When residual acoustic hearing is worth keeping, electrode choice matters. This meta-analysis of 72 studies and 3,783 ears compared lateral-wall against perimodiolar cochlear implant arrays for hearing preservation.
The pooled hearing-preservation rate was 45.9% for lateral-wall versus 34.2% for perimodiolar electrodes (P<0.000005). In 18 head-to-head studies the advantage was borderline (risk ratio 1.24, 95% CI 0.99–1.56, P=0.057), but excluding short-term (≤1 month) studies made it statistically significant (RR 1.37, 95% CI 1.06–1.77, P=0.016) — the difference holds up where it matters, over longer follow-up.
The practical steer is to favour a lateral-wall array when preserving residual low-frequency hearing is a goal, while still weighing cochlear anatomy, preoperative hearing and surgeon experience. It is not an absolute rule, but it is a reasonable default for hearing-preservation candidates.
- Hearing preserved in 45.9% with lateral-wall vs 34.2% with perimodiolar arrays
- Advantage significant over longer follow-up (RR 1.37) though borderline overall
- Favour lateral-wall arrays when residual hearing preservation is a goal
- Still individualise for cochlear anatomy, baseline hearing and surgeon experience
The statistics, in plain English
The overall head-to-head risk ratio of 1.24 crossed 1.0 (P=0.057), meaning the advantage was not quite statistically certain until very short studies were removed, after which it reached significance (RR 1.37). That pattern — a benefit that firms up with longer follow-up — is more convincing than a single pooled number, because early hearing preservation often fades.
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