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Potential benefits from deeply inserted cochlear implant electrodes.

Paul J Boyd1

  • 1Audiology & Deafness Research Group, School of Psychological Sciences, University of Manchester, Manchester, United Kingdom. boyd.diag.audiol@btinternet.com

Ear and Hearing
|January 21, 2011
PubMed
Summary
This summary is machine-generated.

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Longer cochlear implant electrodes may offer some benefits for hearing perception, but evidence is mixed. Deeper insertion can cause cochlear trauma, potentially impacting long-term outcomes and residual hearing.

Area of Science:

  • Otorhinolaryngology
  • Biomedical Engineering
  • Neuroscience

Background:

  • Cochlear implant electrode arrays typically extend 1-1.5 turns from the cochleostomy.
  • Longer arrays aim to provide additional low-frequency auditory percepts and increase spectral information.
  • One manufacturer (MED-EL) utilizes longer electrode arrays, with experimental versions developed by others.

Purpose of the Study:

  • To review evidence on the potential benefits of cochlear implant electrodes extending into the apical cochlear regions.
  • To examine underlying issues including cochlear anatomy, electrode design, and surgical considerations.
  • To draw general conclusions about apical electrodes rather than specific device performance.

Main Methods:

  • Review of imaging studies on electrode insertion depth.

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  • Assessment of anatomical and modeling studies.
  • Examination of pitch scaling trials and performance studies.
  • Consideration of surgical trauma and long-term consequences.

    • Main Results:

    • Current electrode arrays rarely exceed two turns (mean insertion ~630°), shorter than the cochlea's full length.
    • Longer electrodes may stimulate discrete neural populations near the apex.
    • Pitch scaling studies show success in many cases, but pitch confusions/reversals occur in a significant number of individuals.
    • Evidence suggests longer arrays may cause more intracochlear trauma, impacting residual hearing and neural substrate.

    Conclusions:

    • Benefits of deeply inserted electrodes for speech recognition are unclear, with conflicting results from acute and chronic studies.
    • While some studies suggest performance benefits, others show improvement after deactivating apical electrodes.
    • Potential long-term consequences include loss of residual hearing and neural substrate reduction.
    • A clinical dilemma exists as patients who might benefit most from apical electrodes may also benefit from bimodal electroacoustic stimulation requiring shallower insertion.