Cochlear implantation with the nucleus slim straight electrode in subjects with residual low-frequency hearing.

OBJECTIVES: To measure benefit in terms of speech recognition in quiet and in noise, and conservation of residual hearing in three groups of subjects implanted with the Nucleus Straight Research Array cochlear implant. This device incorporates the Nucleus Slim Straight electrode carrier designed to be easier to insert into the cochlea via the round window while potentially minimizing insertion trauma.

DESIGN: The study was prospective, with sequential enrolment and within-subject repeated measures; 35 subjects were 15 to 84 years of age with varying levels of bilateral high-frequency HL. Subjects were divided into three groups (A, B, and C) according to preoperative air conduction hearing thresholds in the ear to implant at 500 Hz; A ≤ 50 (n = 11), 50 < B < 80 (n = 13), and C ≥ 80 (n = 11) dB HL. Speech recognition was assessed preoperatively and at intervals up to 1 year postimplantation. Hearing thresholds were monitored over time and CT scans were used to estimate electrode positions.

RESULTS: Preoperative mean word recognition score was significantly greater for group A compared with group C in quiet (diff. 26.6%pts, p < 0.05), but not so in noise (diff. 7.9%pts, p = 0.72). However, a greater proportion of subjects in group A (81%) achieved a "worthwhile" gain in speech recognition score (>20%pts) in quiet compared with group C (63%). More importantly, for speech recognition in noise, all subjects in groups A and B achieved a >20%pts gain compared with only 73% in group C. Hearing in implanted ears was well conserved for low frequencies, both initially and up to 12 months postoperatively (15 dB median increase in thresholds 250 to 500 Hz). Only 3 of 35 (9%) cases lost all residual hearing in the implanted ear by 12 months. Where characteristic frequency corresponded to a position occupied by the electrode array, threshold increase was correlated with the preoperative hearing threshold (r = 0.7; p < 0.001) and closely approximated reported estimates of residual outer hair cell gain. For characteristic frequencies at positions apical to the electrode tip, the relation between threshold increase and residual hearing decreased in amplitude at 45 to 135 degrees (r = 0.42; p < 0.05), and disappeared at >135 degrees (r = 0.05; p > 0.05).

CONCLUSION: Gains in speech recognition scores for subjects with better residual low-frequency hearing were greater or equal to those obtained by subjects with poorer residual hearing. Residual hearing after cochlear implantation with the Nucleus Slim Straight electrode array was well conserved across all three groups. It appears that the gain provided by outer hair cell function may be completely suppressed when an electrode array is in close proximity to the organ of Corti.