What is hearing potential?
What is hearing potential?
The journey with a cochlear implant is a lifelong one, and every patient is unique. Factors like duration of deafness, etiology of hearing loss, neural substrate, cochlear anatomy and more all correlate to how well someone may perform with a cochlear implant.1 Thus, each patient has their own unique ‘hearing potential’ that they can achieve with a cochlear implant.
Cochlear™ understands those factors and integrates them into our product portfolio so that your patients have the best possible chance of achieving their maximum hearing potential. Inspired by a lifetime of hearing performance, Cochlear has implemented slim, perimodiolar electrodes which are designed to enable focused stimulation of the hearing nerve and to structurally preserve the cochlea. Some of the relevant research is explored below.
What is hearing potential?
The journey with a cochlear implant is a lifelong one, and every patient is unique. Factors like duration of deafness, etiology of hearing loss, neural substrate, cochlear anatomy and more all correlate to how well someone may perform with a cochlear implant.1 Thus, each patient has their own unique ‘hearing potential’ that they can achieve with a cochlear implant.
Cochlear™ understands those factors and integrates them into our product portfolio so that your patients have the best possible chance of achieving their maximum hearing potential. Inspired by a lifetime of hearing performance, Cochlear has implemented slim, perimodiolar electrodes which are designed to enable focused stimulation of the hearing nerve and to structurally preserve the cochlea. Some of the relevant research is explored below.
Considering outcomes over a patient's lifetime
Benefits of early implantation
Benefits of early implantation
There are several factors to consider that contribute to a lifetime of hearing performance. For candidates, simply receiving an implant can deliver a significant improvement in speech recognition and overall hearing and the earlier they receive intervention the better.2
Benefits of early implantation
There are several factors to consider that contribute to a lifetime of hearing performance. For candidates, simply receiving an implant can deliver a significant improvement in speech recognition and overall hearing and the earlier they receive intervention the better.2
Scala tympani placement
Scala tympani placement
Optimal placement of the implant electrode in the scala tympani also contributes to long term outcomes, with correct placement maintaining the integrity of the cochlea and helping to deliver improved hearing performance.3,4
In a US multicentre study, all Slim Modiolar electrodes were placed successfully in the scala tympani.
Scala tympani placement
Optimal placement of the implant electrode in the scala tympani also contributes to long term outcomes, with correct placement maintaining the integrity of the cochlea and helping to deliver improved hearing performance.3,4
In a US multicentre study, all Slim Modiolar electrodes were placed successfully in the scala tympani.
Functional residual hearing
Functional residual hearing
When looking at emerging data, Iso-Mustajavari,5 Woodson,6 and Ramos7 have all found that the Slim Modiolar array allows for preservation of structures and thresholds in populations with low frequency residual hearing, with Iso-Mustajavari reporting an 11dB threshold shift at 582 days. This shows that hearing preservation is possible with the CI632, which has additional benefits in electric-only stimulation, should patients lose residual hearing over time.
Functional residual hearing
When looking at emerging data, Iso-Mustajavari,5 Woodson,6 and Ramos7 have all found that the Slim Modiolar array allows for preservation of structures and thresholds in populations with low frequency residual hearing, with Iso-Mustajavari reporting an 11dB threshold shift at 582 days. This shows that hearing preservation is possible with the CI632, which has additional benefits in electric-only stimulation, should patients lose residual hearing over time.
Acoustic hearing considerations
Acoustic hearing considerations
All cochlear implant candidates will rely on electrical stimulation for hearing over their lifetime.13,14 A very small number of candidates (<10%) may have mild-moderate levels of residual low frequency hearing which may potentially be preserved and aided acoustically in combination with their cochlear implant postoperatively. Many of these patients will experience a delayed onset of progressive loss and and come to rely solely on electrical stimulation with their cochlear implant for hearing.13,14
That's why the goal should be to optimise outcomes of electrical stimulation. 13,14
Acoustic hearing considerations
All cochlear implant candidates will rely on electrical stimulation for hearing over their lifetime.13,14 A very small number of candidates (<10%) may have mild-moderate levels of residual low frequency hearing which may potentially be preserved and aided acoustically in combination with their cochlear implant postoperatively. Many of these patients will experience a delayed onset of progressive loss and and come to rely solely on electrical stimulation with their cochlear implant for hearing.13,14
That's why the goal should be to optimise outcomes of electrical stimulation. 13,14
Modiolar proximity
Modiolar proximity
Modiolar proximity is another important contributor to effective electrical stimulation.8,9,10 Placement of the electrode close to the modiolar wall reduces both acute and long-term trauma to the structures of the lateral wall, contributing to better hearing performance.11,12 Only Cochlear offers a Slim Modiolar electrode which sits close to the modiolus to permit more precise and effective stimulation of the hearing nerve. In research studies, the Slim Modiolar electrode delivered better outcomes on average than a lateral wall electrode.8,9
Modiolar proximity
Modiolar proximity is another important contributor to effective electrical stimulation.8,9,10 Placement of the electrode close to the modiolar wall reduces both acute and long-term trauma to the structures of the lateral wall, contributing to better hearing performance.11,12 Only Cochlear offers a Slim Modiolar electrode which sits close to the modiolus to permit more precise and effective stimulation of the hearing nerve. In research studies, the Slim Modiolar electrode delivered better outcomes on average than a lateral wall electrode.8,9
Protecting the natural structure of cochlea
Placement of the electrode close to the modiolar wall also reduces both acute and long-term trauma to the structure of the lateral wall, further supporting ongoing hearing outcomes.10,12,16,17
Early and late changes to the intra-cochlea environment driven by inflammatory and fibrotic processes due to electrode insertion are inevitable.¹⁰ However, there are several factors that can help reduce the level and severity of these changes over time: 3,8,10-13,15,16,18-20
1
ensure scala tympani placement of the electrode array
2
position the electrode such that impact on cochlea health is minimized
3
reduce volume of the electrode (foreign body) response
Independent electrode channels
Independent electrode channels
Cochlear offers the only electrode with 22 independent channels, which may support improved speech recognition outcomes, particularly in noise.10 Having more independent channels closer to the hearing nerve also provides greater opportunity to take advantage of future sound coding strategies.10
Independent electrode channels
Cochlear offers the only electrode with 22 independent channels, which may support improved speech recognition outcomes, particularly in noise.10 Having more independent channels closer to the hearing nerve also provides greater opportunity to take advantage of future sound coding strategies.10
Haftungsausschluss
Informieren Sie sich bei Ihrem Arzt über die Möglichkeiten der Behandlung von Hörverlust. Ergebnisse können abweichen; Ihr Arzt berät Sie bezüglich der Faktoren, die Ihr Ergebnis beeinflussen könnten. Lesen Sie stets das Benutzerhandbuch. Nicht alle Produkte sind in allen Ländern erhältlich. Für Produktinformationen wenden Sie sich bitte an Ihren Vertreter von Cochlear vor Ort.
Eine vollständige Liste der Marken von Cochlear finden Sie auf unserer Seite mit den Nutzungsbedingungen.
* “A lifetime of hearing performance” and similar phrases should not be understood as claims relating to the expected life, reliability, quality or performance of Cochlear’s products.
References
- Zhao EE, Dornhoffer JR, Loftus C, Nguyen SA, Meyer TA, Dubno JR, McRackan TR. Association of Patient-Related Factors With Adult Cochlear Implant Speech Recognition Outcomes: A Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2020 Jul 1;146(7):613-620. doi: 10.1001/jamaoto.2020.0662. PMID: 32407461; PMCID: PMC7226297.
- Lazard DS, et.al. PJ. Pre-, per- and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants: a new conceptual model over time. PLoS One. 2012;7(11):e48739.
- Shaul C, et al. Scalar localisation of peri-modiolar electrodes and speech perception outcomes. The Journal of Laryngology & Otology. 2018;132(11):1000-1006.
- Holden L, et al. Factors Affecting Open-Set Word Recognition in Adults With Cochlear Implants. Ear & Hearing. 2013;34(3):342-360
- Iso-Mustajärvi, M., Sipari, S., Löppönen, H., & Dietz, A. (2019). Preservation of residual hearing after cochlear implant surgery with slim modiolar electrode. European Archives of Oto-Rhino-Laryngology. https://doi.org/10.1007/s00405-019-05708-x
- Woodson E, Nelson RC, Smeal M, Haberkamp T, Sydlowski S. Initial hearing preservation outcomes of cochlear implantation with a slim perimodiolar electrode array. Cochlear implants international [Internet]. 2021 [cited 2021 Jul 28];(3):148.
- Ramos-Macías A, Borkoski-Barreiro SA, Falcón-González JC, Ramos-de Miguel A. Hearing Preservation with the Slim Modiolar Electrode Nucleus CI532® Cochlear Implant: A Preliminary Experience. Audiol Neurootol. 2017;22(6):317-325. doi: 10.1159/000486409. Epub 2018 Feb 27. PMID: 29486475.Holder
- Holden L, et al. Factors Affecting Open-Set Word Recognition in Adults With Cochlear Implants. Ear & Hearing. 2013;34(3):342-360
- Berg K, et al. Speech recognition as a function of the number of channels in perimodiolar electrode recipients. The Journal of the Acoustical Society of America. 2019;145(3):1556-1564.
- Somdas M, et al. Quantitative Evaluation of New Bone and Fibrous Tissue in the Cochlea following Cochlear Implantation in the Human. Audiology and Neurotology. 2007;12(5):277-284.
- Bester C, et al. Four-point impedance as a biomarker for bleeding during cochlear implantation. Scientific Reports. 2020;10(1).
- Verberne J, et al. The Effect of Scala Tympani Morphology on Basilar Membrane Contact With a Straight Electrode Array: A Human Temporal Bone Study. Otol Neurotol. 2017 Jan;38(1):47-53.
- Scheperle R, et al. Delayed changes in auditory status in cochlear implant users with preserved acoustic hearing. Hearing Research. 2017;350:45-57.
- Carlson M, et al. Survey of the American Neurotology Society on Cochlear Implantation: Part 2, Surgical and Device-Related Practice Patterns. Otology & Neurotology. 2018;39(1):e20-e27.
- Holder JT, et. al. Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays. Otol Neurotol. 2019 Oct;40(9):1160-1166.
- Kamakura T, Nadol JB Jr. Correlation between word recognition score and intracochlear new bone and fibrous tissue after cochlear implantation in the human. Hearing research. 2016;339:132-41. 19.
- Pfingst B, et al. Importance of cochlear health for cochlear-implant function. The Journal of the Acoustical Society of America. 2015;137(4):2297-2297.
- Adunka O, et al. Minimum Reporting Standards for Adult Cochlear Implantation. Otolaryngology–Head and Neck Surgery. 2018;159(2):215-219.
- Wright CG, Roland PS. Vascular trauma during cochlear implantation: a contributor to residual hearing loss? Otolology & Neurotology. 2013;34(3):402-7.
- Danielian A, et al. Morphometric linear and angular measurements of the human cochlea in implant patients using 3-dimensional reconstruction. Hear Res. 2020;386:107874