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Silva VAR, Pauna HF, Lavinsky J, Guimarães GC, Abrahão NM, Massuda ET, Vianna MF, Ikino CMY, Santos VM, Polanski JF, Silva MNLD, Sampaio ALL, Zanini RVR, Lourençone LFM, Denaro MMDC, Calil DB, Chone CT, Castilho AM. Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101303. [PMID: 37647735 PMCID: PMC10474207 DOI: 10.1016/j.bjorl.2023.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Guilherme Corrêa Guimarães
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Nicolau Moreira Abrahão
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericordia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Departamento de Cirurgia e Hospital Universitário, Florianópolis, SC, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackensie do Paraná, Curitiba, PR, Brazil
| | | | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | | | - Luiz Fernando Manzoni Lourençone
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil
| | | | - Daniela Bortoloti Calil
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Lailach S, Zahnert T. Results and Quality of Life after Implantation of Active Middle Ear Implants. Laryngorhinootologie 2022; 101:S3-S35. [PMID: 35605611 DOI: 10.1055/a-1647-8616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.
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Affiliation(s)
- Susen Lailach
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
| | - Thomas Zahnert
- Universitätsklinikum Dresden Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie (Klinikdirektor: Prof. Dr.med. Dr. h.c. Thomas Zahnert) Dresden
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Lailach S, Müller C, Lasurashvili N, Seidler H, Zahnert T. [Active hearing implants in chronic otitis media]. HNO 2021; 69:447-463. [PMID: 31712875 DOI: 10.1007/s00106-019-00775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.
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Affiliation(s)
- S Lailach
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Müller
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - N Lasurashvili
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - H Seidler
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Zahnert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf-Hals-Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Fully Implantable Active Middle Ear Implants After Subtotal Petrosectomy With Fat Obliteration: Preliminary Clinical Results. Otol Neurotol 2021; 41:e912-e920. [PMID: 32658109 DOI: 10.1097/mao.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In patients with chronic middle ear disease, especially after revision surgery for ventilation problems and mixed hearing loss, active middle ear implants may provide an alternative treatment option. The fully implantable active middle-ear implant (FI-AMEI) is designed for implantation in a ventilated mastoid with an intact posterior canal wall. Until now, there have been no reports on audiometric results after implantation of a FI-AMEI in a fat-obliterated cavity after subtotal petrosectomy (SPE). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Twelve patients were included after numerous previous tympanoplasty surgeries for severe mixed hearing loss and FI-AMEI implantation. INTERVENTION In five patients, the FI-AMEI was implanted in a cavity, with fat obliteration, after SPE. Seven patients received FI-AMEI implantation after intact canal wall (ICW) surgery. MAIN OUTCOME MEASURE(S) Audiometric results (pure-tone audiometry, Freiburger monosyllables) are demonstrated for 12 patients after an observation period of 3 months. RESULTS The improvement in monosyllable score was 40 to 85% for the 12 patients. Free-field-aided thresholds showed high heterogeneity. CONCLUSION FI-AMEI implantation combined with SPE provides an alternative approach to hearing rehabilitation to non-FI-AMEI implantation. Studies with a high number of patients and long-term observation periods are necessary to statistically verify these results.
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Wardenga N, Snik AFM, Kludt E, Waldmann B, Lenarz T, Maier H. Hearing Aid Treatment for Patients with Mixed Hearing Loss. Part II: Speech Recognition in Comparison to Direct Acoustic Cochlear Stimulation. Audiol Neurootol 2020; 25:133-142. [PMID: 32007992 DOI: 10.1159/000504285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The conventional therapy for severe mixed hearing loss is middle ear surgery combined with a power hearing aid. However, a substantial group of patients with severe mixed hearing loss cannot be treated adequately with today's state-of-the-art (SOTA) power hearing aids, as predicted by the accompanying part I of this publication, where we compared the available maximum power output (MPO) and gain from technical specifications to requirements for optimum benefit using a common fitting rule. Here, we intended to validate the theoretical assumptions from part I experimentally in a mixed hearing loss cohort fitted with SOTA power hearing aids. Additionally, we compared the results with an implantable hearing device that circumvents the impaired middle ear, directly stimulating the cochlea, as this might be a better option. OBJECTIVES Speech recognition outcomes obtained from patients with severe mixed hearing loss supplied acutely with a SOTA hearing aid were studied to validate the outcome predictions as described in part I. Further, the results obtained with hearing aids were compared to those in direct acoustic cochlear implant (DACI) users. MATERIALS AND METHODS Twenty patients (37 ears with mixed hearing loss) were provided and fitted with a SOTA power hearing aid. Before and after an acclimatization period of at least 4 weeks, word recognition scores (WRS) in quiet and in noise were studied, as well as the speech reception threshold in noise (SRT). The outcomes were compared retrospectively to a second group of 45 patients (47 ears) using the DACI device. Based on the severity of the mixed hearing loss and the available gain and MPO of the SOTA hearing aid, the hearing aid and DACI users were subdivided into groups with prediction of sufficient, partially insufficient, or very insufficient hearing aid performance. RESULTS The patients with predicted adequate SOTA hearing aid performance indeed showed the best WRS in quiet and in noise when compared to patients with predicted inferior outcomes. Insufficient hearing aid performance at one or more frequencies led to a gradual decrease in hearing aid benefit, validating the criteria used here and in the accompanying paper. All DACI patients showed outcomes at the same level as the adequate hearing aid performance group, being significantly better than those of the groups with inadequate hearing aid performance. Whereas WRS in quiet and noise were sensitive to insufficient gain or output, showing significant differences between the SOTA hearing aid and DACI groups, the SRT in noise was less sensitive. CONCLUSIONS Limitations of outcomes in mixed hearing loss individuals due to insufficient hearing aid performance can be accurately predicted by applying a commonly used fitting rule and the 35-dB dynamic range rule on the hearing aid specifications. Evidently, when outcomes in patients with mixed hearing loss using the most powerful hearing aids are insufficient, bypassing the middle ear with a powerful active middle ear implant or direct acoustic implant can be a promising alternative treatment.
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Affiliation(s)
- Nina Wardenga
- Cluster of Excellence Hearing4all, Hannover, Germany, .,Department of Otolaryngology, Hannover Medical School, Hannover, Germany,
| | - Ad F M Snik
- Department of Biophysics, Radboud University, Nijmegen, The Netherlands
| | - Eugen Kludt
- Cluster of Excellence Hearing4all, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Hannes Maier
- Cluster of Excellence Hearing4all, Hannover, Germany.,Department of Otolaryngology, Hannover Medical School, Hannover, Germany
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D’hondt C, Wouters J, Verhaert N. Alteration of the relative vibration of the round window membrane after implantation of a direct acoustic cochlear implant. Int J Audiol 2019; 59:341-347. [DOI: 10.1080/14992027.2019.1705405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Christiane D’hondt
- Research and Development, Cochlear Technology Centre Belgium, Mechelen, Belgium
- Research Group ExpORL, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group ExpORL, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Nicolas Verhaert
- Research Group ExpORL, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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Cochlear Implantation in Chronic Otitis Media: Investigation of Long-term Speech Comprehension and Rate of Complications. Otol Neurotol 2019; 39:e979-e984. [PMID: 30289846 DOI: 10.1097/mao.0000000000002026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the long-term speech comprehension and rate of complications of cochlear implantation in chronic otitis media. STUDY DESIGN Retrospective data analysis. SETTING Tertiary referral center with a large cochlear implant program. MAIN OUTCOME MEASURE Speech perception scores in quiet and background noise and rate of complications. PATIENTS Forty ears from a total of 38 patients with a mean age of 63.28 ± 2.16 years at the time of implantation were included. RESULTS Patients with a history of multiple ear surgeries, with no alternative option for hearing restoration than a cochlear implant, were implanted with satisfactory results in regard to speech comprehension. Preoperative bone conduction PTA4 correlated to postoperative speech comprehension scores in background noise. The rate of complications was low, but higher than in cases of cochlear implantation in normal middle ears. CONCLUSION Cochlear implantation in chronic otitis media can be a satisfactory and safe procedure, if the surgery technique and aftercare is appropriate to the altered anatomy.
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Direct Acoustic Cochlear Implants Lead to an Improved Speech Perception Gap Compared to Conventional Hearing Aid. Otol Neurotol 2019; 39:1147-1152. [PMID: 30106855 DOI: 10.1097/mao.0000000000001954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study was to evaluate the aided speech perception in quiet of direct acoustic cochlear implant (DACI) patients and the speech perception gap in comparison with hearing aid users. STUDY DESIGN Retrospective comparative study. SETTING Tertiary referral center. PATIENTS Adults with moderate-to-severe mixed hearing loss who have been implanted with a DACI and fitted with a processor for at least 6 months. INTERVENTION(S) Comparison of aided monosyllabic word scores and speech perception gap of 59 DACI-implanted ears speech perception gap with published data on 208 ears aided with a conventional hearing aid (HA) divided into four different hearing loss groups between 35 and 75 dB HL. MAIN OUTCOME MEASURE(S) Aided monosyllabic word score, predicted maximum monosyllabic word recognition score (PBmax) and speech perception gap. RESULTS In terms of aided speech perception, DACI patients with cochlear reserves between 45 and 65 dB HL have a significant advantage compared with conventional HA users. A speech perception gap of 11% points for DACI and 21% points for conventional HAs were determined and an approximation of PBmax is achieved by 52% of the DACI patients compared with only 36% of the HA users. CONCLUSIONS For patients with moderate-to-severe inner ear hearing loss between 45 and 65 dB HL, better speech perception in quiet is obtained with the DACI system. Compared with conventional hearing aids, speech performance with the DACI is closer to the maximally possibly score PBmax.
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McElveen JT, Kutz JW. Controversies in the Evaluation and Management of Otosclerosis. Otolaryngol Clin North Am 2018; 51:487-499. [PMID: 29502731 DOI: 10.1016/j.otc.2017.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis. In addition, opinions vary regarding the optimal postoperative care of patients undergoing stapedotomy and a patient's ability to participate in activities that may result in barotrauma.
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Affiliation(s)
- John T McElveen
- Carolina Ear & Hearing Clinic, PC, Carolina Ear Research Institute, 5900 Six Forks Road, Suite #200, Raleigh, NC 27609, USA.
| | - J Walter Kutz
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA
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Deprez H, Gransier R, Hofmann M, Wouters J, Verhaert N. Development and validation of a method to record electrophysiological responses in direct acoustic cochlear implant subjects. Hear Res 2018; 370:217-231. [PMID: 30213516 DOI: 10.1016/j.heares.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/25/2022]
Abstract
Acoustic hearing implants, such as direct acoustic cochlear implants (DACIs), can be used to treat profound mixed hearing loss. Electrophysiological responses in DACI subjects are of interest to confirm auditory processing intra-operatively, and to assist DACI fitting postoperatively. We present two related studies, focusing on DACI artifacts and electrophysiological measurements in DACI subjects, respectively. In the first study we aimed to characterize DACI artifacts, to study the feasibility of measuring frequency-specific electrophysiological responses in DACI subjects. Measurements of DACI artifacts were collected in a cadaveric head to disentangle possible DACI artifact sources and compared to a constructed DACI artifact template. It is shown that for moderate stimulation levels, DACI artifacts are mainly dominated by the artifact from the radio frequency (RF) communication signal, that can be modeled if the RF encoding protocol is known. In a second study, the feasibility of measuring intra-operative responses, without applying the RF artifact models, in DACI subjects is investigated. Auditory steady-state and brainstem responses were measured intra-operatively in three DACI subjects, immediately after implantation, to confirm proper DACI functioning and coupling to the inner ear. Intra-operative responses could be measured in two of the three tested subjects. Absence of intra-operative responses in the third subject can possibly be explained by the hearing loss, attenuation of intra-operative responses, the difference between electrophysiological and behavioral threshold, and a temporary threshold shift due to the DACI surgery. In conclusion, RF artifacts can be modeled, such that electrophysiological responses to frequency-specific stimuli could possibly be measured in DACI subjects, and intra-operative responses in DACI subjects can be obtained.
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Affiliation(s)
- Hanne Deprez
- ExpORL, Dept. of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Robin Gransier
- ExpORL, Dept. of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michael Hofmann
- ExpORL, Dept. of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan Wouters
- ExpORL, Dept. of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Nicolas Verhaert
- ExpORL, Dept. of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium; University Hospitals Leuven, Department of Otolaryngology, Head and Neck Surgery, 3000, Leuven, Belgium
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Fiorino F, Amadori M. Mastoidectomy dimensions for direct acoustic cochlear implantation: a human cadaveric temporal bone study. Eur Arch Otorhinolaryngol 2017; 274:2155-2160. [PMID: 28246895 DOI: 10.1007/s00405-017-4504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
The objective of the present paper was to acquire information about the mastoidectomy size necessary to obtain an optimal placement of the direct acoustic cochlear implant actuator and fixation system. Ten human cadaveric temporal bones were dissected and implanted with direct acoustic cochlear implant. Mastoidectomy size was determined after implantation in each temporal bone. A bone bed for the receiver/stimulator, mastoidectomy and a large posterior tympanotomy were drilled out. The mastoidectomy was progressively enlarged posteriorly in small steps until the actuator template was judged adequately oriented to enable passage of the rod through the posterior tympanotomy without any contact with the bony walls. The distance between different landmarks in the mastoidectomy was measured. All measured values showed a high degree of consistency, with limited median absolute deviation values. One of the most critical measure, i.e. the distance between the posterior margin of the mastoidectomy to the superior rim of the bony external ear canal wall, ranged from 13 to 16 mm with a median value of 15 mm. Prior knowledge of the ideal size of the mastoidectomy for direct acoustic cochlear implant facilitates the positioning of the fixation system and may save time during implant surgery.
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Affiliation(s)
- Francesco Fiorino
- Unità Operativa Complessa di Otorinolaringoiatria, Department of Otolaryngology, Ospedale Mater Salutis, Azienda Unita Locale Socio Sanitaria 9 Scaligera, Via Gianella 1, 37045, Legnago, VR, Italy.
| | - Maurizio Amadori
- Department of Otolaryngology, Ospedale di Mirano, Azienda Unita Locale Socio Sanitaria 3 Serenissima, 30035, Mirano, VE, Italy
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