Contralateral acoustic hearing aid use in adult unilateral cochlear implant recipients: Current provision,practice, and clinical experience in the UK

Objectives: The study surveyed practising cochlear implant (CI) audiologists with the aim of: (1) characterizing UK clinical practice around the management and fitting of a contralateral hearing aid (HA) in adult unilateral CI users (‘bimodal aiding’); (2) identifying factors that may limit the provision of bimodal aiding; and (3) ascertaining the views of audiologists on bimodal aiding.

Methods: An online survey was distributed to audiologists working at the 20 centres providing implantation services to adults in the UK.

Results: Responses were received from 19 of the 20 centres. The majority of centres reported evaluating HAs as part of the candidacy assessment for cochlear implantation. However, a majority also indicated that they do not take responsibility for the contralateral HA following implantation, despite identifying few practical limiting factors. Bimodal aiding was viewed as more beneficial than wearing the implant alone, with most respondents actively encouraging bimodal listening where possible. Respondents reported that fitting bimodal devices to take account of each other's settings was potentially more beneficial than independently fit devices, but such sympathetic fitting was not routine practice in any centre.

Discussion: The results highlight some potential inconsistencies in the provision of bimodal aiding across the UK as reported by practising audiologists. The views of audiologists about what is best practice appear to be at odds with the nature and structure of the services currently offered.

Conclusion: Stronger evidence that bimodal aiding can be beneficial for UK patients would be required in order for service providers to justify the routine provision of bimodal aiding and to inform guidelines to shape routine clinical practice.     

Contribution of hearing aids to music perception by cochlear implant users

Abstract

Objectives

Modern cochlear implant (CI) encoding strategies represent the temporal envelope of sounds well but provide limited spectral information. This deficit in spectral information has been implicated as a contributing factor to difficulty with speech perception in noisy conditions, discriminating between talkers and melody recognition. One way to supplement spectral information for CI users is by fitting a hearing aid (HA) to the non-implanted ear.

Methods

In this study 14 postlingually deaf adults (half with a unilateral CI and the other half with a CI and an HA (CI + HA)) were tested on measures of music perception and familiar melody recognition.

Results

CI + HA listeners performed significantly better than CI-only listeners on all pitch-based music perception tasks. The CI + HA group did not perform significantly better than the CI-only group in the two tasks that relied on duration cues. Recognition of familiar melodies was significantly enhanced for the group wearing an HA in addition to their CI. This advantage in melody recognition was increased when melodic sequences were presented with the addition of harmony.

Conclusion

These results show that, for CI recipients with aidable hearing in the non-implanted ear, using a HA in addition to their implant improves perception of musical pitch and recognition of real-world melodies.     

Practice patterns of South African audiologists in cerumen management: a pilot study

Abstract

Objective: To determine the training, self-reported competence and practice patterns of South African audiologists (SAAs) regarding cerumen management (CM).

Design: Prospective cross-sectional survey. An online questionnaire was completed by SAA between July and September 2016. The questionnaire addressed sections on educational training, experience and practice patterns of SAAs regarding CM.

Study sample: Three hundred and fifty-six SAAs responded to an email invitation sent to 382 actively-practicing audiologists.

Results: Majority of the participants (85%) were employed for less than 10 years. Forty-nine percent received less than 10?hours of theoretical training while 57% received less than 10?hours of clinical education. A total of 96% of the participants indicated they felt competent to perform CM, with 96% preferring manual, ear syringing, or a combination of the two. Handwashing pre- and post-procedure was the preferred method of infection prevention and control by 87% of the participants with 66% of these indicating they only wore gloves. Majority (85%) of the participants indicated that they always explained the possible complications of CM to their patients.

Conclusion: Findings from this study indicate that South African audiologists feel that they are adequately trained and competent to perform CM.     

Factors influencing degree of hearing loss at presentation,hearing aid choice,and usage in first time hearing aid users in Singapore

Abstract

Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore.

Design: Retrospective cross-sectional study.

Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013.

Results: Half of the subjects presented with more severe (>55?dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4?h of daily HA usage.

Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.     

Effect of extreme adaptive frequency compression in bimodal listeners on sound localization and speech perception

Objectives: This study aimed to improve access to high-frequency interaural level differences (ILD), by applying extreme frequency compression (FC) in the hearing aid (HA) of 13 bimodal listeners, using a cochlear implant (CI) and conventional HA in opposite ears.

Design: An experimental signal-adaptive frequency-lowering algorithm was tested, compressing frequencies above 160?Hz into the individual audible range of residual hearing, but only for consonants (adaptive FC), thus protecting vowel formants, with the aim to preserve speech perception. In a cross-over design with at least 5 weeks of acclimatization between sessions, bimodal performance with and without adaptive FC was compared for horizontal sound localization, speech understanding in quiet and in noise, and vowel, consonant and voice-pitch perception.

Results: On average, adaptive FC did not significantly affect any of the test results. Yet, two subjects who were fitted with a relatively weak frequency compression ratio, showed improved horizontal sound localization. After the study, four subjects preferred adaptive FC, four preferred standard frequency mapping, and four had no preference. Noteworthy, the subjects preferring adaptive FC were those with best performance on all tasks, both with and without adaptive FC.

Conclusion: On a group level, extreme adaptive FC did not change sound localization and speech understanding in bimodal listeners. Possible reasons are too strong compression ratios, insufficient residual hearing or that the adaptive switching, although preserving vowel perception, may have been ineffective to produce consistent ILD cues. Individual results suggested that two subjects were able to integrate the frequency-compressed HA input with that of the CI, and benefitted from enhanced binaural cues for horizontal sound localization.     

Patterns of recognition of Arabic consonants by non-native children with cochlear implants and normal hearing

Objective: This study examined the patterns of recognition of Arabic consonants, via information transmission analysis for phonological features, in a group of Malay children with normal hearing (NH) and cochlear implants (CI).

Method: A total of 336 and 616 acoustic tokens were collected from six CI and 11 NH Malay children, respectively. The groups were matched for hearing age and duration of exposure to Arabic sounds. All the 28 Arabic consonants in the form of consonant–vowel /a/ were presented randomly twice via a loudspeaker at approximately 65?dB SPL. The participants were asked to repeat verbally the stimulus heard in each presentation.

Results: Within the native Malay perceptual space, the two groups responded differently to the Arabic consonants. The dispersed uncategorized assimilation in the CI group was distinct in the confusion matrix (CM), as compared to the NH children. Consonants /?/, /t?/, /s?/ and /?/ were difficult for the CI children, while the most accurate item was /k/ (84%). The CI group transmitted significantly reduced information, especially for place feature transmission, then the NH group (p?Conclusion: CI and NH Malay children may be using different acoustic cues to recognize Arabic sounds, which contribute to the different assimilation categories’ patterns within the Malay perceptual space.     

Pitch and lexical tone perception of bilingual English–Mandarin-speaking cochlear implant recipients,hearing aid users,and normally hearing listeners

Abstract

Objectives

The purpose of this current study was to investigate whether pitch, lexical tone, and/or speech-in-noise perception were significantly correlated for Singaporean teenagers or adults who spoke both Mandarin and English.

Methods

Thirty-three normal hearing or near-normal hearing listeners who did not use a hearing device (NNH group), eight postlingually deafened cochlear implant (CI) recipients (CI group), and three postlingually deafened bilateral hearing aid (HA) users (HA group) were recruited. All participants were bilingual Mandarin–English-speaking Singaporean residents. Participants were assessed on tests of pitch-ranking, lexical tone perception, and speech-in-noise.

Results

The NNH group scored significantly better than the CI group for all tests and subtests. There were no significant differences for the pitch test between the HA group and either the CI or NNH group. However, HA users scored significantly better than the CI group, and more aligned with the NNH group's scores for both the lexical tone and Mandarin speech-in-noise test. There were highly significant moderate positive correlations between all three tests.

Discussion

Overall, the performance of the CI users in this study indicates that CI recipients still struggle on pitch-related auditory perception tasks. Additionally, although the test scores from the HA users were better than the CI recipients, they were not as good as the NNH listeners. The significant moderate correlations between all three tests indicate that there is at least some degree of overlap in the skills required to accurately perceive these stimuli.

Conclusion

The overall results suggest that CI users, and to a lesser extent HA users, still struggle with complex auditory perceptual tasks, particularly when it requires the perception of pitch. However, it may be possible that training one of these skills (e.g. musical pitch) may then generalize to other tasks (e.g. lexical tone and/or speech-in-noise). This is important for counseling, as well as for planning effective rehabilitation programs.     

Development of hearing standards for Ontario’s Constable Selection System

Abstract

Objective: Develop valid and defensible hearing standards for Ontario constables to ensure safe and efficient operations.

Design: Research involved three steps: (1) identification of hearing critical (HC) tasks, (2) characterisation of real-world noise environments where these tasks are performed (3) and establishment of screening criteria and protocols for determining fitness for duty.

Study sample: Three panels of subject matter experts (SMEs) from different Ontario police services participated in Steps 1 and 3.

Result: Fifty-one HC tasks conducted in 25 different environments were identified. Acceptable levels of speech communication in noise were based on environments with the highest frequency, importance and difficulty ratings. The ability to understand soft speech was also deemed critical. These translated into a 2?dB maximum elevation in the Noise Composite speech recognition threshold (SRT) with the Hearing-In-Noise-Test and a threshold in quiet of 35 dBA or better.

Conclusions: Speech communication modelling methodology greatly facilitates the task of developing fitness for duty hearing standards, but participation of SMEs is crucial for face validity.     

Quality of life in persons with hearing loss: a study of patients referred to an audiological service

Abstract

Objective: To investigate the relationship between hearing loss (HL) and general quality of life (QoL) in adults seeking hearing aids (HAs).

Design: The patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire’s general part and a questionnaire measuring self-assessed communication ability (Abbreviated Profile of hearing Aid Benefit—APHAB). These responses were compared with EORTC scores from a general population and patients with former head and neck cancer.

Study sample: One-hundred and fifty-eight adults with HL were recruited prior to hearing aid (HA) fitting with one half seeking renewal of their HA.

Results: General QoL scores among patients with HL were similar to those in the general population, but higher than in many chronic serious diseases. Patients with unilateral HL reported slightly worse social function and more fatigue than patients with bilateral HL. Self-assessed communication ability correlated with general QoL scores. Also, we found that best ear pure tone average (PTA), cognitive and physical QoL function predicted APHAB scores.

Conclusion: In the investigated HL group, general QoL scores seem to be relatively close to those seen in the general population.     

Hyaluronan in vocal folds and false vocal folds in patients with recurrent respiratory papillomatosis

Abstract

Background: Hyaluronan (HA) is a glycosaminoglycan with viscoelastic properties necessary for vocal fold (VF) vibration and voice production. Changes in HAs molecular mass, possibly related to human papilloma virus, could affect formation/persistence of recurrent respiratory papillomatosis (RRP).

Aims/Objective: Describing mass and localization of HA and localization of HA receptor CD44 in VF and false vocal folds (FVF) in RRP.

Materials and Methods: Biopsies from VF and FVF from 24 RRP patients. Twelve were studied with histo-/immunohistochemistry for HA and CD44 in epithelium, stroma and RRP lesions. Twelve samples were analyzed for HA molecular mass distribution with gas-phase-electrophoretic-molecular-mobility-analyzer (GEMMA).

Results: Three of 23 stains (VF and FVF combined) showed faint HA staining in the epithelium; there was more extensive staining in the stroma. CD44 was present throughout all areas in FVF and VF, it did not concur with HA. GEMMA analysis revealed very high mass HA (vHMHA) with more varying amounts in VF.

Conclusions/Significance: HA was mainly distributed in the stroma. CD44 not binding to HA might explain the non-inflammatory response described in RRP. Possibly crosslinked vHMHA was seen in VF and FVF, with more variable amounts in VF samples. Counteracting HA crosslinking could become a treatment option in RRP.     

Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide

Objectives: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation.

Methods: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children?

Summary: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.     

Translation and validation of the drooling impact scale questionnaire into Brazilian Portuguese

IntroductionInadequate drooling can cause serious clinical, functional and social problems. Validated questionnaires to evaluate drooling impact on quality of life are lacking in Brazilian Portuguese.ObjectivesTo translate and validate the drooling impact scale to Brazilian Portuguese.MethodsThe drooling impact scale was translated to Brazilian Portuguese and back- translated to English to assess potential conceptual differences. Brazilian Portuguese version of drooling impact scale was applied to a 40 patients’ sample of sialorrhea presenting pediatric patients (up to 20 years of age). Chronbach’s alpha, exploratory factorial analysis and confirmatory factorial analysis were then proceeded with data collected.ResultsThe mean drooling impact scale value for the whole population was 51.77 (SD = 16.13). The internal consistency obtained with Cronbach’s alpha indicated a value of 0.72 for the entire sample. The Bartlett’s test of sphericity was significant (p < 0.0001), confirming correlation among variables tested. Kaiser-Meyer-Olkin measure of sampling adequacy revealed a value of 0.72, indicating that the correlation matrix was reasonably suitable for factor analysis. Regarding exploratory factorial analysis, parallel analysis suggested a two-factor solution that was used for confirmatory factorial analysis. The first factor was responsible for 33.78% of the variance with an Eigenvalue of 3.38. The second factor explained 16.1% of the variance with an Eigenvalue of 1.61. At confirmatory factorial analysis, the two-factor model showed consistently better adjustments parameters than the one-factor model.ConclusionThe drooling impact scale has been successfully translated to Brazilian Portuguese language, showing adequate internal validity. Validation of this instrument allows physicians and other personnel involved in the care of these patients to perform a better management of patients experiencing drooling. With this tool, we are now able to guide routines and provide guidelines both before and after the different kinds of treatments in order to improve the general well-being of the patient and his family.     

Preliminary study on lyrics intelligibility at different pitches in Chinese vocal music

Abstract

Background: There is still no clear experimental data on the relationship between the intelligibility of Chinese vocal lyrics and different pitch.

Aims/Objective: This study aims at investigating the intelligibility of Chinese sung words at different pitch.

Material and methods: A word list is created and sung by eight singers at five different pitches (C5, F4, bB4, bE5, and bA5). The intelligibility of the words is tested by listeners with and without music background.

Results: The average intelligibility score in the music-listeners is 84.9% (SD = 9.5%). The score at five pitches (from low to high) is 93%, 91.7%, 89.7%, 83.1%, and 67.1%, respectively. The average score is 77.4% (SD = 10.7%) in the non-music listeners. The average score is 87%, 86%, 79.8%, 76.8%, and 57.5% at five pitches, respectively. The ratio of unidentified sung words is 19.3% (SD, 4.3%) in female singers and 11.9% (SD = 1.5%) in male singers.

Conclusions: The intelligibility of Chinese sung words declines gradually with increase in pitch, and the extent of decreases gradually elevating. Generally, the identified ratio of words sung by male singers is higher than that of female singers. The listeners who had no musical background have a lower intelligibility score than those with experience.     

Hearing results after type III tympanoplasty: incus transposition versus PORP. A systematic review

Objective: The objective of this study is to compare hearing improvements in the air-bone gap (ABG) after type III tympanoplasties, comparing between incus transposition (IT) and partial ossicular replacement prosthesis (PORP).

Materials and methods: Publications in English were searched in PUBMED database and were systematically reviewed. A total of 14 articles were included, obtaining 1055 patients, 614 for the IT group and 441 for the PORP group. Preoperative ABG, postoperative ABG, dB gain and ABG closure rate were compared.

Results: IT group: preoperative ABG of 31.74?dB (SD 10.51); postoperative ABG of 18.97?dB (SD 10.6); dB gain of 12.76?dB (SD 14.97); and ABG closure rate of 64.48%. PORP group: preoperative ABG of 28.02?dB (SD 10.47); postoperative ABG of 16.27?dB (SD 10.45); dB gain of 11.75 (SD 15.02); and ABG closure rate of 71.32%. No significant statistical difference was found in dB mean gain between groups (p?>?.05), although a difference was found in the ABG closure rate between groups favouring PORP series (p?Conclusion: An improvement in hearing results was observed within both groups after type III tympanoplasty. There is no difference in decibels gained between both ossiculoplasty materials, but a better closure rate (%) was observed in the PORP group.     

From manual to artificial intelligence fitting: Two cochlear implant case studies

Objective: To assess whether CI programming by means of a software application using artificial intelligence (AI), FOX®, may improve cochlear implant (CI) performance.

Patients: Two adult CI recipients who had mixed auditory results with their manual fitting were selected for an AI-assisted fitting. Even after 17 months CI experience and 19 manual fitting sessions, the first subject hadn’t developed open set word recognition. The second subject, after 9 months of manual fitting, had developed good open set word recognition, but his scores remained poor at soft and loud presentation levels.

Main outcome measure(s): Cochlear implant fitting parameters, pure tone thresholds, bisyllabic word recognition, phonemic discrimination scores and loudness scaling curves.

Results: For subject 1, a first approach trying to optimize the home maps by means of AI-proposed adaptations was not successful whereas a second approach based on the use of Automaps (an AI approach based on universal, i.e. population based group statistics) during 3 months allowed the development of open set word recognition. For subject 2, the word recognition scores improved at soft and loud intensities with the AI suggestions. The AI-suggested modifications seem to be atypical.

Conclusions: The two case studies illustrate that adults implanted with manual CI fitting may experience an improvement in their auditory results with AI-assisted fitting.     

Measuring growth of residual cholesteatoma in subtotal petrosectomy

Background: Little is known about the growth rate of cholesteatoma in patients.

Objective: Investigate the growth of residual cholesteatoma in subtotal petrosectomy based on volume measured in MRI scans.

Materials and methods: Retrospective case series in a Tertiary Medical Centre. Thirteen residual cholesteatomas were identified in 10 patients after subtotal petrosectomy for which a wait-and-scan policy was adopted. Volume of the residual cholesteatoma was calculated by manual segmentation as well as the ‘box method’.

Results: Mean growth rate was 27.9 mm3/month (SD 22.8), with a large individual variation ranging from 2.2 to 69.8 mm3/month. No complications were reported in 10 patients with a wait-and-scan policy for residual cholesteatoma in subtotal petrosectomy. The box method overestimates growth rate compared to the reference method manual segmentation and a linear increase of this systematic error was seen with increasing size of the cholesteatoma.

Conclusions: Residual cholesteatoma growth rate shows a large individual variation. A wait-and-scan policy could be considered in case of a (small) residual in subtotal petrosectomy with ample room to grow before destroying any remaining structures. Furthermore, the clinically more applicable and less time-consuming box method can be used to accurately measure volumes of small cholesteatomasup to a volume of 500?mm³.     

Improved speech and language development after unilateral cochlear implantation in children with a potentially useable contralateral ear

Objectives: Increasingly, children are considered for a unilateral cochlear implant (CI), even if the contralateral ear falls outside current audiological guidelines, especially if they are not considered to be reaching their educational potential. Here we present the outcomes of CI in children with potentially useable hearing in the contralateral ear.

Methods: A retrospective case note review was performed for a total of 57 patients. Primary outcome was speech and language (SaL) development, as measured by the Manchester Speech and Language Development Scale (MSLDS) and SaL age equivalent. Secondary outcomes were auditory perception, perceived parental benefit and compliance; respectively measured by Categories of Auditory Performance (CAP), Brief Assessment of Parental Perception (BAPP) and reported use.

Results: SaL development improved after CI with a mean pre-operative MSLDS score of 5.8 to a postoperative score of 8.0 (n?=?57) and a mean SaL age equivalent of 14 months in a one-year period (n?=?14). Furthermore, CAP scores improved from 4.9 to 7.0 (n?=?57). Analysis of BAPP scores showed improved quality of life in 18/19 patients (94.7%). With regards to compliance, 50/57 (87.7%) are fulltime users of both their CI and their HA.

Conclusion: The present study indicates that despite one ear having potentially useable hearing outside national audiological criteria, the majority of participants received benefit from a CI in the poorer hearing ear. We suggest that assessment of each ear separately and treatment with the most appropriate amplification device, has given these children a benefit they may not otherwise have acquired if they only had bilateral HA.     

Perceptual sensitivity to,and electrophysiological encoding of,a complex periodic signal: effects of age

Objective: The purpose of this study was to investigate perceptual and electrophysiological encoding of complex periodic signals as a function of age.

Design: Two groups of adults completed three listening tasks: a behavioural task of detection of a mistuned harmonic component in a complex tone, an electrophysiological measure of speech-evoked auditory brainstem response (sABR), and a speech-in-noise measure. Between group comparisons were undertaken for each task as well as pairwise correlation analyses for all tasks.

Study sample: One group of younger adults (n?=?20) and one group of older adults (n?=?20) participated. All listeners had relatively normal audiometric thresholds (≤20?dB HL) from 250–4000?Hz.

Results: Younger adults had better results than the older adults on all three tasks: sensitivity for detecting a mistuned harmonic, spectral encoding for sABR, and release from masking for the speech-in-noise test. There were no significant correlations between measures when evaluating the older adults in isolation.

Conclusions: The results are consistent with the body of literature that demonstrates reduced temporal processing abilities for older adults. The combined method approach undertaken in this investigation did not result in correlations between the perceptual and electrophysiological measures of temporal processing.     

The first experiences of implementation of the Swedish tonsil register in Denmark

Abstract

Background: Tonsil surgery is a daily procedure at Ear, Nose and Throat (ENT) departments as well as ENT practices. Despite national tonsil guidelines in Denmark, no national survey has been introduced.

Objectives: To display the process of implementing a Danish version of the Swedish tonsil register including a presentation and validation of the first year’s results.

Methods: The Swedish tonsil register was translated into Danish. Minor modifications were executed and the register was implemented at the ENT department, Region Hospital West Jutland, Denmark. All patients undergoing surgery due to benign tonsil and/or adenoid diseases were eligible. Written informed consent was obtained. Indication for surgery, comorbidity, surgical and haemostasis techniques, and complications were registered by the surgeon.

Results: Several obstacles were encountered due to legal procedures, daily work, IT organisation, and discontinuous information. 58% of eligible patients were registered. The incidence of post-tonsillectomy haemorrhage requiring secondary surgery was 6.4%. The potential underlying risk factors were easily retrieved from the register.

Conclusions and significance: The Danish version of the national Swedish tonsil database is a useful, easily accessible, and informative tool for monitoring and validation of tonsil/adenoid surgery. We recommend a nationwide register with a central steering committee.     

Cerebrospinal fluid gusher in cochlear implant and its associated factors

Abstract

Introduction: Cochlear implants (CI) is considered a safe procedure with overall complication rate of 12.5% amongst adult and pediatric population. Cerebrospinal fluid (CSF) gusher is regarded as a common CI intraoperative complication.

Objective: In this study, we determined the association between probable associated factors and occurrence of intraoperative CSF gusher.

Method: In a retrospective survey, 394 patients with severe to profound sensorineural hearing loss who underwent primary cochlear implantation surgery were evaluated. Patients with incomplete electronic or manual file and those with revision, explantation or reimplantation surgery were excluded.

Result: three hundred and ninety-four CI patients with a mean age of 8.74?±?12.21?years were reviewed 49.62% of them were female. CSF gusher developed in 22 patients (5.58%). Patients with CSF gusher had more structural abnormalities in their CT scans’ report. Common cavity malformation and Mondini dysplasia were the most common abnormal reports amongst those with intra-operative CSF gusher.

Conclusion: In conclusion, cochlea structural abnormalities affect the incidence of CSF gusher in CI recipients. Common cavity malformation and Mondini dysplasia were associated with an increased incidence of CSF gusher. We insist on more precise pre-operative imaging of those with abnormal cochlea structures to provide the needed management.