title: Hearing preservation after cochlear reimplantation.
abstract: OBJECTIVE
  The combination of electrical and acoustical hearing (EAS) is the aim of successful hearing preservation in patients with low-frequency residual hearing who receive a cochlear implant. With adequate surgical treatment and electrode arrays designed for hearing preservation, partial hearing preservation can nowadays be achieved in the majority of patients. Over recent years, the number of patients with EAS has increased, and device failures within this group are a problem that will need to be addressed. It remains unclear how reliably hearing can be preserved during revision surgery. The outcome of 3 subjects requiring cochlear reimplantation after surgery for hearing preservation is presented and discussed. Our aim was to investigate the influence of electrode reinsertion on hearing preservation.
  
  
  METHODS
  Three patients with measurable residual hearing were implanted with a flexible, free-fitting electrode array in 3 different centers.
  
  
  METHODS
  Two subjects received a 31.5-mm array inserted 24 mm into the cochlea, whereas a third was treated with a 24-mm array, which was inserted 21 mm into the cochlea. In all cases, hearing was preserved at the initial operation. All of these subjects subsequently represented with device problems, and reimplantation was performed.
  
  
  METHODS
  Hearing preservation was measured using preoperative and postoperative pure tone audiograms. In addition, speech perception with the implant was evaluated before and after reimplantation surgery.
  
  
  RESULTS
  Reimplantation was feasible in all subjects also in cases where a slightly deeper reinsertion was performed. Speech understanding scores after reimplantation were comparable to those seen after the first intervention.
  
  
  CONCLUSIONS
  Revision surgery in patients with preserved hearing after cochlear implantation does not necessarily lead to loss of natural residual hearing, and patients can continue to benefit from the combination of electric and acoustic hearing. Even deeper insertion is possible without hearing loss within residual frequencies.
authors.affiliation: Department of Otorhinolaryngology, Goethe University, Frankfurt, Germany. silke.helbig@kgu.de
authors.forename: Silke
authors.initials: S
authors.lastname: Helbig
authors.forename: Gunesh P
authors.initials: GP
authors.lastname: Rajan
authors.forename: Timo
authors.initials: T
authors.lastname: Stöver
authors.forename: Morag
authors.initials: M
authors.lastname: Lockley
authors.forename: Jafri
authors.initials: J
authors.lastname: Kuthubutheen
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Green
mesh_terms: D000161:Acoustic Stimulation; D000293:Adolescent; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D002648:Child; D019929:Cochlear Implantation; D003054:Cochlear Implants; D005260:Female; D006309:Hearing / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation