title: Conservation of low-frequency hearing in cochlear implantation.
abstract: OBJECTIVE
  As results with cochlear implants have continued to improve, patients with some remaining cochlear function have become eligible for cochlear implantation. Thus, preservation of acoustic hearing after implantation has gained importance. Hearing preservation can be considered a benchmark for atraumatic implantation preventing neural degeneration from loss of residual hair cells or subsequent to local trauma. In this prospective study, the possibility of preserving low-frequency hearing in cochlear implantation using a modified surgical technique has been explored.
  
  
  METHODS
  In a prospective study design, 14 subjects with considerable low-frequency hearing of 20-60 dB in the frequency range 125-500 Hz but with unsatisfactory speech understanding with hearing aids of < 35% monosyllabic word understanding were implanted with a MED-EL COMBI-40+ cochlear implant. The insertion depth was intentionally limited to 19-24 mm to prevent damage to low-frequency regions of the cochlea. Pre- and postoperative pure-tone thresholds were measured.
  
  
  RESULTS
  Hearing was conserved within 0-10 dB in 9/14 subjects and within 11-20 dB in 3/14; in 2/14 subjects hearing was completely lost in the implanted ear. Thus hearing could at least partially be conserved in 12/14 subjects (86%). Median threshold values decreased by 10, 15, 17.5 and 5 dB at 125, 250, 500 and 1000 Hz, respectively. Even high levels of hearing, e.g. 30 dB at 500 Hz, could be maintained after implantation in some subjects.
  
  
  CONCLUSIONS
  This study reports successful conservation of hearing after cochlear implantation using a modified surgical technique. Even high levels of hearing could be maintained, showing that implantation of an intracochlear electrode can be performed atraumatically with preservation of functional structures.
authors.affiliation: Clinic of Otorhinolaryngology, Head and Neck Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. J.Kiefer@em.uni-frankfurt.de
authors.forename: Jan
authors.initials: J
authors.lastname: Kiefer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gstoettner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Baumgartner
authors.forename: Stephan Marcel
authors.initials: SM
authors.lastname: Pok
authors.forename: Jochen
authors.initials: J
authors.lastname: Tillein
authors.forename: Qing
authors.initials: Q
authors.lastname: Ye
authors.forename: Christoph
authors.initials: C
authors.lastname: von Ilberg
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome