Improving Cochlear Implantation: a Patient's Perspective on the Role of Intraoperative Imaging
Year: 2025
Type: article
Abstract: March 10, 2025 Improving Cochlear Implantation: A Patient's Perspective on the Role of Intraoperative Imaging To the Editors of Otology & Neurotology, I am writing in response to the recently published case study on the use of photon-counting detector computed tomography (PCD-CT) in revision cochlear implantation (1). As the patient in this case, I would like to add a few words about my experience. My perspective is shaped by both my lived patient experience and my professional background as a Professor of Biostatistics. I was bilaterally implanted in March 2016, having worn a hearing aid in my left ear for 40 years. At activation, I sensed something was wrong, but my concerns were dismissed. For the next 3 years, despite working with eight different audiologists and consulting my surgeon, my speech perception remained poor. Drawing on my background, I immersed myself in cochlear implant research, volunteered for studies, and persistently sought answers, but I was continually dismissed. I eventually sought an appointment with a published CI researcher who was the first to mention imaging as a diagnostic tool. A CT scan uncovered a severe tip fold-over in my left ear, leading to revision surgery in February 2019 that disrupted my balance and resulted in limited electrode placement. Full electrode insertion was achieved in August 2023 during a second revision, made possible by advancements in PCD-CT imaging. My case highlights a preventable gap in surgical quality control that caused years of unnecessary suffering, multiple revision surgeries, and lasting balance issues. I have been told that providers cite cost, surgical time, skill, and radiation exposure as barriers, but these must be weighed against the risks of inadequate placement. My case highlights why the benefits of intraoperative imaging outweigh these drawbacks: 1. Cost Considerations Should Consider Revision Surgeries and Patient Burden Although intraoperative imaging may incur expenses upfront, it can reduce long-term healthcare expenditures by preventing costly and complex revision surgeries. For example, a 2022 study showed that imaging can be cost-effective (2). My experience required multiple surgeries over several years. Early detection of the initial tip fold-over and misplacement could have avoided the financial burden of revision surgeries and many audiology appointments and tests. 2. Surgical Efficiency Should Not Come at the Expense of Patient Outcomes Several surgeons in private practice have argued to me that intraoperative imaging increases operative time. The minutes spent verifying placement are negligible compared to years of functional impairment, pain, and poor hearing outcomes. Quick confirmatory imaging in 2016 could have identified my severe tip fold-over, sparing me two additional surgeries and a permanent decline in balance. 3. Radiation Exposure Should be Weighed Against the Harm of Missed Diagnoses While limiting radiation exposure is an important goal, modern imaging techniques like PCD-CT use dramatically reduced doses compared to traditional CT. Given the choice, I would opt for a single low-dose intraoperative scan, as it is less harmful than the cumulative effects of multiple revision surgeries, prolonged hearing impairment, and unnecessary pain. 4. The Burden of Advocacy Should Not Fall on the Patient Cochlear implant recipients range from infants to older adults, from highly educated professionals to those with limited healthcare literacy. It is unfair to place the burden of advocacy on them. I am an experienced scientist trained to critically evaluate evidence, ask the right questions, and advocate for myself in medical settings. And yet, despite my background and extreme efforts, it took 7+ years of persistence, repeated concerns dismissed by providers, and multiple revision surgeries to correct. If I struggled to get the care I needed, how many other patients—many of whom lack the knowledge, confidence, or communication skills to challenge their providers—are suffering in silence with a preventable and fixable electrode placement? Given these considerations, I urge the field to act and adopt these recommendations: 1. Routine intraoperative imaging: Cone-beam CT or PCD-CT should be standard practice in CI surgeries to verify electrode placement. A few extra minutes in the OR can prevent years of suffering. If CT is simply not available, an intraoperative x-ray when available should be done. 2. Mandatory postoperative imaging when intraoperative imaging is not available: If intraoperative imaging is not feasible, postsurgical imaging should be done promptly to confirm placement and prevent complications, even if it requires additional surgery. 3. Improved attention topatient-reportedsymptoms: Patients reporting poor performance, pain, unusual sensations, or declining sound quality should be taken seriously, with imaging prioritized when issues arise. Thank you for the opportunity to share my perspective. I hope this case sparks meaningful discussion on improving cochlear implantation standards and care. Sincerely, Matt Hayat Matthew J. Hayat Department of Population Health Sciences School of Public Health Georgia State University Atlanta, Georgia [email protected]
Source: Otology & Neurotology
Author: Matthew J. Hayat
Institution: Georgia State University
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: hybrid
OpenAlex ID: W4411196685