title: Cochlear implantation in obstructed cochleas: the effect of the degree of obstruction on the number of activated electrodes and the amount of postoperative speech perception.
abstract: OBJECTIVE
  With cochlear implantation, insertion of the electrodes can be hampered by cochlear obstructions. The aim of this study was to investigate the effects of these obstructions on the number of activated electrodes and postoperative speech perception.
  
  
  METHODS
  Retrospective analysis of the operation reports and CT-scans of patients who underwent cochlear implantation, at the Department of Otorhinolaryngology of the University Medical Center of Utrecht (n = 295).
  
  
  METHODS
  Fifty patients with a certain degree of cochlear obstruction were included. Based on the surgical intervention to overcome these obstructions they were subdivided into first-, second- and third degree obstructions. The number of implanted and activated electrodes was determined.
  
  
  METHODS
  Three different speech perception tests after 12 months of cochlear implant use.
  
  
  RESULTS
  The number of activated electrodes significantly diminished with increasing obstruction degree (P < 0.01). This was caused by a lower amount of implanted electrodes combined with a higher amount of switched off electrodes. With a higher degree of obstruction the amount of postoperative speech perception decreased significantly (P < 0.01). This is partly explained by the lower number of activated electrodes and partly explained by the fact that a higher obstructions degree correlates with a higher degree of (retro-) cochlear pathology. Significantly more electrodes can be inserted into the severely obstructed cochlea using a Double Array Cochlear Implant.
  
  
  CONCLUSIONS
  Cochlear obstructions pose a surgical threat and negatively influence the postoperative speech perception results. Fortunately, due to surgical techniques, first and second degree obstructed cochleas can often be bypassed. Implanting of a Double Array implant brightens the prospects of patients with third (severe) degree obstructed cochleas.
authors.affiliation: Department of Otorhinolaryngology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: Rinia
authors.forename: A F
authors.initials: AF
authors.lastname: Olphen
authors.forename: E A
authors.initials: EA
authors.lastname: Dunnebier
mesh_terms: D001302:Audiometry, Speech; D015834:Cochlear Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019929:Cochlear Implantation / Q000295:instrumentation / Q000379:methods; D003054:Cochlear Implants; D006320:Hearing Tests; D006801:Humans; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013067:Speech Perception; D013701:Temporal Bone / Q000000981:diagnostic imaging; D016896:Treatment Outcome