Advanced Bionics HiRes Ultra and Ultra 3D Series Cochlear Implant Recall: Time Course of Anomalies

Performance After Cochlear Reimplantation Using a Different Manufacturer

OBJECTIVE

To better understand cochlear implant (CI) performance after reimplantation with a different device manufacturer.

STUDY DESIGN

Multisite retrospective review.

SETTING

Tertiary referral centers.

PATIENTS

Patients older than 4 years who received a CI and subsequently underwent CI reimplantation with a different manufacturer over a 20-year period.

INTERVENTION

Reimplantation.

MAIN OUTCOME MEASURE

The primary outcome was difference in the best CNC score obtained with the primary CI, compared with the most recent CNC score obtained after reimplantation.

RESULTS

Twenty-nine patients met the criteria at three centers. The best average CNC score achieved by adult patients after primary cochlear implantation was 46.2% (n = 16), measured an average of 14 months (range: 3-36 mo) postoperatively. When looking at the most recent CNC score of adult patients before undergoing reimplantation, the average CNC score dropped to 19.2% (n = 17). After reimplantation, the average 3- to 6-month CNC score was 48.3% (n = 12), with most recent average CNC score being 44.4% (n = 17) measured an average of 19 months (range: 3-46 mo) postoperatively. There was no statistically significant difference (p = 0.321; t11 = 0.48) identified in performance between the best CNC score achieved by adult patients after primary cochlear implantation, and the most recent score achieved after reimplantation (n = 12). Analysis of prerevision and postrevision speech performance was not possible in pediatric patients (<18 yr old) because of differences in tests administered.

CONCLUSION

Patients undergoing reimplantation with a different manufacturer achieved CNC score performance comparable to their best performance with their original device.

Pediatric Failure Rates and Speech Outcomes in the HiRes Ultra and Ultra 3D Series Recall

OBJECTIVE

The recent Field Corrective Action (FCA) for the HiRes Ultra and Ultra 3D (V1) cochlear implants (CIs) triggered much research investigating clinical identification, failure rates, and postrevision outcomes. Pediatric data remain limited, especially with regards to speech outcomes. We aim to characterize the trajectory of children implanted with these devices with specific attention to speech outcomes.

PATIENTS

Retrospective cohort study of pediatric patients with FCA-affected CIs from March 2017 to January 2020 at a tertiary children's hospital.

INTERVENTIONS

CI placement, device monitoring, audiologic evaluation, revision surgery.

MAIN OUTCOME MEASURES

CI failure rates, revision surgery rate, speech recognition outcomes.

RESULTS

Forty-one devices were implanted in 27 pediatric patients. Average age at implantation was 4.01 years (range, 0.87-12.75). To date, 30 devices (73%) are known failures with 90% of these having undergone revision surgery. No statically significant difference was noted on open-set speech testing across best prerevision, immediate prerevision, and best postrevision time points. Best postrevision CNC scores had a mean score of 71% ± 26%, n = 16.

CONCLUSIONS

Pediatric patients implanted with FCA-affected CI devices have a high risk of device failure. Open-set speech recognition was not significantly different from prerevision to postrevision testing, suggesting preserved speech outcomes. This may be partially attributable to limitations of cohort size and the pediatric population with open-set speech testing. However, we suspect that close follow-up with standardized testing and a low threshold for revision surgery provided by our multidisciplinary team may have mitigated these changes. Postrevision open-set speech testing remains positive for these patients.

Failure in HiRes Ultra Series Recall Devices Does Not Necessarily Lead to Decrement in Performance

OBJECTIVE

To understand the impact on speech perception for patients experiencing Advanced Bionics V1 series Ultra and Ultra 3D cochlear implant failure.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary academic center.

PATIENTS

Adult patients implanted with V1 series devices.

INTERVENTIONS

Device integrity and speech perception testing.

MAIN OUTCOME MEASURES

consonant-nucleus-consonant and AzBio in quiet speech recognition scores.

RESULTS

At our institution, 116 V1 series cochlear implants were placed in 114 patients. Thirteen devices in prelingual patients were excluded, leaving 103 (89%) for final analysis. Forty-eight (46.6%) devices were considered as failed using the company provided EFI analysis tool. There were 36 (65.5%) of the remaining 55 devices that consistently tested within normal range; the remainder lost to follow-up with unknown status. Among the 48 device failures, 29 were revised and 19 patients were not revised. Among those not revised, 11 self-opted for observation (57.9%). Observed patients, despite impedance changes meeting failure criteria, had no subjective or objective changes in speech perception. Sentence testing scores for failure patients who elected observation (82.9 ± 11.4%) were significantly higher at failure compared with those opting for revision (55 ± 22.8%, p = 0.006). For those undergoing revision surgery, significant improvement in post-activation scores was noted as compared with time of failure with a mean improvement of 12.9% (p = 0.002, n = 24) for consonant-nucleus-consonant word scores and 17.2% (p = 0.001, n = 19) for AzBio in quiet scores.

CONCLUSIONS

Proactive monitoring using EFI identifies a higher rate of Ultra Series V1 device failure than previously reported. However, about 20% of these patients may not have subjective change in hearing or objective decline in test scores and could be observed. Should performance worsen, reimplantation provides significant improvement in speech recognition.

Cochlear Implant Device Failures Falling Under the 2020 FDA Voluntary Field Corrective Action: A Systematic Review and Meta-analysis

OBJECTIVE

To compare the rate of device failure for those cochlear implants (CIs) involved in the 2020 Food and Drug Administration (FDA) voluntary field corrective action (VFCA).

DATABASES REVIEWED

Medline, Embase, and Scopus.

METHODS

A systematic review was performed according to the PRISMA guidelines. Publications reporting institutional experiences with implants affected by the VFCA were included. Outcomes assessed included etiology of, rate of, and time to failure and pre-/post-device failure speech perception testing. All outcomes reported in at least two independent studies were included in a meta-analysis.

RESULTS

Six studies met criteria for analysis. The overall pooled failure rate was 23.7% (95% CI, 11.6-38.4%). The pooled device, inconclusive, and medical failure rates were 21.5%, 0.2%, and 0.7%, respectively. Pediatric failure rates were higher than those of adults (46.9% [95% CI, 11.2-84.5%] versus 32.6% [95% CI, 8.2-63.7%]). WRS declined with primary implant failure (55.1% [95% CI, 48.0-62.1%] to 34.1% [95% CI, 30.2-38.0%]) but improved after reimplantation (34.1% [95% CI, 30.2-38.0%] to 50.1% [95% CI, 45.2-55.1%]).

CONCLUSIONS

The rate of pooled reported failure for CIs falling under the 2020 VFCA in the literature thus far is 23.7%. The overwhelming majority of these failures were device related, the rates of which were higher in children. Speech perception improved significantly after reimplantation.

Seven-Year Revision Rates for Cochlear Implants in Pediatric and Adult Populations of an Integrated Healthcare System

OBJECTIVE

We assessed three cochlear implant (CI) suppliers: Advanced Bionics, Cochlear Limited, and MED-EL, for implant revision requiring reoperation after CI placement.

STUDY DESIGN

Retrospective cohort study of integrated-health-system database between 2010 and 2021. Separate models were created for pediatric (age <18) and adult (age ≥18) cohorts.

PATIENTS

Pediatric (age <18) and adult (age ≥18) patients undergoing cochlear implantation within our integrated healthcare system.

MAIN OUTCOME MEASURE

Revision after CI placement. Cox proportional hazard regression was used to evaluate revision risk and adjust for confounding factors. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.

RESULTS

A total of 2,347 patients underwent a primary CI placement, and Cochlear Limited was most implanted (51.5%), followed by Advanced Bionics (35.2%) and MED-EL (13.3%). In the pediatric cohort, the 7-year crude revision rate was 10.9% for Advanced Bionics and 4.8% for Cochlear Limited, whereas MED-EL had insufficient cases. In adults, the rates were 9.1%, 4.5%, and 3.3% for Advanced Bionics, MED-EL, and Cochlear Limited, respectively. After 2 years of postoperative follow-up, Advanced Bionics had a significantly higher revision risk (HR = 8.25, 95% CI = 2.91-23.46); MED-EL had no difference (HR = 2.07, 95% CI = 0.46-9.25).

CONCLUSION

We found an increased revision risk after 2 years of follow-up for adults with Advanced Bionics CI devices. Although we found no statistical difference between manufacturers in the pediatric cohort, after 2 years of follow-up, there were increasing trends in the revision probability for Advanced Bionics. Further research may determine whether patients are better suited for some CI devices.

How Can We Compare Cochlear Implant Systems across Manufacturers? A Scoping Review of Recent Literature

Electric stimulation via a cochlear implant (CI) enables people with severe-to-profound sensorineural hearing loss to regain speech understanding and music appreciation and, thus, allow them to actively engage in social life. Three main manufacturers (CochlearTM, MED-ELTM, and Advanced BionicsTM "AB") have been offering CI systems, thus challenging CI recipients and otolaryngologists with a difficult decision as currently no comprehensive overview or meta-analysis on performance outcomes following CI implantation is available. The main goals of this scoping review were to (1) map the literature on speech and music performance outcomes and to (2) find whether studies have performed outcome comparisons between devices of different manufacturers. To this end, a literature search was conducted to find studies that address speech and music outcomes in CI recipients. From a total of 1592 papers, 188 paper abstracts were analyzed and 147 articles were found suitable for an examination of full text. From these, 42 studies were included for synthesis. A total of 16 studies used the consonant-nucleus-consonant (CNC) word recognition test in quiet at 60 db SPL. We found that aside from technical comparisons, very few publications compared speech outcomes across manufacturers of CI systems. However, evidence suggests that these data are available in large CI centers in Germany and the US. Future studies should therefore leverage large data cohorts to perform such comparisons, which could provide critical evaluation criteria and assist both CI recipients and otolaryngologists to make informed performance-based decisions.

Institutional Experience With Cochlear Implants Falling Under the 2020 FDA Corrective Action

OBJECTIVE

To determine the rate of device failure for those cochlear implants falling under the 2020 Food and Drug Administration (FDA) voluntary corrective action.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary otology-neurotology practice.

PATIENTS

Those with cochlear implant failure falling under the FDA corrective action.

INTERVENTIONS

Cochlear implant explant and reimplantation.

OUTCOME MEASURES

Reason for cochlear implant failure, time to failure, symptoms of failure, and benefit from reimplantation.

RESULTS

The overall failure rate was 20.0% (18 of 90 ears); of the failures, 15 of 18 (83.3%) were hard device failures, and 3 of 18 (16.7%) were medical or surgical failures. All hard device failures were confirmed with integrity testing as performed by the company. The average time to integrity testing was 38.0 months. Of the hard failures, 14 of 15 had successful initial activation and benefit. Lack of expected progress was seen in 7 of 15 and a sudden decline in function in 8 of 15. Electrodes 9 to 16 were most often defunct. Significant drops in speech perception were often seen in device failure cases. Three medical/surgical failures were explanted; one had migration of the receiver/stimulator causing discomfort, and the other two had electrode migration after partial insertion. Of the reimplanted patients, 11 of 12 are deriving benefit from their new devices.

CONCLUSIONS

The rate of device failure for the cochlear implants of interest is significantly higher in our series than reported in the initial FDA voluntary field corrective action publication.