Browsing by Subject "Cochlear Implantation"
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Item Barriers to Cochlear Implantation(2021-05-01T05:00:00.000Z) Balachandra, Sanjana; Hunter, Jacob B.; Kutz, J. Walter; Isaacson, BrandonINTRODUCTION: Cochlear implantation (CI) is the most effective treatment for profound sensorineural hearing loss, despite the low utilization of CI in the United States. Only about 5-7% of CI-eligible adults pursue CI, for reasons which remain unclear. OBJECTIVE: Our research has two primary aims: 1) to identify sociodemographic disparities in CI in Texas and explore trends using an all-payer database from 2010-2017; and 2) to investigate patient-reported barriers to, and motivators for, pursuing CI. METHODS: Aim 1) The publicly available Texas Outpatient Surgical and Radiological Procedure Data was accessed to analyze outpatient CI cases in the entire state of Texas. Variables analyzed include patient age, sex, race/ethnicity, and insurance status. Population data from the American Community Survey were utilized to generate CI utilization rates by patient demographic characteristics. Insurance data was obtained from the Kaiser Family Foundation. Aim 2) A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery, as well as those who pursued surgery after a delayed time period or at a different institution. A 21-question survey was developed internally, aimed at identifying and ranking patients' concerns regarding surgical risks, adaptation to the CI, time commitment to adapt, costs, loss of residual hearing, and lack of benefit. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered via email or telephone. RESULTS: Aim 1) 6,158 CI cases were identified during the study period. The number of CI per year nearly doubled from 497 in 2010 to 961 in 2017. The majority of CI recipients were white (59.5%), male (51.9%), and privately insured (47.9%). Patients over 75 demonstrated the greatest increase in the CI rate per 100,000 population, increasing from 4.60 in 2010 to 14.30 in 2017. All racial/ethnic groups noted an increase in the CI per 100,000 population, with white patients demonstrating the highest rate in 2017, at 4.36 CI per 100,000 population. Asian patients had a 502% increase in the CI rate (from 0.42 to 2.53), compared with 87.9%, 84.4%, and 69.2% increases for White, Black, and Hispanic populations, respectively. Medicaid recipients were the only insurance group that did not experience a statistically significant growth from 2010-2017 (3.27 to 3.49, p=0.26). Aim 2) Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. The most commonly reported barrier was a belief that CI would not significantly improve the ability to communicate, followed by concerns over the post-operative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. The most commonly reported facilitator was a belief that hearing loss was affecting job performance. CONCLUSIONS: CI became more widespread between 2010-2017; however, vast disparities exist in who benefitted most from this growth in CI. Black and Hispanic populations had lower CI per 100,000 population than their white peers, while patients >65 years of age accounted for the greatest increase in CI. Moreover, the decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery. Resources should be devoted to promote CI to disadvantaged groups as identified in our research.Item Minimizing Insertion Trauma with a Novel Shape Memory Polymer Cochlear Implant Array(2016-01-19) Lee, Roxanne; Pham, Tiffany; Ajieren, Hans; Shao, Dongmei; Voit, Walter; Lee, KennethHYPOTHESIS: Novel self-coiling electrode arrays made of shape memory polymer allow for atraumatic implantation of cochlear implants, minimizing loss of residual hearing and maximizing hearing outcomes for cochlear implant patients. BACKGROUND: Cochlear implants are effective devices in improving the hearing experiences of patients with severe to profound hearing loss. However, current cochlear implants are linear and collide with cochlear walls upon implantation into the cochlear spiral. This traumatic contact results in destruction of inner ear structures and a subsequent inflammatory response, leading to loss of residual hearing and submaximal patient outcomes post-implantation. Shape memory polymers (SMP), which can store a metastable shape and return to it in response to a stimulus, can be customized to fit perfectly into a patient's cochlea. Thus, an SMP cochlear implant electrode array can be straight and stiff enough to facilitate implant manufacturing, yet soften upon warming to body temperature and self-navigate through the cochlear spiral without contacting cochlear walls for totally atraumatic implantation. RESULTS: We have created a novel shape memory polymer cochlear implant electrode array that self-navigates through the cochlear spirals to allow for full and completely atraumatic insertion. We have also constructed a robotic linear actuator to provide consistent and controllable insertion of our SMP implants. Histological studies performed on implanted rat cochlea show lack of trauma to inner ear structures in cochlea implanted with SMP implants, indicating the superiority of our SMP implants over more traumatic conventional linear implants. CONCLUSIONS: We have demonstrated that shape memory polymers can be used in a novel way to make self-coiling cochlear implants that offer full yet atraumatic insertion, minimizing the adverse side effects usually experienced with implantation of more traumatic conventional linear implants.Item Reflections on a Single Institution Cochlear Implant Experience(2020-05-01T05:00:00.000Z) Schauwecker, Natalie Marie-Rose; Hunter, Jacob B.; Kutz, J. Walter; Isaacson, BrandonOBJECTIVE: To utilize cochlear implant (CI) outcomes to further explore health disparities, hearing preservation (HP) surgery, and standardization of pre- and post-operative CI assessment, with the goal of predicting and improving CI outcomes, including quality of life. STUDY DESIGN: Retrospective chart review of adult patients who underwent CI evaluation and surgery at a single institution between 2009 and 2018. MAIN OUTCOME MEASURES: Improvement in open sentence testing postoperatively, according to patient marital status, race, and gender, as well as HP status. RESULTS: Post-operative performance: Of the 402 total patients who underwent CI during the study period, 372 were followed and programmed at the institution. A total of 87% of these patients achieved "good performance" with their CI, based upon an improvement in post-operative open sentence testing ≥10%. Patient demographics, including gender, age, marital status, and race did not significantly affect whether a patient achieved higher post-operative performance levels. Unmarried patients saw poorer outcomes, but this did not reach significance (37.5% vs 24.3%, p = 0.2123). HEARING PRESERVATION: HP surgery evolved during the study period, with modern "soft surgery" technique defined by perioperative steroids, round window cochleostomy, and atraumatic CI insertion. A slight majority of HP surgical patients maintained low frequency hearing postoperatively (54.2%). However, documentation of preserved hearing was limited, with only 53.7% of patients with recorded unaided audiograms. Analyzing speech perception outcomes, HP candidates, and patients who underwent "soft surgery," did not demonstrate significantly larger improvements with their post-operative open sentence testing when compared to patients who underwent standard CI, and were concurrently not HP candidates, during the study period (overall improvement: 41% vs 53% respectively, p = 0.10). Additionally, non-white hearing preservation candidates were less likely to retain low frequency hearing post-operatively, but this did not reach significance in the study population (22.2% vs 8.5%, p=0.0992). However, HP surgery, and overall CI surgery outcomes assessment was limited by lack of standardized documentation. CONCLUSIONS: Unmarried patients and non-white patients continue to warrant special attention post-operatively to ensure equability in CI. HP surgery has evolved over the past decade. All, patients, should also have their quality of life evaluated, with standard assessment through open sentence testing failing to demonstrate the added benefit of HP, and likely the overall benefit of any CI. There continues to be a need for standardization in CI evaluation, documentation, and follow-up to allow for larger outcomes based research. IRB: STU 032018-085 PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: The field of CI is in need of large outcome based studies to better predict which patient factors, including demographics and HP status, may predict CI success. DESIRED RESULT: Systematic review of a decade of cochlear implantation outcomes in order to identify areas in which improvement will result in increased ability to assess outcomes, and augmented cochlear implant success leading to improved CI patient quality of life.