title: Elimination of facial nerve stimulation by reimplantation in cochlear implant subjects.
abstract: OBJECTIVE
  Perimodiolar intracochlear electrodes with contacts facing towards the modiolus have limited current flow towards the outer wall of the cochlea and therefore, may reduce the occurrence of facial nerve stimulation (FN) in cochlear implant subjects.
  
  
  BACKGROUND
  Facial nerve stimulation is a well-known complication in cochlear implant treatment especially in the group of subjects with otosclerosis. The possible explanation of this side effect is a change of the electrical properties of the otosclerotic bone leading to leakage current and resulting in facial nerve stimulation.
  
  
  METHODS
  Four CI subjects who had been implanted with a Nucleus Mini22 device with a Nucleus Straight electrode between 9 to 12 years ago suffered from severe FN stimulation. Electrode contacts had to be switched off so that they could only use 4, 11, 13, and 15 electrodes of their usual set of 22. The switch off resulted in deteriorating speech understanding over time. Therefore, all subjects were reimplanted with a Nucleus 24R device with a Contour electrode. Preoperatively, the threshold of FN stimulation was obtained on all electrodes subjectively. Intraoperatively, FN stimulation thresholds were measured objectively with both, the old and the new device and were compared. NRT and SRT thresholds were also obtained with the reimplanted device to assure effective electrical stimulation of the auditory nerve.
  
  
  RESULTS
  In all four cases the postoperative fitting demonstrated no FN stimulation on all electrodes up to maximum comfortable level. The insertion of the Contour electrode array was complete in three cases, in one case the array could only be inserted partially similarly to the situation before the reimplantation. Speech perception tests showed a significant improvement in all subjects with the new device.
  
  
  CONCLUSIONS
  Electrodes with modiolar facing contacts and perimodiolar position like the Nucleus Contour electrode reduce the possibility of facial nerve stimulation significantly due to more focused electrical stimulation.
authors.affiliation: Department of Otolaryngology, Medizinische Hochschule, Germany. battmer.rolf-dieter@mh-hannover.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Battmer
authors.forename: Joerg
authors.initials: J
authors.lastname: Pesch
authors.forename: Timo
authors.initials: T
authors.lastname: Stöver
authors.forename: Anke
authors.initials: A
authors.lastname: Lesinski-Schiedat
authors.forename: Minoo
authors.initials: M
authors.lastname: Lenarz
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
mesh_terms: D000328:Adult; D000368:Aged; D003051:Cochlea / Q000601:surgery*; D019929:Cochlear Implantation / Q000009:adverse effects* / Q000379:methods; D003054:Cochlear Implants / Q000009:adverse effects*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D005152:Facial Muscles / Q000294:innervation; D005154:Facial Nerve / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D012022:Reflex, Acoustic / Q000502:physiology; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome