Douglas D. Backous
Professor Backous (Drbackous.com) is a board-certified Neurotologist who practices in Puyallup, Washington. He graduated the University of Washington School of Medicine, did his internship and residency at Baylor College of Medicine and went on to complete a research followed by a clinical fellowship in Neurotology at Johns Hopkins University. His professional mission is ensuring access to care for patients with ear disease and hearing loss. He is an inaugural member of the Healthy Hearing Ears Initiative committed to creating standards of care for treating hearing loss in people with chronic otitis media. Prof. Backous hosts the Northwest Otology Fellowship and runs the largest implantable hearing device program in the Pacific Northwest. His passion is working to protect the richness of otolaryngology practice with doctors being able to choose their practice environment to optimally serve their patients with enjoyment and resilience. He is Past-President the American Academy of Otolaryngology-Head and Neck Surgery. His interests include flyfishing, water and Nordic skiing, golf, church activities, spending time with his wife and family and hiking.
Sessions
Abstract:
Purpose: In revisions and in patients with unusual cochlear duct anatomy, optimal CI electrode insertion is the goal to secure patient performance. Verification of placement should be done at surgery.
Methods: Retrospective review of all CI cases in our center between January 1, 2023 and October 15, 2025. Of 131 cases, 6 were revisions for device malfunction, 3 for delayed infection, 3 for intracochlear schwannoma, 4 for basal turn ossification, and two for unexpected cochlear duct soft tissue obstruction. Depth of insertion, wound complications, facial nerve stimulation, balance issues, and comparison to prior performance was analyzed.
Results: 18 (13.7%) patients met criteria for 22-month study period. 5/6 re-implants for device failure achieved full insertion. 1 was inserted to 16/22 electrodes. Removal of the receiver stimulator while leaving the electrode, 6 weeks of culture specific antibiotics, and re-implantation was successfully achieved in 3/3 cases of delayed implant site infection. 2/3 with intracochlear schwannomas had full insertion. 1 had partial insertion. 3/4 with basal turn ossification had full insertion with a drill-through technique. 1 case had a partial insertion. 2/2 patients with unexpected soft tissue obstruction of the basal turn obtained full insertion, 1 was concurrently treated for a round window gusher. All 21 patients in this cohort are full time CI users with average follow-up of 15 months.
Conclusions: Electrode selection and verification of placement are essential components to optimize patient performance in this challenging population. SmartNav estimates both electrode position without a radiograph and provides starting programming parameters in this population.