Lindquist, Nathan R.

Objective To assess Advanced Bionics (AB) HiRes Ultra and Ultra 3D initial version (V1) cochlear implant electrode failures over time at four large cochlear implant programs. Study Design Retrospective cohort. Setting Four tertiary referral centers. Patients Patients receiving AB HiRes Ultra and Ultra 3D initial version (V1) devices as of December 31, 2022. Main Outcome Measures Failure rate, revision surgery, speech recognition scores. Results Over a span of 7 years, 205 (42.6%) of 483 implanted V1 devices have failed. Device failure rate varied across institutions from 32 to 67%. Of the 205 detected failures, 163 (79%) have undergone revision surgery, with 94% of revisions being performed with Advanced Bionics devices. Average time from implantation to diagnosis of device failure was 2.7 ± 1.2 years. Most patients (89.8%) with available testing were matched or exceeded their best prefailure speech performance after implant revision. After revision, patients had an average CNC score improvement of 24.7 percentage points over their most recent pre-revision scores and demonstrated average datalogging of 12.7 ± 4.1 h/d at most recent evaluation. Conclusions Comparison of patients across multiple high-volume implant centers confirms the presence of ongoing device failures. There is variability across institutions in the rate of revision surgery once a patient is diagnosed with a V1 device failure, as well as in the rate of device failure detection. Inter-institutional variability in failure rates may be explained by the variation in the routine use of electrical field imaging. Reimplantation with a new device typically results in a return to prefailure peak performance. Professional Practice Gap & Educational Need To our knowledge, a comparison of AB HiRes (V1) device failures across multiple institutions has not been conducted. Learning Objective To identify device failure rate across multiple institutions with different testing protocols. Desired Result Providers will have an improved understanding of the trajectory of device failures for HiRes (V1) devices over time. Level of Evidence Level IV—Historical cohort or case-controlled studies. Indicate IRB or IACUC IRB #230017; IRB #22-000183; IRB #STU-032018-085; IRB #H-49479.

Objective To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation. Study Design Retrospective multi-institutional cohort study. Setting Eleven tertiary academic medical centers across Germany, Denmark, and the United States. Patients One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022. Interventions Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management. Main Outcome Measures Monosyllabic speech perception testing scores and rates of open-set speech perception. Results Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 months (interquartile range [IQR] 12–42 mo) of audiometric follow-up. Median ipsilateral monosyllabic speech perception testing achieved was 72% (IQR 54–85%), and median ipsilateral AzBio in quiet was 75% (IQR 46–90%). Most (91 of 106 [86%]) underwent microsurgery for tumor control, with cochlear implantation performed simultaneously in 98% (89 of 91) of these patients. The ability to achieve gross total resection significantly differed by tumor complexity, with 97% of low-complexity tumors, 100% of intermediate complexity, and 0% of high-complexity tumors undergoing gross total resection (p < 0.001). However, among patients managed with microsurgery, there was not a statistically significant difference in post-cochlear implantation monosyllabic speech perception scores across complexity groupings, with median scores of 75 and 70% for patients with tumors of low or intermediate complexity and those with tumors of high complexity, respectively (p = 0.5). Eight of 102 patients (8%) assessed experienced deterioration in cochlear implant performance over time. Among the subset of 39 patients with available MRI to review, the region of surveillance interest could be visualized postoperatively on MRI in all cases. Conclusions Open-set speech perception is achieved in most patients with inner ear schwannoma undergoing ipsilateral cochlear implantation. Although cochlear implantation in high-complexity inner ear schwannomas is only possible with incomplete tumor resection, long-term open-set speech perception outcomes are similar to lower-complexity tumors.

Objective To compare cochlear implant (CI) speech perception outcomes in patients with sporadic vestibular schwannoma (VS) managed with observation, radiosurgery, or microsurgery. Study Design Retrospective review. Setting Eleven tertiary academic medical centers. Patients One hundred patients with sporadic VS who received an ipsilateral CI. Interventions Ipsilateral cochlear implantation. Main Outcome Measures Pure-tone thresholds, monosyllabic speech perception testing scores, and rates of open-set speech acquisition. Results Of the 100 patients studied, 54 underwent microsurgery, 26 underwent radiosurgery, 19 continued observation, and 1 underwent multimodal therapy. Among all patients, the median post-implantation pure-tone average was 31 dB (interquartile range [IQR] 25–39 dB) and the median monosyllabic speech perception score was 30% (IQR 0–60%) at a median of 12 months (IQR 5–25 months) post-implantation. Patients who were managed with microsurgery (median speech perception score 11%, IQR 0–52%) exhibited poorer implant outcomes overall compared with those managed with observation (median speech perception score 52%, IQR 40–72%) or radiosurgery (median speech perception score 30%, IQR 16–60%). Open-set speech perception was achieved in 61% of patients managed with microsurgery, 100% with observation, and 80% with radiosurgery. In a multivariable setting, those managed with observation (p = 0.02) or who underwent radiosurgery (p = 0.04) were significantly more likely to achieve open-set speech perception compared with patients who underwent microsurgery. Conclusions Cochlear implants offer benefit in selected patients with sporadic VS. Although achieved in over half of people after microsurgery, open-set speech perception is more reliably attained in patients who are treated with observation or radiosurgery compared with microsurgical resection. These data may inform patient counseling and VS tumor management in people who may benefit from implantation.

AbstractObjectiveThis study investigated the comparative performance of ear, nose, and throat (ENT) physicians in correctly detecting ear abnormalities when reviewing digital otoscopy imaging using 3 different visualization methods, including computer‐assisted composite images called “SelectStitch,” single video frame “Still” images, and video clips. The study also explored clinicians' diagnostic confidence levels and the time to make a diagnosis.Study DesignClinician diagnostic reader study.SettingOnline diagnostic survey of ENT physicians.MethodsNine ENT physicians reviewed digital otoscopy examinations from 86 ears with various diagnoses (normal, perforation, retraction, middle ear effusion, tympanosclerosis). Otoscopy examinations used artificial‐intelligence (AI)‐based computer‐aided composite image generation from a video clip (SelectStitch), manually selected best still frame from a video clip (Still), or the entire video clip. Statistical analyses included comparisons of ability to detect correct diagnosis, confidence levels, and diagnosis times.ResultsThe ENT physicians' ability to detect ear abnormalities (33.2%‐68.7%) varied depending on the pathologies. SelectStitch and Still images were not statistically different in detecting abnormalities (P > .50), but both were different from Video (P < .01). However, the performance improvement observed with Videos came at the cost of significantly longer time to determining the diagnosis. The level of confidence in the diagnosis was positively associated with correct diagnoses, but varied by particular pathology.ConclusionThis study explores the potential of computer‐assisted techniques like SelectStitch in enhancing otoscopic diagnoses and time‐saving, which could benefit telemedicine settings. Comparable performance between computer‐generated and manually selected images suggests the potential of AI algorithms for otoscopy applications.