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Objective: The current study aims to investigate whether objective measurements of the cochlear nerve (CN), derived from preoperative MRI images, correlate with postoperative speech perception in CI patients., Study Design: Retrospective cohort study., Setting: University Medical Center, tertiary academic referral center., Patients: Patients undergoing a cochlear implant surgery including MED-EL (Synchrony 2, FLEX electrode series; MED-EL, Innsbruck, Austria) Cochlear (slim straight electrodes; Cochlear Ltd., Sydney, Australia), Advanced Bionics (HiRes Ultra 3D CI, HiFocus SlimJ electrodes; Sonova, Zürich, Switzerland), and Oticon (Neuro Zti EVO; Oticon A/S, Smørum, Denmark) between 2020 and 2023., Intervention: Preoperative MRI images were utilized to measure the volume of the modiolus (VM), the cross-sectional areas of the CN (ACN), and for normalization, the area of the facial nerve (AFN) and the area of the internal ear canal (AIEC). Postoperative speech perceptions were assessed through word recognition scores (WRS) at several stages following the first fitting (FF) of the CI processor: immediately after FF, 1 month, 3 months, and 6 months after FF., Main Outcome Measures: Sixty-eight patients were enrolled in this study. A statistically significant positive correlation between the ratio between ACN and AFN (ACN/AFN) and WRSFF was identified (R = 0.36, p < 0.003). However, this correlation disappeared in subsequent follow-up tests. Moreover, upon grouping patients based on their degree of asymmetrical hearing loss, it was observed that the correlation was primarily driven by patients with moderate to severe asymmetrical hearing loss (AHLm) on the contralateral side (R = 0.62, p = 0.0003)., Conclusion: The present results suggest that assessing the size of the CN through MRI has limited predictive utility for postoperative speech perceptions during CI consultations. This limitation seems to be particularly relevant for AHLm patients and is confined to the initial activation period., Competing Interests: Conflict of interest: The authors declare no competing interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Objective: Accurate positioning of the electrode array during cochlear implant (CI) surgery is crucial for achieving optimal hearing outcomes. Traditionally, postoperative radiological imaging has been used to assess electrode position. Transimpedance matrix (TIM) measurements have also emerged as a promising method for assessing electrode position. This involves utilizing electric field imaging to create an electric distance matrix by analyzing voltage variations among adjacent electrodes. This study aimed to investigate the feasibility of using intraoperative TIM measurements to estimate electrode position and monitor postoperative changes., Study Design: Retrospective cohort study., Setting: University Medical center, tertiary academic referral center., Patients: Patients undergoing CI (CI622) surgery between January 2019 and June 2022., Intervention: CI electrode positions and maximal angular insertion depths (maxAID) were determined using X-ray imaging according to Stenvers' projection. The mean gradient phase (MGP) was extracted from the TIM, and a correlation between the MGP and maxAID was examined. A model was then built to estimate the maxAID using the MGP, and changes in electrode location over time were assessed using this model., Main Outcome Measures: Twenty-four patients were included in this study. A positive correlation between the maxAID and the MGP ( R = 0.7, p = 0.0001) was found. The established model was able to predict the maxAID with an accuracy of 27.7 ± 4.4°. Comparing intraoperative and postoperative TIM measurements, a decrease of 24.1° ± 10.7° in maxAID over time was observed., Conclusion: TIM measurements are useful for estimating the insertion depth of the electrode and monitoring changes in the electrode's position over time., Competing Interests: Conflict of interest: The authors declare no competing interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objective: The primary objective was to report on experiences regarding the safety and efficacy of the Vibrant Soundbridge (VSB) using a floating mass transducer (FMT)-partial/total ossicular replacement prosthesis (PORP/TORP) assembly as a treatment for conductive and mixed hearing losses of mild-to-moderate/severe degree. The secondary objective was to gather information regarding device fitting, as well as to refine surgical procedures., Patients: Five German-speaking adults from 2 European study sites were implanted with a VSB using an FMT-PORP/TORP assembly and evaluated before and after surgery for air-and bone-conduction thresholds and speech recognition performance., Main Outcome Measures: Evaluating the safety and efficacy of the VSB in combination with a PORP or TORP to treat conductive and mixed hearing loss., Results: Residual cochlear hearing was unaffected by implantation with the device. Functional gain (measured as the difference between preoperative unaided and postoperative VSB-aided thresholds) could be calculated in 2 of 5 subjects, demonstrating that the VSB is effective in treating bone-conduction hearing losses of moderate/severe degree. Word recognition tests in quiet and noise showed good improvement in 3 of the cases. One patient experienced several other medical problems, making her audiological outcomes limited. One patient was excluded from the study owing to insufficient benefit and subsequently underwent revision surgery with FMT placement at the round window., Conclusion: The use of the VSB, implanted using the FMT-PORP/TORP assembly, was safe in all and efficacious in 3 of the 5 cases in this study. These are patients who may have few, if any, other options to manage their hearing loss.

Objectives: To describe a technique for the intraoperative monitoring of residual hearing during a cochlear implant (CI) procedure and, thus, to identify the time of occurrence and surgical steps leading to hearing loss., Study Design: Prospective audiologic analysis in a patient series., Setting: Tertiary referral center., Subjects: Patients with residual hearing subjected to cochlear implantation., Interventions: During cochlear implantation, cochlear microphonics (CMs) in response to frequency-specific stimuli were recorded in patients with residual hearing. Thresholds were determined before and after opening of the cochlea, with a limited portion of the electrode array inserted, and after full insertion., Results: Monitoring of the hearing state using CMs was quick, reliable, and capable of detecting an intracochlear trauma. In a first series of patients, thresholds were preserved in all patients after opening of the cochlea. Thresholds were preserved in 5 of 6 patients after limited insertion and half of the patients after full insertion of the electrode array. Despite threshold preservation until the end of surgery, the residual hearing was lost in patients with deep insertions 1 week postoperative., Conclusion: Intraoperative monitoring of CM thresholds may be valuable for identifying the exact point of time at which residual hearing is affected in CI patients. Opening of the cochlea itself seems to be unrelated to hearing loss. A significant proportion of patients may have hearing loss caused by secondary effects rather than a direct trauma.

Objective: To describe a technique enabling the intraoperative assessment of the mechanical coupling of active middle ear implants in patients with normal or dysfunctional middle ears., Patients: Patients with sensorineural or mixed hearing loss subjected to revision surgery of an active middle ear implant., Intervention: Recording of compound action potentials (CAPs) of the auditory nerve in response to stimulation via an active middle ear implant during revision surgery., Main Outcome Measures: CAP thresholds as a measure of mechanical coupling and system integrity., Conclusion: Determining CAP thresholds may be suitable for identifying a proper mechanical coupling of active middle ear implants in patients with a dysfunctional middle ear, even if the ossicular chain is disrupted.