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Impact of Perioperative Oral Steroid Use on Low-frequency Hearing Preservation After Cochlear Implantation

Sweeney, Alex D.; Carlson, Matthew L.; Zuniga, M. Geraldine; Bennett, Marc L.; Wanna, George B.; Haynes, David S.; Rivas, Alejandro

doi: 10.1097/MAO.0000000000000847
Cochlear Implants

Objective: To investigate the efficacy of a perioperative oral steroid taper on low-frequency hearing preservation after cochlear implantation.

Study Design: Retrospective case series.

Setting: Tertiary referral center.

Patients: Consecutive cochlear implant recipients between January 2012 and December 2014 who were candidates for a hearing preservation approach based on preoperative pure tone thresholds were identified.

Interventions: A subgroup of patients received a 2-week oral corticosteroid taper beginning 3 days before surgery. All patients were implanted using standard length electrodes.

Main Outcome Measures: The preservation of low-frequency pure tone thresholds on the first postoperative audiogram was assessed. Secondary outcome measures included the respective impacts of age, diabetes, and electrode array type on hearing preservation, the durability of hearing preservation over time, and the development of medical complications related to steroid use.

Results: Twenty-seven ears met inclusion criterion, and the mean age at implantation was 49.8 years (median 62 yr, range 2–81 yr). Twenty patients (74.1%, mean age 48.7 yr) received an oral corticosteroid taper, whereas 7 (25.9%, mean age 53.1 yr) did not. The rate (p < 0.01) and degree (p < 0.01) of hearing preservation as measured at implant activation was greater for patients who received an oral steroid taper than those who did not. There were no medical complications related to steroid use.

Conclusion: A 2-week oral prednisone taper beginning before surgery may positively affect the incidence and degree of low-frequency hearing preservation after cochlear implantation.

The Otology Group of Vanderbilt University, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Address correspondence and reprint requests to Alejandro Rivas, M.D., Department of Otolaryngology–Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology and Communication Sciences, 7209 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN 37232-8605, U.S.A.; E-mail: alejandro.rivas@vanderbilt.edu

Internal departmental funding was used without commercial sponsorship or support.

Institutional review board approval: Data Integrated Study Console of Vanderbilt's Research Enterprise (DISCOVR-E) IRB 140944.

D.S.H. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. G.B.W. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, and Oticon. A.R. is a consultant for Advanced Bionics Corp., Cochlear Corp., MED-EL GmbH, and Grace Medical.

The authors disclose no other conflicts of interest.

Copyright © 2015 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company