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Interdependence of the dimensions of the cochlea and scalar position of the electrode array
Beck R.L. , Arndt S. , Hassepaß F. , Ketterer M. , Wesarg T. , Laszig R. , Aschendorff A.
Medical Center - Freiburg University, Department of Oto-Rhino-Laryngology, Freiburg, Germany
Introduction: The anatomy of the cochlea is quite constant in some respects, more variable in others like length
of the cochlear duct and size. Therefore, the electrode positions of the electrode array can vary significantly
regardless of the insertion technique and may have an effect regarding the auditory outcome. Traumatization of
the cochlea - indicated by scalar dislocation for example - may be detrimental in regard to future technology like
hair cell regeneration or light based stimulation of the cochlear nerve as it may promote degeneration of ganglion
cells. As type of electrode array and the implantation process are under control of the surgeon implanting, it is
important to understand the interdependency of array and anatomy of the cochlea to optimize the position of the
electrode array.
Methods: 440 adult patients (518 ears) without cochlear anomalies have been implanted with a perimodiolar
electrode array (contour advanced, Cochlear) in the years 2003 to 2010 at the Department of Oto-RhinoLaryngology, Medical Center - University of Freiburg. Cone beam tomography is used for postoperative
evaluation regularly and has been analyzed in regard to electrode position (scala, insertion angle) and cochlear
size (diameters and height). Speech discrimination scores have been collected during the postoperative
rehabilitation phase using the Freiburg monosyllables and Oldenburg sentence test.
Results: Speech perception is influenced by the scalar position of the electrode, albeit a small effect size. Scalar
dislocation is most likely to occur after the first half turn, no reliable correlation between the cochlear dimensions
and probability of dislocation could be found.
Conclusion: Due to the small effect sizes expected, a higher number of samples may be necessary to show the
effects of the size relation between cochlea and electrode array. Nevertheless, postoperative quality control in
the form of imaging techniques and the prevention of cochlear damage is important to optimize the surgical
technique. Cochlear trauma may not only be detrimental to future techniques of hearing rehabilitation but
influences speech discrimination outcomes.
Learning outcome: The listener will learn about the variations in cochlear anatomy and factors in scalar