A COMPARISON OF IMPEDANCES, DYNAMIC RANGES AND … · 2018-04-03 · Background! • A pre-curved,...
Transcript of A COMPARISON OF IMPEDANCES, DYNAMIC RANGES AND … · 2018-04-03 · Background! • A pre-curved,...
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December 13, 2014!Sandra Velandia, AuD!Ear Institute, Miller School of Medicine, University of Miami!
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A COMPARISON OF IMPEDANCES, DYNAMIC RANGES AND NRTs FOR THE NUCLEUS 422 AND CONTOUR ELECTRODE ARRAYS
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Sandra Velandia, AuD Diane Martinez, AuD Annelle Hodges, PhD!Rosemary Ojo, MD Simon Angeli, MD!
University of Miami Ear Institute
Miller School of Medicine!
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Background!
• A pre-curved, perimodiolar electrode array was introduced by Cochlear Corporation in 2000 to replace the straight Nucleus 22.!
!
• Claudiu Treaba, Tom Roland and surgeons from Australia, Germany and the U.S. were major contributors in the design of the Contour Advance electrode.!
• With this design the stimulation contacts are placed closer to the spiral ganglion cells by matching the natural shape of the cochlea.!
• Focused spiral ganglion stimulation could be achieved with modiolar wall electrode placement.!
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Background!
• Research had shown that perimodiolar electrodes deliver unprecedented hearing performance, more focused stimulation and greater power efficiency.!
• With introduction of the contour electrode, changes in programming as compared to the N22 straight electrode were noted.!
• T and C levels seemed to be much more consistent.!!
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!
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N22 map!
Contour map!
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Background!
• Skarzynski et al.2012: preliminary report described the new, thinner, lateral wall intracochlear electrode array that was incorporated into the Nucleus Straight Research Array (SRA) cochlear implant. !
• Developed by the first author in collaboration with Cochlear Ltd., Sydney.!
• The SRA, renamed Slim Straight TM array, is now available in the Nucleus CI422.!
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Characteristics of the CA and the CI422!
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Characteristics! Contour Advance Electrode Array!
CI422 Electrode Array!
Design Concept! • Pre -Curved for perimodiolar wall placement (modiolus hugging)!
• Focused spiral ganglion stimulation and greater power efficiency !
• Slim Straight!• Smooth surface to
minimize trauma!• For lateral wall
placement !
Receiver Stimulator ! CIRE24! CIRE24!
Active Length ! 15 mm ! 20 mm !
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Characteristics of the CA and the CI422!
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Characteristics! Contour Advance Electrode Array!
CI422 Electrode Array!
Diameter at apex! 0.5 mm! 0.3 mm !Diameter at base! 0.8 mm! 0.6 mm !Diameter at tip! 0.2 mm!Electrode Contacts ! • 22 half- banded!
• Medial facing!• Larger surface
contact positioned in a non-uniform arrangement!
• 22 half- banded!• Medial facing!
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Case study-Map comparison!
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CI 422!
Contour!
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Examples of programming with the two electrodes!
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Contour map!
CI422 map!
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Hypothesis!
The modiolar wall placement of the Contour electrode produces more consistent proximity to the spiral ganglion cells and thus results in more consistent T and C levels, greater power efficiency, and less variation in impedances than the Slim Straight lateral wall design.!
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Methods: Procedures!
• Retrospective chart review!• Data recorded at second programming and at 3 to 6 month
programming sessions!• Data analyzed statistically to determine if actual differences exist
between the two electrode designs!
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Methods: Procedures!
• Data recorded included:!§ Threshold levels!§ Comfort levels!§ NRT thresholds!§ Dynamic range!§ Pulse width!§ Impedances!
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Methods: Subjects!• 91 subjects for impedance comparison!
§ 62 CI 422 patients implanted between 2012 and 2014!§ 29 Contour Advance patients implanted between 2011
and 2014!§ No CI512 patients were included!
• Gender!§ 43 female!§ 48 male!
• Mean age at implant 46!• Age range 7 months to 89 years!
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Methods: Subjects!• 54 subjects with complete data:!
§ 40 CI 422 users!§ 14 Contour users!
• Gender!§ 28 females!§ 25 males!
• Mean age at implantation 46 years!• Age range 5-89 years!
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Methods: Subjects!
!• Inclusion criteria included:!
§ Programmed by counting T levels!§ Consistent and reliable judgment of C levels or presence of stapedial
reflexes!
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Results!
Are T and C levels different for the two electrode designs?!!This could not be analyzed with current data. Variations in PW could not be taken into account due to sample sizes!
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Results!
Are pulse widths different between the two electrode designs?!!!
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25! 37! 50!
422! 57%! 38%! 5%!
Contour! 79%! 21%! 0%!
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Results!Are impedances different for the two electrode designs? No significant differences at 95% confidence intervals!!!
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5.00!6.00!7.00!8.00!9.00!
10.00!11.00!12.00!13.00!
1! 2! 3! 4! 5! 6! 7! 8! 9!10!11!12!13!14!15!16!17!18!19!20!21!22!
Impe
danc
e!Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
5.00!6.00!7.00!8.00!9.00!
10.00!11.00!12.00!13.00!
1! 2! 3! 4! 5! 6! 7! 8! 9! 10!
11!
12!
13!
14!
15!
16!
17!
18!
19!
20!
21!
22!
Impe
danc
e!
Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
2nd visit
3 to 6 mo visit
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Results!Are dynamic ranges different between the two electrode designs?!No significant differences at 95% confidence intervals for any electrodes!
!!
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45.00!
50.00!
55.00!
60.00!
65.00!
70.00!
1! 2! 3! 4! 5! 6! 7! 8! 9!10!11!12!13!14!15!16!17!18!19!20!21!22!
Dyn
amic
Ran
ge!
Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
45.00!
50.00!
55.00!
60.00!
65.00!
70.00!
1! 2! 3! 4! 5!6! 7! 8! 9!10!11!12!13!14!15!16!17!18!19!20!21!22!
Dyn
amic
Ran
ge!
Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
2nd visit!
3 to 6 mo visit!
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Results!Are NRTs different between the two electrode designs?!No significant differences at 95% confidence intervals for any electrodes!
!!
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120.00!130.00!140.00!150.00!160.00!170.00!180.00!190.00!200.00!
1! 2! 3! 4! 5! 6! 7! 8! 9!10!11!12!13!14!15!16!17!18!19!20!21!22!
NR
T!Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
120.00!130.00!140.00!150.00!160.00!170.00!180.00!190.00!200.00!
1! 2! 3! 4! 5! 6! 7! 8! 9!10!11!12!13!14!15!16!17!18!19!20!21!22!
NR
T!
Electrode!
Contour!
Slim!
Contour(95%CI)!
Slim(95%CI)!
2nd visit!
3 to 6 mo visit !
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Conclusions!!• Even though there were no significant differences at
95% confidence intervals, there were trends that reflected our clinical impressions and may bear further study.!
• There is too much variability in programming across patients to generalize (levels needs).!
• Clinical application: Every patient has to be programmed on an individualized basis. We cannot assume all 422 DRs are narrower across the array, or that all Contour impedances are lower.!
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Future directions!
• Speech perception results !• Hearing preservation!
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