Objective. Despite the widespread use and technical improvement of cochlear implant (CI) devices over past decades, further research into the bioelectric bases of CI stimulation is still needed. Various stimulation modes implemented by different CI manufacturers coexist, but their true clinical benefit remains unclear, probably due to the high inter-subject variability reported, which makes the prediction of CI outcomes and the optimal fitting of stimulation parameters challenging. A highly detailed full-head model that includes a cochlea and an electrode array is developed in this study to emulate intracochlear voltages and extracochlear current pathways through the head in CI stimulation. Approach. Simulations based on the finite element method were conducted under monopolar, bipolar, tripolar (TP), and partial TP modes, as well as for apical, medial, and basal electrodes. Variables simulated included: intracochlear voltages, electric field (EF) decay, electric potentials at the scalp and extracochlear currents through the head. To better understand CI side effects such as facial nerve stimulation, caused by spurious current leakage out from the cochlea, special emphasis is given to the analysis of the EF over the facial nerve. Main results. The model reasonably predicts EF magnitudes and trends previously reported in CI users. New relevant extracochlear current pathways through the head and brain tissues have been identified. Simulated results also show differences in the magnitude and distribution of the EF through different segments of the facial nerve upon different stimulation modes and electrodes, dependent on nerve and bone tissue conductivities. Significance. Full-head models prove useful tools to model intra and extracochlear EFs in CI stimulation. Our findings could prove useful in the design of future experimental studies to contrast FNS mechanisms upon stimulation of different electrodes and CI modes. The full-head model developed is freely available for the CI community for further research and use.

Background/Objectives: Cochlear implantation (CI) has been shown to be effective in children with inner ear malformations (IEMs). However, outcomes vary with malformation type and anatomical complexity. Advances in radiological classification may improve the understanding of such variability to better guide patient counseling. We aimed to assess one-year post-implant auditory outcomes in children with IEMs using radiology-based classifications, and to explore genetic and perinatal predictors. We also propose a preliminary severity score derived from the INCAV system. Methods: Out of 303 pediatric CI recipients assessed at a tertiary center, we retrospectively analyzed 41 children (82 ears) diagnosed with IEMs. Malformations were categorized with the Sennaroğlu system and re-coded using INCAV, from which a severity score was derived. Postoperative outcomes were assessed in 56 implanted ears, including pure-tone average (PTA), word recognition score (WRS), and post-surgical complications. Statistical analyses included Spearman’s correlation, linear regression, and exploratory discriminant MANOVA. Results: The most frequent malformation was enlarged vestibular aqueduct (33%), followed by incomplete partition type II (22%). CI was performed in 56 malformed ears with a complication rate of 10.7%. PTA and WRS correlated with the INCAV-derived severity score, with higher severity linked to poorer thresholds and lower WRS. Linear regression showed severity explained ~20% of PTA variance, with outcomes more frequently impaired in ears with scores > 3. Exploratory analysis revealed inter-subject variability, with partial separation of mild versus moderate/severe groups mainly driven by PTA and WRS. Conclusions: CI in pediatric IEMs is safe and consistently improves hearing thresholds. PTA was the most robust predictor of performance, while the INCAV-derived severity score, though exploratory, may provide additional value for anatomical stratification, prognostic counseling, and rehabilitation planning.

Background: Traditional audiological assessment often does not properly reflect the challenges experienced by cochlear implant (CI) users in complex listening environments. Deficits in speech recognition and sound localization ability persist despite clinically satisfactory audiometric thresholds. Objective: The objective of this study is to evaluate the impact of acoustic environment complexity on speech recognition and sound localization ability in CI users compared to normal-hearing (NH) individuals and to assess subjective auditory performance using validated questionnaires. Methods: Thirty-four unilateral CI users and fifty NH participants were evaluated in a sound environment audiometric room equipped with an eight-speaker 360° array. The variables examined were pure-tone average (PTA), word recognition score (WRS) in quiet and noise (sea, traffic, cafeteria), sound localization ability, and the SSQ-12 auditory quality questionnaire. Correlation, regression, and MANOVA analyses examined associations among objective and subjective outcomes. Results: CI users exhibited significantly lower WRS in quiet and noise conditions, reduced sound localization, and decreased SSQ-12 scores compared to NH participants, with performance declining as noise complexity increased. Pre-implant PTA was the strongest predictor of post-implant speech recognition. No significant differences were observed between unilateral CI users and those with bimodal fittings. The SSQ-12 questionnaire correlated with objective measures, supporting its clinical relevance. Conclusions: CI users exhibit persistent deficits in ecologically valid listening conditions not demonstrated by standard audiometry. Integrating sound field testing and validated hearing quality questionnaires may provide a more comprehensive assessment to guide personalized rehabilitation and device programming.