Worldwide differences in surgeon intraoperative practices for cochlear implantation

Abstract

Objective

To characterize practice patterns of intraoperative imaging and/or functional confirmation of cochlear implant electrode location worldwide.

Methods

A cross-sectional survey of otolaryngologists performing cochlear implantation was conducted between March 1 and May 6, 2023. Participants were recruited worldwide using an international otologic society membership email list and at professional meetings. Ninety-seven of the 125 invited participants (78%) completed the survey. Participants were categorized by continent.

Results

North American surgeons use intraoperative X-rays more frequently than surgeons in Europe and Asia (p < 0.001). Otolaryngologists in Europe and Asia more frequently use no intraoperative imaging (p = 0.02). There is no regional difference between the intraoperative use of electrophysiologic instruments. European and Asian surgeons implant MED-EL devices (p = 0.012) more frequently than North American surgeons, who more frequently use Cochlear Corporation devices (p = 0.003). MED-EL use is related to less frequent intraoperative X-ray use (p = 0.02). Advanced Bionics use is related to more frequent intraoperative CT use (p = 0.03). No significant association existed between years of practice, number of cochlear implantation surgeries performed yearly, volume of pediatric CI practice, and use of intraoperative tools.

Conclusion

Intraoperative practice for radiologic and functional verification of cochlear implant electrode positioning varies worldwide. Practice guidelines may help establish a standard of care for cochlear implantation.

Keywords:

• Cochlear implant
• Intraoperative practices
• X-Ray
• Electrophysiology
• International surgery
• Imaging
• Electrode array

Acknowledgments

We thank Deborah Goss for her help with the literature review and Andreas Eckhard for his assistance with recruitment.

Disclaimer statements

Contributions NTJ: Design, Conduct, Analysis, Presentation, Manuscript; AP: Design, Analysis, Manuscript; AMQ: Design, Manuscript Review; OH: Design, Manuscript.

Funding None.

Conflicts of interest NTJ is the Chief Executive Officer of IIAM corporation and a consultant for Oticon Medical. She has received an educational grant from KLS Martin. AMQ has consulted for Alcon and Frequency Therapeutics and has had a sponsored research agreement with Grace Medical. OH is a consultant for Smartsound.

Ethics approval This study was approved by the Massachusetts Eye and Ear IRB (Study Number: 2023P000039). All participants provided written consent.

Data availability Interested parties may directly email the corresponding author regarding the data discussed in this manuscript.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14670100.2024.2367309.

Additional information

Notes on contributors

Nicole T. Jiam

Dr. Nicole T. Jiam is an otology & neurotology surgeon-scientist at the University of California - San Francisco. Her research expertise focuses on cochlear implantation, complex sound processing, music perception, personalized treatments, precision medicine, patient access, and machine learning/artificial intelligence. She completed her Neurotology and Skull Base Surgery fellowship at Harvard Medical School and Massachusetts Eye and Ear. She received her medical degree from the Johns Hopkins School of Medicine and holds a B.A. in neuroscience with honors and a minor in entrepreneurship & management from Johns Hopkins University.

Archana Podury

Dr. Archana Podury is an Otolaryngology-Head & Neck Surgery resident at the University of California San Diego. Her research focuses on cochlear implantation, systems/computational neuroscience, social support network modeling, and natural language processing. She received her MD from Harvard Medical School in the Harvard-MIT Health Sciences & Technology Program and her B.A in Neurobiology and Behavior from Cornell University.

Alicia M. Quesnel

Dr. Alicia M. Quesnel is an otologist and neurotologist at Massachusetts Eye and Ear, and Assistant Professor in the Department of Otolaryngology-Head and Neck Surgery at Harvard Medical School. Her research interests focus on the histopathology of the temporal bone, particularly related to otosclerosis and post-cochlear implantation pathology. She is an Investigator in Mass. Eye and Ear's Otopathology Laboratory, which houses one of the world's largest and most well-curated human temporal bone collections. She received her medical degree from Northwestern University Feinberg School of Medicine in Chicago, prior to completing her residency in otolaryngology at Harvard Medical School. Subsequently, she completed her fellowship training in neurotology and skull base surgery at Mass. Eye and Ear.

Ophir Handzel

Dr. Ophir Handzel is the Chief of the Division of Otology and Neurotology at Tel Aviv Sourasky Medical Center and Visiting Associate Professor at Harvard Medical School and Massachusetts Eye and Ear. His research expertise includes temporal bone histopathology, cochlear implantation, patient access, and treatment outcomes. He completed his Neurotology and Skull Base Surgery fellowship at Harvard Medical School and Massachusetts Eye and Ear. He received his medical degree from the Hebrew University of Jerusalem.