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Gehrke M, Verin J, Gnansia D, Tourrel G, Risoud M, Vincent C, Siepmann F, Siepmann J. Hybrid Ear Cubes for local controlled dexamethasone delivery to the inner ear. Eur J Pharm Sci 2018; 126:23-32. [PMID: 29723597 DOI: 10.1016/j.ejps.2018.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 01/13/2023]
Abstract
A new type of miniaturized implants for local controlled drug delivery to the inner ear is proposed: Hybrid Ear Cubes. They are composed of two main parts: (i) a cylinder, which is placed into a tiny hole (<0.4 mm) drilled into (or close to) the oval (or round) window, and (ii) a cuboid, which is placed into the middle ear. The drug is released at a pre-programmed rate into the perilymph: (i) via the cylindrical part of the implant, which is in direct contact with this liquid, and (ii) via diffusion from the cuboid through the oval/round window. Importantly, the cylindrical part assures a reliable fixation of the drug delivery system at the site of administration. Furthermore, the cuboid provides a relatively "large" drug reservoir, without expulsing perilymph from the cochlea. The required surgery is minimized compared to the placement of an intracochlear implant. In contrast to previously proposed Ear Cubes, which are mono-block systems, Hybrid Ear Cubes consist of two halves, which can: (i) be loaded with different drugs, (ii) be loaded with the same drug at different concentrations, and/or (iii) be based on two different matrix formers. This offers a substantially increased formulation flexibility. Different types of silicone-based Hybrid Ear Cubes were prepared, loaded with 10% dexamethasone in one half and 0-60% dexamethasone in the other half. Importantly, tiny drug crystals were homogeneously distributed throughout the respective implant halves. The observed drug release rates were very low (e.g., <0.5% after 2 months), which can be attributed to the type of drug and silicone as well as to the very small surface area exposed to the release medium. Importantly, no noteworthy implant swelling was observed.
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Affiliation(s)
- M Gehrke
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France
| | - J Verin
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France
| | - D Gnansia
- Oticon Medical/Neurelec, R&D, 2720 Chemin Saint-Bernard, F-06224 Vallauris, France
| | - G Tourrel
- Oticon Medical/Neurelec, R&D, 2720 Chemin Saint-Bernard, F-06224 Vallauris, France
| | - M Risoud
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France
| | - C Vincent
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France
| | - F Siepmann
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France
| | - J Siepmann
- Univ. Lille, Inserm, CHU Lille, U1008, F-59000 Lille, France.
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Liu X, Li M, Smyth H, Zhang F. Otic drug delivery systems: formulation principles and recent developments. Drug Dev Ind Pharm 2018; 44:1395-1408. [PMID: 29659300 DOI: 10.1080/03639045.2018.1464022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Disorders of the ear severely impact the quality of life of millions of people, but the treatment of these disorders is an ongoing, but often overlooked challenge particularly in terms of formulation design and product development. The prevalence of ear disorders has spurred significant efforts to develop new therapeutic agents, but perhaps less innovation has been applied to new drug delivery systems to improve the efficacy of ear disease treatments. This review provides a brief overview of physiology, major diseases, and current therapies used via the otic route of administration. The primary focuses are on the various administration routes and their formulation principles. The article also presents recent advances in otic drug deliveries as well as potential limitations. Otic drug delivery technology will likely evolve in the next decade and more efficient or specific treatments for ear disease will arise from the development of less invasive drug delivery methods, safe and highly controlled drug delivery systems, and biotechnology targeting therapies.
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Affiliation(s)
- Xu Liu
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Mingshuang Li
- b Department of Communication Sciences and Disorders , The University of Texas at Austin , Austin , TX , USA
| | - Hugh Smyth
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
| | - Feng Zhang
- a College of Pharmacy , The University of Texas at Austin , Austin , TX , USA
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Effects of dexamethasone on intracochlear inflammation and residual hearing after cochleostomy: A comparison of administration routes. PLoS One 2018; 13:e0195230. [PMID: 29601595 PMCID: PMC5877881 DOI: 10.1371/journal.pone.0195230] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/06/2018] [Indexed: 12/20/2022] Open
Abstract
Preservation of residual hearing after cochlear implant is an important issue with regards to hearing performance. Various methods of steroid administration have been widely used in clinical practice to reduce inflammation and preserve residual hearing. Here we compare the effect of different routes of dexamethasone administration on intracochlear inflammation and residual hearing in guinea pig ears. Dexamethasone was delivered into the guinea pigs either through intracochlear, intratympanic or systemic route. The intracochlear concentration of dexamethasone, residual hearing, inflammatory cytokines and histopathologic changes were evaluated over time. A higher intracochlear dexamethasone concentration was observed after intracochlear administration than through the other routes. Residual hearing was better preserved with local dexamethasone administration as was supported by the reduced inflammatory cytokines, more hair cell survival and less severe intracochlear fibrosis and ossification concurrently seen in the local delivery group than in the systemic group. The results demonstrate that local dexamethasone delivery can reduce intracochlear inflammation and preserve residual hearing better than in systemically administered dexamethasone.
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Mäder K, Lehner E, Liebau A, Plontke SK. Controlled drug release to the inner ear: Concepts, materials, mechanisms, and performance. Hear Res 2018; 368:49-66. [PMID: 29576310 DOI: 10.1016/j.heares.2018.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 12/01/2022]
Abstract
Progress in drug delivery to the ear has been achieved over the last few years. This review illustrates the main mechanisms of controlled drug release and the resulting geometry- and size-dependent release kinetics. The potency, physicochemical properties, and stability of the drug molecules are key parameters for designing the most suitable drug delivery system. The most important drug delivery systems for the inner ear include solid foams, hydrogels, and different nanoscale drug delivery systems (e.g., nanoparticles, liposomes, lipid nanocapsules, polymersomes). Their main characteristics (i.e., general structure and materials) are discussed, with special attention given to underlining the link between the physicochemical properties (e.g., surface areas, glass transition temperature, microviscosity, size, and shape) and release kinetics. An appropriate characterization of the drug, the excipients used, and the formulated drug delivery systems is necessary to achieve a deeper understanding of the release process and decrease variability originating from the drug delivery system. This task cannot be solved by otologists alone. The interdisciplinary cooperation between otology/neurotology, pharmaceutics, physics, and other disciplines will result in improved drug delivery systems for the inner ear.
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Affiliation(s)
- Karsten Mäder
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany.
| | - Eric Lehner
- Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany
| | - Arne Liebau
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, University Medicine Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
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Zhang L, Xu Y, Cao W, Xie S, Wen L, Chen G. Understanding the translocation mechanism of PLGA nanoparticles across round window membrane into the inner ear: a guideline for inner ear drug delivery based on nanomedicine. Int J Nanomedicine 2018; 13:479-492. [PMID: 29403277 PMCID: PMC5784583 DOI: 10.2147/ijn.s154968] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The round window membrane (RWM) functions as the primary biological barrier for therapeutic agents in the inner ear via local application. Previous studies on inner ear nano-drug delivery systems mostly focused on their pharmacokinetics and distribution in the inner ear, but seldom on the interaction with the RWM. Clarifying the transport mechanism of nanoparticulate carriers across RWM will shed more light on the optimum design of nano-drug delivery systems intended for meeting demands for their clinical application. Methods The poly (lactic-co-glycolic acid) nanoparticles (PLGA NPs) encapsulating coumarin-6 were prepared by emulsifying solvent evaporation method. We utilized confocal laser scanning microscope (CLSM) in combination with transmission electron microscope to investigate the transport pathway of PLGA NPs in the RWM. Simultaneously, the concentration and time dependence of NPs across the RWM were also determined. The endocytic mechanism of NPs through this membrane interface was classically analyzed by means of various endocytic inhibitors. The intracellular location of NPs into lysosomes was evaluated using CLSM scanning microscope colocalization analysis. The Golgi-related inhibitors were employed to probe into the function of Golgi and endoplasmic reticulum (ER) in the discharge of NPs out of cells. Results PLGA NPs were herein transported through the RWM of a sandwich-like structure into the perilymph via the transcellular pathway. NPs were internalized predominantly via macropinocytosis and caveolin-mediated endocytic pathways. After being internalized, the endocytosed cargos were entrapped within the lysosomal compartments and/or the endoplasmic reticulum/Golgi apparatus which mediated the exocytotic release of NPs. Conclusion For the first time, we showed the translocation itinerary of NPs in RWM, providing a guideline for the rational fabrication of inner ear nanoparticulate carriers with better therapeutic effects.
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Affiliation(s)
- Liping Zhang
- School of Pharmacy.,Guangdong Provincial Key Laboratory of Advanced Drug Delivery.,Guangdong Provincial Engineering Center of Topical Precise Drug Delivery System, Guangdong Pharmaceutical University, Guangzhou, China
| | | | | | - Shibao Xie
- School of Pharmacy.,Guangdong Provincial Key Laboratory of Advanced Drug Delivery.,Guangdong Provincial Engineering Center of Topical Precise Drug Delivery System, Guangdong Pharmaceutical University, Guangzhou, China
| | | | - Gang Chen
- School of Pharmacy.,Guangdong Provincial Key Laboratory of Advanced Drug Delivery.,Guangdong Provincial Engineering Center of Topical Precise Drug Delivery System, Guangdong Pharmaceutical University, Guangzhou, China
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Abu Ammar A, Gruber M, Martin P, Stern O, Jahshan F, Ertracht O, Sela E, Srouji S, Zussman E. Local delivery of mometasone furoate from an eluting endotracheal tube. J Control Release 2018; 272:54-61. [PMID: 29331580 DOI: 10.1016/j.jconrel.2018.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Laryngeal and tracheal morbidity is a common complication of endotracheal tube (ETT)-based airway management, and manifests as local irritation, inflammation, and edema. Systemic corticosteroids are commonly administered to manage these conditions; however, their efficacy is inadequate and limited by potential severe side effects. In the present study, a steroid delivery system for local therapy was developed to generate relatively high local drug concentrations and to improve drug efficacy. ETTs were coated with electrospun poly (lactic-co-glycolic acid) (PLGA) nanofibers loaded with mometasone furoate (MF), creating a microscale thick layer. MF exhibited sustained release from coated ETTs over 14days in vitro. An in vivo efficacy study in rats demonstrated the therapeutic benefit of MF-coated ETTs over bare ETTs, as measured by reduced laryngeal mucosal thickness and submucosal laryngeal edema. The fiber coating remained intact during tube intubation and extubation, demonstrating good adhesion to the tubes even after 24h in aqueous solution at 37°C. These findings demonstrate the potential of drug-loaded ETTs to revolutionize the standard of care for endotracheal intubation.
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Affiliation(s)
- Aiman Abu Ammar
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Maayan Gruber
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Patrick Martin
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Ohad Stern
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Offir Ertracht
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Samer Srouji
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Institute of Oral and Maxillofacial Surgery and Oral Medicine, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Zussman
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel.
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Al-Lawati H, Aliabadi HM, Makhmalzadeh BS, Lavasanifar A. Nanomedicine for immunosuppressive therapy: achievements in pre-clinical and clinical research. Expert Opin Drug Deliv 2018; 15:397-418. [DOI: 10.1080/17425247.2018.1420053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Hanan Al-Lawati
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | | | | | - Afsaneh Lavasanifar
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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58
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Valente F, Astolfi L, Simoni E, Danti S, Franceschini V, Chicca M, Martini A. Nanoparticle drug delivery systems for inner ear therapy: An overview. J Drug Deliv Sci Technol 2017. [DOI: 10.1016/j.jddst.2017.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zanetti D, Di Berardino F, Nassif N, Redaelli De Zinis LO. Intratympanic steroid delivery by an indwelling catheter in refractory severe sudden sensorineural hearing loss. Auris Nasus Larynx 2017; 45:227-233. [PMID: 28511890 DOI: 10.1016/j.anl.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Many studies over the last decade showed favorable outcomes with intratympanic (IT) steroid treatment, alone as salvage treatment or in combination with conventional systemic therapy (ST). However, in severe to profound sensorineural hearing loss resistant to ST, the optimal infusion mode, the type and concentration of the solution, the preferable drug, its total amount, and the duration and fractionation of the treatment are still debated. Aim of the study was to investigate the feasibility and the outcomes of a direct and constant IT delivery of dexamethasone (DEX) by means of a new indwelling catheter. METHODS A prospective case-control study in a tertiary referral university hospital. Ninety-nine subjects treated with ST only and 28 with additional IT DEX have been included in the study. A 4 Fr catheter inserted in a sub-annular fashion with a minimal postero-inferior tympanotomy through and endocanalar approach under local anesthesia. DEX 4mg/ml delivered daily, up to 7 days. Daily bone and air-conducted pure tone and speech audiometry were performed with a follow-up at 1, 3, 6 months after treatment. RESULTS Twenty-one out of 28 patients (75%) refractory to ST gained on average 24.0dB±20.5dB HL after IT-DEX, compared to 35.4% (average 6.7dB±16.6dB HL) of those receiving only medical ST (p<0.001). No significant side effects were noted. CONCLUSION In severe to profound sudden deafness refractory to conventional ST, the daily perfusion of 4mg/ml DEX through an intratympanic catheter is an easy, well accepted procedure that enables patients to receive a drug in the middle ear in a repeatable or sustained form, with minimal discomfort and a partial rescue (67.86%) and a speech recognition gain of 39%.
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Affiliation(s)
- Diego Zanetti
- Audiology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Federica Di Berardino
- Audiology Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Department of Clinical Sciences and Community Health, University of Milano, Italy.
| | - Nader Nassif
- Otorhinolaryngology Department-University of Brescia, Italy
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Mixtures of hyaluronic acid and liposomes for drug delivery: Phase behavior, microstructure and mobility of liposomes. Int J Pharm 2017; 523:246-259. [DOI: 10.1016/j.ijpharm.2017.03.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 01/25/2023]
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Mambrini G, Mandolini M, Rossi L, Pierigè F, Capogrossi G, Salvati P, Serafini S, Benatti L, Magnani M. Ex vivo encapsulation of dexamethasone sodium phosphate into human autologous erythrocytes using fully automated biomedical equipment. Int J Pharm 2016; 517:175-184. [PMID: 27939571 DOI: 10.1016/j.ijpharm.2016.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/14/2016] [Accepted: 12/05/2016] [Indexed: 02/01/2023]
Abstract
Erythrocyte-based drug delivery systems are emerging as potential new solutions for the release of drugs into the bloodstream. The aim of the present work was to assess the performance of a fully automated process (EDS) for the ex-vivo encapsulation of the pro-drug dexamethasone sodium phosphate (DSP) into autologous erythrocytes in compliance with regulatory requirements. The loading method was based on reversible hypotonic hemolysis, which allows the opening of transient pores in the cell membrane to be crossed by DSP. The efficiency of encapsulation and the biochemical and physiological characteristics of the processed erythrocytes were investigated in blood samples from 34 healthy donors. It was found that the processed erythrocytes maintained their fundamental properties and the encapsulation process was reproducible. The EDS under study showed greater loading efficiency and reduced variability compared to previous EDS versions. Notably, these results were confirmed using blood samples from Ataxia Telangiectasia (AT) patients, 9.33±1.40 and 19.41±2.10mg of DSP (mean±SD, n=134) by using 62.5 and 125mg DSP loading quantities, respectively. These results support the use of the new EDS version 3.2.0 to investigate the effect of erythrocyte-delivered dexamethasone in regulatory trials in patients with AT.
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Affiliation(s)
| | | | - Luigia Rossi
- EryDel SpA, via Sasso 36, 61029, Urbino (PU), Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029, Urbino (PU), Italy.
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029, Urbino (PU), Italy.
| | | | | | | | - Luca Benatti
- EryDel SpA, via Sasso 36, 61029, Urbino (PU), Italy.
| | - Mauro Magnani
- EryDel SpA, via Sasso 36, 61029, Urbino (PU), Italy; Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029, Urbino (PU), Italy.
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Mamelle E, Kechai NE, Granger B, Sterkers O, Bochot A, Agnely F, Ferrary E, Nguyen Y. Effect of a liposomal hyaluronic acid gel loaded with dexamethasone in a guinea pig model after manual or motorized cochlear implantation. Eur Arch Otorhinolaryngol 2016; 274:729-736. [PMID: 27714498 DOI: 10.1007/s00405-016-4331-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/30/2016] [Indexed: 11/26/2022]
Abstract
Goals of cochlear implantation have shifted from complete insertion of the cochlear electrode array towards low traumatic insertion with minimally invasive techniques. The aim of this study was first to evaluate, in a guinea pig model of cochlear implantation, the effect of a motorized insertion technique on hearing preservation. The second goal was to study a new gel formulation containing dexamethasone phosphate loaded in liposomes (DEX-P). Guinea pigs had a unilateral cochlear implantation with either a manual technique (n = 12), or a motorized technique (n = 15), with a 0.4 mm diameter and 4 mm long array trough a cochleostomy. At the end of the procedure, hyaluronic acid gel containing drug-free liposomes, or liposomes loaded with DEX-P, was injected into the bulla. Auditory brainstem responses thresholds were recorded before surgery and day 2 and 7 after surgery. All the animals had increased auditory brainstem responses thresholds after the cochlear implantation. Implanted animals with the motorized insertion tool experienced a partial hearing recovery at day 7 but not in those implanted with the manual insertion procedure (p < 0.001). In the manually implanted animals, a partial recovery was observed when DEX-P contained in liposomal gel was locally administrated (p < 0.0001). Finally, no additive effect with the motorized insertion was noticed. The deleterious effect of manual insertion, during cochlear implantation, can be prevented with local DEX-P administration in the bulla at day 7. The use of a motorized tool performed more atraumatic electrode array insertion for postoperative hearing.
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Affiliation(s)
- Elisabeth Mamelle
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France.
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France.
| | - Naila El Kechai
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Benjamin Granger
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
- Department of Public Health, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Olivier Sterkers
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
| | - Amélie Bochot
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Florence Agnely
- Institut Galien Paris Sud, CNRS 8612, Paris-Sud, Paris-Saclay University, 92290, Châtenay-Malabry, France
| | - Evelyne Ferrary
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
| | - Yann Nguyen
- UMPC, Paris Sorbonne, INSERM, "Minimally Invasive Robot-based Hearing Rehabilitation", Paris 6, France
- AP-HP, Pitié-Salpêtrière Hospital, Unit of Otology, Auditory Implants and Skull Base Surgery, Otolaryngology Department, 75013, Paris 6, France
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