title: Implications of minimizing trauma during conventional cochlear implantation.
abstract: OBJECTIVE
  To describe the relationship between implantation-associated trauma and postoperative speech perception scores among adult and pediatric patients undergoing cochlear implantation using conventional length electrodes and minimally traumatic surgical techniques.
  
  
  METHODS
  Retrospective chart review (2002-2010).
  
  
  METHODS
  Tertiary academic referral center.
  
  
  METHODS
  All subjects with significant preoperative low-frequency hearing (≤70 dB HL at 250 Hz) who underwent cochlear implantation with a newer generation implant electrode (Nucleus Contour Advance, Advanced Bionics HR90K [1J and Helix], and Med El Sonata standard H array) were reviewed.
  
  
  METHODS
  Preimplant and postimplant audiometric thresholds and speech recognition scores were recorded using the electronic medical record.
  
  
  METHODS
  Postimplantation pure tone threshold shifts were used as a surrogate measure for extent of intracochlear injury and correlated with postoperative speech perception scores.
  
  
  RESULTS
  : Between 2002 and 2010, 703 cochlear implant (CI) operations were performed. Data from 126 implants were included in the analysis. The mean preoperative low-frequency pure-tone average was 55.4 dB HL. Hearing preservation was observed in 55% of patients. Patients with hearing preservation were found to have significantly higher postoperative speech perception performance in the CI-only condition than those who lost all residual hearing.
  
  
  CONCLUSIONS
  Conservation of acoustic hearing after conventional length cochlear implantation is unpredictable but remains a realistic goal. The combination of improved technology and refined surgical technique may allow for conservation of some residual hearing in more than 50% of patients. Germane to the conventional length CI recipient with substantial hearing loss, minimizing trauma allows for improved speech perception in the electric condition. These findings support the use of minimally traumatic techniques in all CI recipients, even those destined for electric-only stimulation.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Colin L W
authors.initials: CL
authors.lastname: Driscoll
authors.forename: René H
authors.initials: RH
authors.lastname: Gifford
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Service
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tombers
authors.forename: Becky J
authors.initials: BJ
authors.lastname: Hughes-Borst
authors.forename: Brian A
authors.initials: BA
authors.lastname: Neff
authors.forename: Charles W
authors.initials: CW
authors.lastname: Beatty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D002648:Child; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013067:Speech Perception / Q000502:physiology*; D016896:Treatment Outcome