Innovation in Cochlear Impant Surgery

The results, he added, again point to an important benefit with this approach: “Preservation of supporting cells in the organ of Corti could be important for hair-cell regeneration in the future during the lifetime of the children we are implanting today.”

Other advances include a version of the hybrid device that employs a slightly longer electrode (Hybrid L24) than the Hybrid S (16 vs. 10 mm) but also includes more than double the number of electrodes implanted. “The benefit here is that the relatively short electrode still does a good job of preserving residual hearing, but if any low-frequency hearing is ultimately lost, we can use those extra electrodes as a traditional electric processing-only device when necessary,” said Dr. Gantz, who added that an FDA trial of the device is closed, and researchers are now accruing data.

Electroacoustic Stimulation

Craig A. Buchman, MD, FACS, chief of the division of otology/neurotology at the University of North Carolina School of Medicine in Chapel Hill and director of the University of North Carolina Ear and Hearing Center and Skull Base Center, said he is eager to see how those data pan out, because “right now, there seems to be a lot of excitement over a procedure that doesn’t have much long-term follow-up behind it,” he told ENT Today. As for the claimed benefit of the hybrid devices preserving structures of the inner ear that could later benefit from advances in genetic and/or molecular therapy, “to me, that’s a little bit like reading between the lines,” Dr. Buchman said. “It’s certainly a reasonable assumption, but at this point it’s more of a theoretical benefit rather than a compelling argument in favor of the devices as a preferred option.”

Dr. Buchman’s preferred approach is known as electroacoustic stimulation (EAS), a procedure in which a longer electrode is placed using soft surgery techniques to preserve key structures of the inner ear. “That way, if a patient loses residual hearing, they don’t need to be re-implanted,” he said.

Dr. Buchman cautioned, however, against putting too much emphasis on the differences between techniques used for preserving residual hearing. “The hybrid devices and EAS are conceptually exactly the same,” he said. “The more important point is that preserving residual hearing—regardless of variations in technique—is here to stay; it totally works, and I am sure Dr. Gantz and I are in complete agreement on that point.”—David Bronstein

Disclosures: Dr. Buchman is an unpaid consultant for Cochlear Ltd. Dr. Gantz is a consultant for Cochlear Ltd. and Advanced Bionics.