New trends with cochlear implant electrodes

概要

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Depending on the etiology of sensory neural hearing loss and patient age, it is postulated that a significant number of cochlear implant candidates today have a rich neural substrate consisting of nondegenerated dendrites and a large number of spiral ganglion cells with associated axons. In addition, many patients have some residual hearing especially in the low frequencies, demonstrating neural survival in the apical regions. With long electrodes covering the scala tympani from base to apex, it has become feasible to improve tonotopic stimulation. Key to the long-term success of implantation is preservation of intracochlear structures during electrode insertion. Round window membrane insertion combined with free-fitting lateral wall electrode placement tends to preserve residual hearing. New coding strategies providing fine structure information in the apex can enhance patient performance. Delicate intracochlear tissues must also be preserved during the multiple explantations and reimplantations that young patients face during their 80+ year life span, otherwise some benefits will be lost over time.