Financial Benefits of the Early Fitting of a Cochlear Implant Speech Processor: Assessment of the Direct Cost

A Literature Review on Cochlear Implant Activation: From Weeks to Hours

Objectives: The present literature review discusses the chronological evolution of Cochlear Implant (CI) activation and its definition among the relevant studies in the literature. In addition, the benefits of standardizing the early activation process in implantation centers worldwide are discussed. Methods: A comprehensive literature search was conducted in the major databases such as PubMed, Scopus, and Embase to retrieve all the relevant articles that reported early activation approaches following CI. Results: The evolution of the timing of early activation after CI has been remarkable in the past few years. Some studies reported the feasibility of early activation 1 day after the CI surgery in their users. Conclusions: Within the last decade, some studies have been published to report the feasibility and outcomes of its early activation. However, the process of early activation was not adequately defined, and no apparent guidelines could be found in the literature.

Early activation after cochlear implantation: a systematic review

PURPOSE

To systematically review the outcomes of early activation following cochlear implantation (CI) based on the findings from different studies in the literature.

METHODS

A comprehensive search strategy was conducted through different databases to identify relevant articles. Our outcomes included impedance levels, rates of complications, hearing and speech perception performance, and patients' satisfaction levels.

RESULTS

The total number of included studies in this systematic review is 19, which recruited 1157 patients, including 857 who underwent early activation following CI. Seventeen studies investigated impedance levels or feasibility rates of early activation approaches. Most of these studies (n = 10) reported that mean impedance levels remarkably decreased within the first day-to-month (first measurement) post-activation. In addition, all 17 studies showed that impedance levels finally normalize and become comparable with intraoperative levels or the conventional activation group. Seventeen studies reported the occurrence of complications in their population. Ten of these studies indicated that none of their patients developed any post-operative complications after early activation. Seven studies reported the development of some minor complications, including pain 9.2% (28/304), infection 4.7% (13/275), swelling 8.2% (25/304), vertigo 15.1% (8/53), skin hyperemia 2.2% (5/228), and others 16.4% (9/55). Hearing and speech perception was assessed in six studies, which showed a remarkable improvement in their patients. Three studies investigated patients' satisfaction and showed high satisfaction levels. Only one report investigated the economic advantages of early activation.

CONCLUSION

Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.

Effect of initial switch-on within 24 hours of cochlear implantation using slim modiolar electrodes

Reducing electrode impedance is an important factor in improving the functional benefits of cochlear implants (CIs). The immediate effect of early switch-on within 24 h of surgery on impedance among CI recipients with various types of electrodes has been reported previously; however, the immediate change and the evolution of electrode impedances of slim modiolar electrodes after early switch-on within 24 h of implantation has not. Therefore, the focus of this retrospective cohort study of CI patients was to compare the effect of early switch-on (n = 36) and conventional switch-on (n = 72) 2–4 weeks post-operation on impedance. Compared with impedance measured intraoperatively, our results demonstrate a significant decrease in impedance from 11.5 to 8.9 kΩ (p < 0.001) at 2–4 weeks after implantation in the early switch-on group, which sharply contrasted with elevated impedance values for conventional switch-on 2–4 weeks after implantation (from 10.7 to 14.2 kΩ, p = 0.001). Notably, a comparatively lower impedance than the conventional switch-on protocol was observed for up to 2 months post-operation. Most importantly, a much earlier stabilization of impedance can be achieved with the early switch-on protocol coupled with the slim modiolar electrode array compared to the conventional switch-on protocol, offering the advantage of reducing the number of required mapping sessions in the early stages of rehabilitation.