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Quality of insertion in cochlear implants : a clinical and temporal bone study

Abstract : The cochlear implantation represents the standard technique to restore the hearing in totallydeafened persons, and the indications during the last years are widening also to patients withresidual hearing or presenting single sided deafness. Despite the overall good to very goodresults after cochlear implantation reported in literature a wide heterogeneity of the hearingoutcomes emerges in the single studies and poor results both in unilateral and bilateralcochlear implantation are still reported. Several patients’ specific factors have been identifiedas affecting postimplant speech perception score, including duration of deafness, residualpreoperative speech recognition, and different speech coding strategy. In this thesis theanatomy of the cochlea and the position of the electrode array in implanted patients have beenstudied with the attempt to identify the affecting factors that contribute to the variability of theinter- and intra-individual speech discrimination scores both in bilaterally and unilaterallyimplanted patients. Moreover, following the expanding indication for cochlear implantation,the preservation of inner ear structures is becoming recommended for all cochlear implantcandidates, regardless of their preoperative hearing. A radio-histological temporal bone studywith a motorized insertion of the array was performed in order to identify the insertion forcesparameters that could predict the possible traumatism involving the inner ear. The results ofthis thesis showed a relationship between the intracochlear electrode position and hearingperformance in the short term follow up, whereas the neural plasticity would play animportant role in the adaptation of the cochlear implant to the neural structures in the longterm. A correlation between insertion forces and inner ear traumatism was found in temporalbones. Two different force profiles for traumatic and atraumatic insertion were obtained; thesevalues, if confirmed by further studies, could be useful for the development of future forcefeedback automated cochlear implant insertion tool in order to reduce the risk of insertionrelated damage and provide the best chance for an optimal hearing rehabilitation in cochlearimplanted candidates.
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Submitted on : Monday, December 5, 2016 - 11:46:05 AM
Last modification on : Thursday, December 10, 2020 - 11:04:24 AM
Long-term archiving on: : Monday, March 20, 2017 - 9:32:33 PM


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  • HAL Id : tel-01408709, version 1


Daniele de Seta. Quality of insertion in cochlear implants : a clinical and temporal bone study. Sensory Organs. Université Pierre et Marie Curie - Paris VI; Università degli studi La Sapienza (Rome), 2016. English. ⟨NNT : 2016PA066174⟩. ⟨tel-01408709⟩



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