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Updated: Jul 6, 2026
Performing Repeated Intraoperative Impedance Telemetry Measurements during Cochlear Implantation
Published on: August 4, 2023
Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional
Howard W Francis1, Craig A Buchman, Jiovani M Visaya
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287-0910, USA. hfrancis@jhmi.edu
Insights
Full cochlear implant electrode insertion is linked to better early auditory skills in young children. Surgical technique and electrode placement are crucial for optimal communication outcomes.
Area of Science:
- Audiology
- Pediatric Otolaryngology
- Speech-Language Pathology
Background:
- Cochlear implantation is a vital intervention for profound hearing loss in young children.
- Understanding the impact of surgical factors on device performance and early development is crucial.
Purpose of the Study:
- To evaluate how surgical factors influence electrode status and early communication outcomes in children younger than 5 years within two years of cochlear implantation.
Main Methods:
- A prospective multicenter cohort study involving 188 children (209 ears) aged 5 years or younger.
- Assessed percent active electrode channels, auditory behavior (ITMAIS/MAIS), and receptive language (Reynell scores).
Main Results:
- 96.2% of ears achieved stable full electrode array insertion; 88% had at least 75% active channels.
- Electrode deactivation negatively impacted auditory behavior (ITMAIS/MAIS) but not receptive language at 24 months.
- Meningitis history was linked to fewer active electrodes; complications did not significantly affect early auditory development.
Conclusions:
- Complete electrode array activation correlates with improved early auditory outcomes.
- While not statistically significant, reduced active electrodes and language gains may indicate clinical relevance, emphasizing surgical precision.
Objective:
To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.
Study Design:
Prospective multicenter cohort study.
Setting:
Six tertiary referral centers.
Patients:
Children 5 years or younger before implantation with normal nonverbal intelligence.
Intervention:
Cochlear implant operations in 209 ears of 188 children.
Main Outcome Measures:
Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores.
Results:
Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up.
Conclusion:
Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array.