Facial nerve stimulation after cochlear implantation according to types of Nucleus 24-channel electrode arrays

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acta oto-laryngologica (Impact Factor: 1.1). 09/2008; 129(6):588-91. DOI: 10.1080/00016480802325965
Source: PubMed


In this study, we concluded that electrode design and location did not have a high level of influence on the prevalence of facial nerve stimulation (FNS) in normal cochleae.
To analysis the prevalence of FNS after cochlear implantation with Nucleus 24-channel devices according to types of electrodes arrays.
We retrospectively analyzed medical and mapping records of 394 patients who received cochlear implants (CIs) manufactured by Cochlear Corporation from April 1999 to March 2007.
In all, 23 of 394 (5.8%) patients had FNS (CI24M 4 of 39 [10.3%], CI24RCS 9 of 192 [4.7%], CI24RST 9 of 21 [42.9%], and CI24RECA 1 of 87 [1.1%]). In addition, 4 of 324 (1.2%) patients with normal cochleae complained of FNS (CI24M 1 of 33 [3.0%], CI24RCS 2 of 173 [1.2%], and CI24RECA 1 of 71 [1.4%]). There was no difference between straight and perimodiolar electrode arrays in patients with normal cochleae. In addition, when comparing two types of Contour electrodes, Contour Advance (soft-tip) electrodes offered significantly lower incidence of FNS than Contour electrode arrays. We could manage these patients with methods such as decrease of C-level, selective channel turning off, and changes of mapping strategies.

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    • "In the literature, no difference in the incidence of FNS, between perimodiolar and straight electrodes, in patients with normal cochleas, has been reported 7 12 25. Ahn et al. 25 reported a difference in the incidence of FNS between the devices with perimodiolar electrodes; it was significantly lower in patients with the Nucleus Contour Advance Soft Tip than in patients with the Nucleus Contour. This could be due to the design of this array studied in order to preserve the delicate structure and minimize lateral wall forces on the cochlea during the insertion. "
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    ABSTRACT: Post-implantation facial nerve stimulation is one of the best known and most frequent complications of the cochlear implant procedure. Some conditions, such as otosclerosis and cochlear malformations, as well as high stimulation levels that may be necessary in patients with long auditory deprivation, expose patients to a higher risk of developing post-implant facial nerve stimulation. Facial nerve stimulation can frequently be resolved with minimal changes in speech processor fitting but, in some cases, this can lead to a reduction in the outcome. A retrospective review has been made of the clinical features of 11 patients (out of 119 patients consecutively implanted, from 1999 to 2007, at the ENT Clinic of the University of Pisa) who developed post-implantation facial nerve stimulation.
    Full-text · Article · Feb 2011 · Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale
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    ABSTRACT: We had a case of 75-year old man with a history of progressive hearing loss on both sides who implanted with a Nu-cleus 24 Contour Advance in the right ear. After 4 years from implantation, the patient started to complaint of right fa-cial twitching when his cochlear implant was active. Despite undergoing numerous alterations in his implant program-ming, facial nerve stimulation (FNS) persisted. After increasing the pulse width and changing the stimulation mode, there was no facial nerve stimulation. However there was a deterioration in hearing and speech understanding. CT of the temporal bone showed good position of the implant electrodes und cochleomeatal scintigraphy (CMS) showed a highly positive activity with suspicion of otosclerosis, although the medical history was negative for otosclerosis. The FNS was managed with cochlea reimplantation and advanced programming techniques. FNS in cochlear implant pa-tients may be managed through reimplantation and advanced programming techniques.
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    ABSTRACT: In a common cavity (CC) deformity, the cochlea and vestibule are confluent to form a single cavity without internal architecture, and distribution of auditory neuronal tissue is unclear. The purposes of this study are to reveal the spatial distribution of auditory neuronal tissue in CC deformity using electrically evoked auditory brainstem response (EABR) during cochlear implantation. Retrospective case review. Cochlear implant (CI) center at a tertiary referral hospital. Five patients with CC deformity who underwent cochlear implantation and intraoperative EABR testing. Spatial distribution of electrodes that elicited an evoked wave V (eV) in EABR testing was evaluated in each CC deformity. Electrically evoked auditory brainstem response testing demonstrated that electrodes attached on the inner wall of the anteroinferior cavity of the CC deformity successfully elicited a reproducible eV in all cases, and the latency of each eV was an approximately 4 ms, which is similar to those reported in patients without an inner ear malformation. Interestingly, in Case 1 with the lowest percentage of eV-positive electrodes (31.8%), CI-aided audiometric thresholds were changed, depending on the frequency allocation to eV-positive electrodes in the programming. Cochlear implant-mediated facial nerve stimulation was observed in 3 of 5 cases, and results of EABR testing were useful for optimizing the device program to decrease facial nerve stimulation without sacrificing CI-mediated auditory performance. The results of EABR testing suggested that auditory neuronal elements are distributed to the anteroinferior part of CC deformity, mainly around or near the inner wall of the cavity. In cases with CC deformity, EABR testing is useful to achieve the optimal electrode array placement and to adjust programming parameters of the implanted device, which might be essential to maximize CI outcomes and to decrease facial nerve stimulation.
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