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Otology/Neurotology

(549) Worldwide Differences in Surgeon Intraoperative Practices for Cochlear Implantation

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Nicole T. Jiam, MD

    Neurotology & Skull Base Surgery Fellow
    Massachusetts Eye and Ear Infirmary/Harvard Medical School
    Boston, Massachusetts, United States

    • Co-Author(s)

  • AP

    Archana Podury, BA

    Medical Student
    Harvard Medical School, Harvard-MIT Health Sciences & Technology (HST) Program
    Cambridge, MA, United States

  • AQ

    Alicia M. Quesnel, MD

    Assistant Professor
    Mass Eye and Ear Infirmary
    Boston, MA, United States

    • Senior Author(s)

  • OH

    Ophir Handzel, MD

    Professor
    Tel-Aviv Sourasky Medical Center, United States

Disclosure(s):
Nicole T. Jiam, MD: No relevant relationships to disclose.


Introduction: Cochlear implant performance is dependent on precise intra-cochlear positioning. Despite published evidence demonstrating that intra-operative functional or radiologic tools can be helpful for hearing preservation and determining final electrode position, there is considerable practice heterogeneity among surgeons. This study aims to characterize surgical practice patterns for using intraoperative imaging or functional confirmation of cochlear implant location worldwide.

Methods: A cross-sectional survey of otolaryngologists actively performing cochlear implantation was conducted between March 1, 2023, and May 6, 2023. Participants were recruited across the world using otologic society membership email lists and at professional meetings. Seventy-five out of 125 invited participants (60%) completed the survey. Participants were categorized by continent: Africa (n=1); Asia (n=22); Europe (n=24); North America (n=24), Oceania (n=3); South America (n=1).

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 significant 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, which 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). There was no statistically significant association between the years of practice, the number of cochlear implantation surgeries performed yearly, and the use of intraoperative tools.

Conclusions: Intraoperative use of radiologic and functional adjuncts for verifying cochlear implant positioning varies worldwide. Practice guidelines may help establish a standard of care for surgeons performing cochlear implantation.