Background: Anatomy-based fitting (ABF) is a new research area in the field of cochlear implants (CIs). Despite the reported benefits and acceptable levels of ABF among CI recipients, some limitations remain, like the postoperative computed tomography (CT) scan, which is preferred for confirming electrode array insertion. Objective: This study aimed to investigate the feasibility of using plain film radiography (X-ray) for postoperative electrode detection and for building ABF as an alternative to CT. Methods: A total of 53 ears with CI were studied. All cases had routine post-insertion X-rays in the cochlear view and additionally underwent postoperative CT. The insertion angles and center frequencies measured by two independent observers were compared for each imaging modality. The angular insertion depth and center frequencies resulting from the X-ray and CT scans were then compared. Results: No significant differences were observed between the X-ray– and CT-measured angles for the electrode contacts. Radiographic measurements between the two readers showed an almost perfect (≥0.8) or substantial (0.71) intraclass correlation coefficient along the electrode contacts. X-ray images showed a mean difference of 4.7 degrees from CT. The mean semitone deviation of the central frequency between the CT and X-ray images was 0.6. Conclusions: X-ray imaging provides a valid and easy-to-perform alternative to CT imaging, with less radiation exposure and lower costs. The radiographs showed excellent concordance with the CT-measured angular insertion depth and consequently with the central frequency for most electrode contacts. Therefore, plain X-ray could be a viable alternative in building ABF for the CI recipients.

Objectives: The growing adoption of cochlear implants (CIs) necessitates understanding the factors influencing long-term performance and improved outcomes. This work investigated the long-term effect of early activation of CIs on electrode impedance in a large sample of CI users at different time points. Methods: A retrospective study on 915 ears from CI patients who were implanted between 2015 and 2020. According to their CI audio processor activation time, the patients were categorized into early activation (activated 1 day after surgery, n = 481) and classical activation (activated 4 weeks after surgery, n = 434) groups. Then, the impact of the activation times on the electrode impedance values, along the electrode array contacts, at different time points up to two years was studied and analyzed. Results: The early activation group demonstrated lower impedance values across all the electrode array sections compared to the classical activation at 1 month, 1 year, and 2 years post-implantation. At 1 month, early activation was associated with a reduction of 0.34 kΩ, 0.46 kΩ, and 0.37 kΩ in the apical, middle, and basal sections, respectively. These differences persisted at subsequent intervals. Conclusions: Early activation leads to sustained reductions in the electrode impedance compared to classical activation (CA), suggesting that earlier activation might positively affect long-term CI outcomes.

Objectives: To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS.Data Source: Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO).Review Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co‐anomalies; and duration of hearing loss and their relationships with FNS were also studied.Results: Twenty‐one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients.Conclusion: FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.

Cochlear implantation is the common treatment for severe to profound sensorineural hearing loss if there is no benefit from hearing aids. Measuring the electrode impedance along the electrode array at different time points after surgery is crucial in verifying the electrodes’ status, determining the compliance levels, and helping to identify the electric dynamic range. Increased impedance values without proper reprogramming can affect the patient’s performance. The prediction of acceptable levels of electrode impedance at different time points after the surgery could help clinicians during the fitting sessions through a comparison of the predicted with the measured levels. Accordingly, clinicians can decide if the measured levels are within the predicted normal range or not. In this work, we used a dataset of 80 pediatric patients who had received cochlear implants with the MED-EL FLEX 28 electrode array. We predicted the impedance of the electrode arrays in each channel at different time points: at one month, three months, six months, and one year after the date of surgery. We used different machine learning algorithms such as linear regression, Bayesian linear regression, decision forest regression, boosted decision tree regression, and neural networks. The used features include the patient’s age and the intra-operative electrode impedance at different electrodes. Our results indicated that the best algorithm varies depending on the channel, while the Bayesian linear regression and neural networks provide the best results for 75% of the channels. Furthermore, the accuracy level ranges between 83% and 100% in half of the channels one year after the surgery, when an error range between 0 and 3 KΩ is defined as an acceptable threshold. Moreover, the use of the patient’s age alone can provide the best prediction results for 50% of the channels at six months or one year after surgery. This reflects that the patient’s age could be a predictor of the electrode impedance after the surgery.

Background: Anatomy-based fitting (ABF) for cochlear implant users is a new era that seeks improved outcomes. Recently, different imaging modalities, such as plain X-rays, have been proposed to build the ABF as an alternative to the computed tomography (CT) scan. This study aimed to assess the feasibility and validity of OTOPLAN^® software in building ABF using plain X-ray imaging. Patients and methods: A retrospective evaluation of postoperative CT scans and plain X-ray post-op images of 54 patients was analyzed using the OTOPLAN^® software. The post-op analysis was done for the angular insertion depth (AID) and center frequency of each electrode contact using both imaging modalities. Moreover, inter-rater reliability was assessed for measurements obtained from CT scans and plain X-ray images. Results: Non-significant statistical and clinical mismatches were detected when comparing the AID and center frequency measurements assessed using CT and X-rays. The absolute difference between CT and X-ray approaches ranged from 0.0 to 4.6 degrees for AID and 0.2 to 0.5 semitone for frequency. Moreover, the AID and the frequency measurements from CT and X-ray images demonstrated almost perfect agreement between the raters. The inter-observer reliability for CT scans showed that the intraclass correlation coefficient (ICC) exceeded 0.97 for AID and 0.95 for the frequency across all electrode contacts. Conclusion: Our results demonstrated the validity and reliability of using post-operative X-ray images by OTOPLAN^® software to build Anatomy-based Fitting maps.