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Updated: Jun 20, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Evolution of cochlear implant arrays result in changes in behavioral and physiological responses in children
Arie Gordin1, Blake Papsin, Adrian James
1Department Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada. ariegor@hotmail.com
Insights
The new Freedom 24RE cochlear implant offers better hearing outcomes for children. This advanced precurved electrode array provides wider stimulation and improved speech perception compared to older models.
Area of Science:
- Otorhinolaryngology
- Biomedical Engineering
- Audiology
Background:
- Pediatric cochlear implantation is a crucial intervention for profound hearing loss.
- Electrode array design and technology advancements aim to optimize auditory function.
- Understanding the impact of different cochlear implant arrays is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate the effect of different cochlear implant electrode array designs on auditory performance in children.
- To compare electrophysiological, behavioral, and functional measures across distinct cochlear implant devices.
Main Methods:
- A prospective, nonrandomized study involving 115 pediatric unilateral cochlear implant users.
- Subjects were grouped based on their implanted electrode array: Nucleus 24M (straight), Nucleus 24RCS (perimodiolar), and Nucleus 24RE (precurved).
- Electrically evoked compound action potentials (ECAPs), stapedius reflex thresholds, behavioral thresholds, and speech perception were assessed over 6-12 months.
Main Results:
- The Nucleus 24RE array demonstrated significantly lower ECAP and behavioral thresholds compared to the 24M and 24RCS arrays.
- Speech perception scores (open- and closed-set) were significantly higher in the 24RE group.
- The 24RE array showed the largest ECAP threshold reductions with apical and basal electrode stimulation.
Conclusions:
- The precurved Freedom 24RE cochlear implant offers superior auditory performance in children compared to the 24M and 24RCS devices.
- This advanced technology potentially provides a wider range of stimulation and enhanced functional hearing outcomes.
- The findings support the use of the 24RE array for improved results in pediatric cochlear implant users.
Objectives:
To determine whether a change in cochlear implant technology and electrode array design affects electrophysiological, behavioral, and functional measures of audition in pediatric cochlear implant users.
Design:
Prospective nonrandomized control study over 6 months postimplantation.
Setting:
Tertiary referral pediatric hospital.
Patients:
A total of 115 children using unilateral cochlear implants were included in this study. Subjects were divided into 3 groups: 1) 38 using the Nucleus 24M straight array device, 2) 20 using the perimodiolar Nucleus 24RCS Contour array, and 3) 57 using the perimodiolar Nucleus 24RE array with advance off stylet insertion. The mean ages at implantation were 4.85 +/- 4 (24M), 3.88 +/- 3.4 (24RCS), and 5.41 +/- 4.36 years (24RE; not significant, p > 0.05).
Main Outcome Measures:
The electrically evoked compound action potential (ECAP) and the electrically evoked stapedius reflex and behavioral measures of stimulation threshold were evoked by stimulation of basal, mid, and apical electrodes. These measures were completed at regular intervals over 6 to 12 months of implantation. Age-appropriate speech perception skills were also assessed during this period.
Results:
The 24RE array group had significantly lower ECAP and behavioral thresholds compared with the 24M and 24RCS array groups. The largest reductions of ECAP thresholds in the precurved array group were observed upon apical and basal electrode stimulation. Electrically evoked stapedius reflex thresholds were significantly higher in the 24RE group as compared with 24M and 24RCS groups. Comparing age-matched groups, open- and closed-set speech perception test scores were significantly higher in the 24RE array group.
Conclusion:
The precurved Freedom 24RE cochlear implant potentially provides a wider range of stimulation levels and better functional results than the straight electrode 24M and the precurved 24RCS devices in profoundly hearing impaired children.
