preoperative LFPTA, preoperative CNC scores and daily processor usage were matched within the study to determine significance in the outcome measures and software parameters.  The study found that impedances and pulse duration were significantly lower for the CI532 group, but there was no difference in overall charge between groups. Further, the study found that the CI532 group had significantly better post-operative CNC and LFPTA.

Table 1, provided below, outlines the parameters that were matched and analyzed within the study.

The study compared the speech outcomes directly. While only CNC had a significant difference, Figure 2 from the publication outlines the performance of the devices in CNC, AzBio Quiet and AzBio +5 dB.

The authors call out that “the most notable finding of the current study is that the CI532 group had significantly better post-operative acoustic LFPTA.”  They continue, “This difference in results could be explained by lower rates of translocation for the CI532, which suggests less trauma of the cochlear structures”.

Further investigation shows that the observations regarding lower impedances and differences in pulse duration allow for the center to implement greater maxima, which has been known to have a positive impact on speech understanding in complicated listening situations.1

Results of this study indicate that there are many advantages to a perimodiolar array including closer proximity to the modiolus and decreased translocation rates. More research will be conducted in regards to this new perimodiolar array to assess the performance benefit and the potential for equivalent or better preservation rates, historically associated with lateral wall arrays.

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

About our guest author: Wade Colburn is the Product Manager, Cochlear Implants at Cochlear Americas. Wade is responsible for managing product lifecycle and providing technical support to customers.  Wade is a biomedical engineer from North Carolina State University with extensive experience within otology prior to joining Cochlear.

References:

  1. Holder, J. T., Yawn, R. J., Nassiri, A. M., Dwyer, R. T., Rivas, A., Labadie, R. F., & Gifford, R. H. (2019). Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays. Otology & Neurotology, 40(9), 1160–1166. doi: 10.1097/mao.0000000000002366

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This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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