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Gu W, Daoudi H, Lahlou G, Sterkers O, Ferrary E, Nguyen Y, Mosnier I, Torres R. Auditory outcomes after scala vestibuli array insertion are similar to those after scala tympani insertion 1 year after cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:155-162. [PMID: 37516989 DOI: 10.1007/s00405-023-08107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE In cochlear implantation, a scala vestibuli (SV) insertion of an electrode array is a rare occurrence and is reported to be linked to poor hearing outcomes. Using the same electrode array, the auditory performance of patients with a complete SV location was compared with that of patients having a complete scala tympani (ST) location 1 year after implantation. METHODS Thirty-three patients were included in this retrospective case-control study (SV, n = 12; ST, n = 21). The matching criteria were electrode array type, age at implantation, and duration of severe or profound deafness. The array location was analyzed using 3D reconstruction of postoperative CT scans. Postoperative audiological evaluation of the implanted ear was performed using pure-tone audiometry, speech recognition of monosyllabic words in quiet, and words and sentences in noise. RESULTS On the preoperative CT scan, six patients in the SV group presented with both round window (RW) and ST ossification, three with RW ossification alone, and three with no RW ossification. Auditory performance did not differ between SV and ST groups 1 year after cochlear implantation. Speech recognition of words was 49 ± 7.6% and 56 ± 5.0% in quiet and 75 ± 9.5% and 66 ± 6.0% in noise in SV and ST groups, respectively. CONCLUSION ST insertion is the gold standard that allows the three cochlear scalae to preserve scalar cochlear integrity. However, 1 year after implantation, a planned or unexpected SV insertion is not detrimental to hearing outcomes, providing similar auditory performance in quiet and noise to ST insertion.
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Affiliation(s)
- Wenxi Gu
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases (14DZ2260300), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hannah Daoudi
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Ghizlene Lahlou
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Olivier Sterkers
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Evelyne Ferrary
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Yann Nguyen
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Isabelle Mosnier
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Renato Torres
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France.
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France.
- Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru.
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Shen N, Zhou L, Lai B, Li S. The Influence of Cochlear Implant-Based Electric Stimulation on the Electrophysiological Characteristics of Cultured Spiral Ganglion Neurons. Neural Plast 2020; 2020:3108490. [PMID: 32963515 PMCID: PMC7490630 DOI: 10.1155/2020/3108490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cochlear implant-based electrical stimulation may be an important reason to induce the residual hearing loss after cochlear implantation. In our previous study, we found that charge-balanced biphasic electrical stimulation inhibited the neurite growth of spiral ganglion neurons (SGNs) and decreased Schwann cell density in vitro. In this study, we want to know whether cochlear implant-based electrical stimulation can induce the change of electrical activity in cultured SGNs. Methods Spiral ganglion neuron electrical stimulation in vitro model is established using the devices delivering cochlear implant-based electrical stimulation. After 48 h treatment by 50 μA or 100 μA electrical stimulation, the action potential (AP) and voltage depended calcium current (I Ca) of SGNs are recorded using whole-cell electrophysiological method. Results The results show that the I Ca of SGNs is decreased significantly in 50 μA and 100 μA electrical stimulation groups. The reversal potential of I Ca is nearly +80 mV in control SGN, but the reversal potential decreases to +50 mV in 50 μA and 100 μA electrical stimulation groups. Interestingly, the AP amplitude, the AP latency, and the AP duration of SGNs have no statistically significant differences in all three groups. Conclusion Our study suggests cochlear implant-based electrical stimulation only significantly inhibit the I Ca of cultured SGNs but has no effect on the firing of AP, and the relation of I Ca inhibition and SGN damage induced by electrical stimulation and its mechanism needs to be further studied.
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Affiliation(s)
- Na Shen
- Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, China
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Otolaryngology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Lai
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Shufeng Li
- ENT Institute and Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
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Humphries T, Kushalnagar P, Mathur G, Napoli DJ, Rathmann C. Global Regulatory Review Needed for Cochlear Implants: A Call for FDA Leadership. Matern Child Health J 2020; 24:1345-1359. [PMID: 32876813 DOI: 10.1007/s10995-020-03002-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Using the United States Food and Drug Administration (FDA) as example, we argue that regulatory agencies worldwide should review their guidance on cochlear implants (CIs). METHODS This is a position paper, thus the methods are strictly argumentation. Here we give the motivation for our recommendation. The FDA's original approval of implantation in prelingually deaf children was granted without full benefit of information on language acquisition, on childcaregiver communication, and on the lived experience of being deaf. The CI clinical trials, accordingly, did not address risks of linguistic deprivation, especially when the caregiver's communication is not fully accessible to the prelingually deaf child. Wide variability in the effectiveness of CIs since initial and updated approval has been indicated but has not led to new guidance. Children need to be exposed frequently and regularly to accessible natural language while their brains are still plastic enough to become fluent in any language. For the youngest infants, who are not yet producing anything that could be called language although they might be producing salient social signals (Goldstein et al. Child Dev 80:636-644, 2009), good comprehension of communication from caregiver to infant is critical to the development of language. Sign languages are accessible natural languages that, because they are visual, allow full immersion for deaf infants, and they supply the necessary support for this comprehension. The main language contributor to health outcomes is this combination of natural visual language and comprehension in communication. Accordingly, in order to prevent possible language deprivation, all prelingually deaf children should be exposed to both sign and spoken languages when their auditory status is detected, with sign language being critical during infancy and early childhood. Additionally, all caregivers should be given support to learn a sign language if it is new to them so that they can comprehend their deaf children's language expressions fully. However, both languages should be made accessible in their own right, not combined in a simultaneous or total communication approach since speaking one language and signing the other at the same time is problematic. RESULTS Again, because this is a position paper, our results are our recommendations. We call for the FDA (and similar agencies in other countries) to review its approval of cochlear implantation in prelingually deaf children who are within the sensitive period for language acquisition. In the meantime, the FDA should require manufacturers to add a highlighted warning to the effect that results with CI vary widely and CIs should not be relied upon to provide adequate auditory input for complete language development in all deaf children. Recent best information on users' experience with CIs (including abandonment) should be clearly provided so that informed decisions can be made. The FDA should require manufacturers' guidance and information materials to include encouragement to parents of deaf children to offer auditory input of a spoken language and visual input of a sign language and to have their child followed closely from birth by developmental specialists in language and cognition. In this way parents can align with providers to prioritize cognitive development and language access in both audio-vocal and visuo-gestural modalities. DISCUSSION The arguments and recommendations in this paper are discussed at length as they come up.
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Affiliation(s)
- Tom Humphries
- Education Studies and Department of Communication, University of California at San Diego, La Jolla, CA, USA
| | | | - Gaurav Mathur
- Department of Linguistics, Gallaudet University, Washington, DC, USA
| | - Donna Jo Napoli
- Department of Linguistics, Swarthmore College, Swarthmore, PA, USA.
| | - Christian Rathmann
- Department of Deaf Studies and Sign Language Interpreting, Humboldt-Universität Zu Berlin, Berlin, Germany
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Jang JH, Choo OS, Kim H, Yi Park H, Choung YH. Round window membrane visibility related to success of hearing preservation in cochlear implantation. Acta Otolaryngol 2019; 139:618-624. [PMID: 31066597 DOI: 10.1080/00016489.2019.1609701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study was designed to evaluate the relationship between the degree of round window membrane (RWM) exposure and hearing outcome. Materials and methods: Forty-six ears with cochlear implantation (CI) were enrolled. The degree of RWM exposure was divided into Grade I (<25%), Grade II (25-50%), and Grade III (>50%). The hearing outcomes were evaluated at 1.5 and 12 months postoperatively. Results: Twenty-seven ears were Grade I, 13 were Grade II, and 6 were Grade III. RW approach was used in all ears of Grades II and III and 20 ears of Grade I and cochleostomy was used in 7 ears of Grade I. The pattern of bony overhang was multidirectional in 41 ears. Threshold shift significantly decreased proportional to the increase of RWM exposure after CI. The mean RWM exposure was 32.1 ± 24.4% in ears with more than partial preservation (n = 17), and 13.3 ± 11.7% in the other ears (n = 6) at 12 months post-CI (p = .061). Age at CI differed significantly between ears that had more than partial preservation and the other ears at 1.5 months post-CI. Conclusions and significance: Degree of RWM exposure and age at CI might be factors predicting hearing outcome after CI using the RW approach.
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Affiliation(s)
- Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Oak-Sung Choo
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hantai Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
- Ajou University Graduate School of Medicine, Bk21 Plus Research Center for Biomedical Sciences, Suwon, Korea
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Abstract
OBJECTIVE It is known that the insertion of the intracochlear electrode is critical procedure because the damage around cochlear structures can deteriorate hearing restoration. To reduce the trauma during the electrode insertion surgery, we developed a thin and flexible intracochlear electrode array constructed with carbon nanotube (CNT) bundles. METHODS Each CNT bundle was used for an individual electrode channel after coated with parylene C for insulation. By encapsulating eight CNT bundles with silicone elastomer, an 8-channel intracochlear electrode array was fabricated. The mechanical and electrochemical characteristics were assessed to evaluate the flexibility and feasibility of the electrode as a stimulation electrode. The functionality of the electrode was confirmed by electrically evoked auditory brainstem responses (eABR) recorded from a rat. RESULTS The proposed electrode has a thickness of 135 μm at the apex and 395 μm at the base. It was demonstrated that the CNT bundle-based electrodes require 6-fold the lower insertion force than metal wire-based electrodes. The electrode impedance and the cathodic charge storage capacitance (CSCc) were 2.70 kΩ ∠-20.4° at 1 kHz and - 708 mC/cm2, respectively. The eABR waves III and V were observed when stimulation current is greater than 50 μA. CONCLUSION A thin and flexible CNT bundle-based intracochlear electrode array was successfully developed. The feasibility of the proposed electrode was shown in terms of mechanical and electrochemical characteristics. A proposed CNT bundle-based intracochlear electrode may reduce the risk of trauma during electrode insertion surgery.
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Gautschi-Mills K, Khoza-Shangase K, Pillay D. Preservation of residual hearing after cochlear implant surgery: an exploration of residual hearing function in a group of recipients at cochlear implant units. Braz J Otorhinolaryngol 2018; 85:310-318. [PMID: 29631897 PMCID: PMC9442821 DOI: 10.1016/j.bjorl.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 01/30/2018] [Accepted: 02/13/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction The preservation of residual hearing is becoming increasingly important in cochlear implant surgery. Conserving residual hearing is a positive prognostic indicator for improved hearing abilities. Objective The primary aim of the study was to explore the preservation of residual hearing following cochlear implantation in a group of recipients at two major cochlear implant centers. Methods A quantitative paradigm was adopted and exploratory research conducted within a retrospective data review design. The sample consisted of 50 surgical records and 53 audiological records from 60 observations (53 patients, seven of whom were implanted bilaterally). The records were selected using purposive sampling and consisted of records from participants ranging from six to 59 years of age. The average time of when the postoperative audiograms were performed in the current study was 24.7 months (s.d. = ±9.0). Data were analyzed through both qualitative and inferential statistics and a comparative analysis of unaided pre- and postoperative audiological test results was conducted. Results Results indicated a high success rate of 92% preservation of residual hearing with half of the sample exhibiting complete preservation in cochlear implant recipients across all frequencies postoperatively. A total postoperative hearing loss was found in only 8% of cochlear implantees across all frequencies. There was no relationship between preoperative hearing thresholds and preservation of hearing postoperatively. The two main surgical techniques used in the current study were the contour on stylet and the advance off-stylet techniques, with the majority of surgeons utilizing a cochleostomy approach. From the findings, it became apparent that the majority of cases did not have any reported intraoperative complications. This is a positive prognostic indicator for the preservation of residual hearing. Conclusion Findings suggest improved cochlear implant surgical outcomes when compared to previous studies implying progress in surgical techniques. The surgical skill and experience of the surgeon are evidenced by the minimal intraoperative complications and the high success rate of hearing preservation. This is a positive prognostic indicator for individuals with preoperative residual hearing as the preserved residual hearing allows for the potential of electro-acoustic stimulation, which in turn has its own hearing benefits.
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Affiliation(s)
- Katherine Gautschi-Mills
- University of the Witwatersrand, School of Human and Community Development, Department of Speech Pathology and Audiology, Johannesburg, South Africa
| | - Katijah Khoza-Shangase
- University of the Witwatersrand, School of Human and Community Development, Department of Speech Pathology and Audiology, Johannesburg, South Africa.
| | - Dhanashree Pillay
- University of the Witwatersrand, School of Human and Community Development, Department of Speech Pathology and Audiology, Johannesburg, South Africa
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Ruff S, Bocklet T, Nöth E, Müller J, Hoster E, Schuster M. Speech Production Quality of Cochlear Implant Users with Respect to Duration and Onset of Hearing Loss. ORL J Otorhinolaryngol Relat Spec 2017; 79:282-294. [PMID: 29131113 DOI: 10.1159/000479819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess whether postlingual onset and shorter duration of deafness before cochlear implant (CI) provision predict higher speech intelligibility results of CI users. METHODS For an objective judgement of speech intelligibility, we used an automatic speech recognition system computing the word recognition rate (WR) of 50 adult CI users and 50 age-matched control individuals. All subjects were recorded reading a standardized text. Subjects were divided into three groups: pre- or perilingual deafness (A), both >2 years before implantation, postlingual deafness <2 years before implantation (B), or postlingual deafness >2 years before implantation (C). RESULTS CI users with short duration of postlingual deafness (B) had a significantly higher WR (median 74%) than CI users with long duration of postlingual deafness (C; 68%, p < 0.001) or pre-/perilingual onset (A; 56%, p < 0.001). Compared to their control groups only CI users with short duration of postlingual deafness reached similar WR, others showed significantly lower WR. Other factors such as hearing loss onset, duration of CI use, or duration of amplified hearing showed no consistent influence on speech quality. CONCLUSIONS The speech production quality of adult CI users shows dependencies on the onset and duration of deafness. These features need to be considered while planning rehabilitation.
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Affiliation(s)
- Suzan Ruff
- ORL Clinic Frankfurt/Oder, Frankfurt/Oder, Germany
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Wang J, Sun J, Sun J, Chen J. Variations in electrode impedance during and after cochlear implantation: Round window versus extended round window insertions. Int J Pediatr Otorhinolaryngol 2017; 102:44-48. [PMID: 29106874 DOI: 10.1016/j.ijporl.2017.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess differences in intra- and postoperative electrode impedances following cochlear implantation between round window insertions (RWI) and extended round window insertions (ERWI). METHODS Fifty patients with congenital hearing loss received unilateral hearing implants (Sonata Ti100, Med-El GmbH, Innsbruck, Austria) with standard electrode arrays. The patients were divided into two groups according to the surgical technique used. Thirty-five procedures were performed with RWI (group A) and 15 with ERWI (group B). Electrode impedance was measured and analysed during the operation, and one week and one month postoperatively. RESULTS There were no statistically significant differences (i.e., P > 0.05) in electrode impedance between groups A and B intraoperatively, or at one week or one month postoperatively. Electrode impedance at one month postoperatively was higher than the intraoperative and postoperative one week values in group A (P < 0.05), with similar results in group B. CONCLUSION There was no significant difference between RWI and ERWI in operative duration or complications of cochlear implantation. Moreover, no significant differences in postoperative electrode impedance values were found between the two surgical routes.
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Affiliation(s)
- Jun Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, No.17 Lujiang road, Hefei 230001, Anhui, China.
| | - Jiaqiang Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, No.17 Lujiang road, Hefei 230001, Anhui, China
| | - Jingwu Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, No.17 Lujiang road, Hefei 230001, Anhui, China.
| | - Jianwen Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Anhui Provincial Hospital, Anhui Medical University, No.17 Lujiang road, Hefei 230001, Anhui, China
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Zanetti D, Nassif N, Redaelli de Zinis LO. Factors affecting residual hearing preservation in cochlear implantation. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:433-41. [PMID: 26900250 PMCID: PMC4755056 DOI: 10.14639/0392-100x-619] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The likelihood of residual hearing preservation in cochlear implantation (CI) is related to surgical factors such as type of cochleostomy (trans-fenestral vs. promontorial), use of lubricants and protective drugs, and device-related factors such as shape, length and flexibility of the array. We investigated the impact of these factors on the hearing preservation rate in adults and children with conventional audiological indications to CI. Eighty-two children aged 1-9 years and 73 adults (16-79 years) received a CI in the right (59%) or left ear (41%). An anterior-inferior promontorial cochleostomy was performed in 143 ears (92%); a trans-fenestral approach was used in 12 (8%). A perimodiolar electrode was implanted in 144 ears (93%), and a straight electrode in the remaining 11 (7%). Overall, some post-operative hearing was retained in 39% of ears. The rate of preservation was higher at the low than at the high frequencies. When correlated with age, side of implant, implant model and type of cochleostomy, the mean threshold variations did not reach statistical significance for any of these variables. A slight trend in favour of better residual hearing preservation in children vs. adults was seen, especially at lower frequencies.
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Affiliation(s)
- D Zanetti
- Audiology Department, University of Milano, IRCSS Policlinico "Ca' Granda", Milano, Italy
| | - N Nassif
- Paediatric Otorhinolaryngology Department, University of Brescia, Spedali Civili, Brescia, Italy
| | - L O Redaelli de Zinis
- Paediatric Otorhinolaryngology Department, University of Brescia, Spedali Civili, Brescia, Italy
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Eshraghi AA, Ahmed J, Krysiak E, Ila K, Ashman P, Telischi FF, Angeli S, Prentiss S, Martinez D, Valendia S. Clinical, surgical, and electrical factors impacting residual hearing in cochlear implant surgery. Acta Otolaryngol 2017; 137:384-388. [PMID: 27918225 DOI: 10.1080/00016489.2016.1256499] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONCLUSIONS This study recommends using soft surgical principal and round window insertion to protect residual hearing with favorable anatomical exposure. Further studies are needed to evaluate the impact of the electrical stimulation on the organ of corti and hearing. OBJECTIVE The objective of this study is to analyze various factors that impact on preservation of residual hearing post-implantation. METHODS A retrospective study was performed to analyze loss of residual hearing in a cohort of 225 patients implanted in a large academic center. Sixty-four patients met the inclusion criteria. The impact of age at implantation, gender, etiology of hearing loss, cochleostomy vs round window insertion, partial vs full insertion, and effect of initial stimulation were analyzed using appropriate statistical analysis. RESULTS The overall hearing preservation rate for all implanted patients was 64%. Loss of residual hearing was significantly more observed in cases of cochleostomy and/or non-soft surgical techniques. No correlation was observed with age at implantation, gender, side of implant, device manufacturer, and presence of pre-lingual deafness vs post-lingual, full or partial electrode insertion. In addition, there was a small but significant decrease in hearing between pre-stimulation and post-stimulation audiograms at 6000 Hz.
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Affiliation(s)
- Adrien A. Eshraghi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jamal Ahmed
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric Krysiak
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kadri Ila
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter Ashman
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fred F. Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simon Angeli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sandra Prentiss
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diane Martinez
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sandra Valendia
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
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Residual Hearing Outcomes After Cochlear Implant Surgery Using Ultra-flexible 28-mm Electrodes. Otol Neurotol 2016; 37:878-81. [DOI: 10.1097/mao.0000000000001089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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A Retrospective Analysis of the Contribution of Reported Factors in Cochlear Implantation on Hearing Preservation Outcomes. Otol Neurotol 2016; 36:1137-45. [PMID: 25853614 DOI: 10.1097/mao.0000000000000753] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Preservation of residual hearing is essential to perceive acoustic stimulation from hybrid cochlear implants (CI). Preservation is a good marker of atraumatic surgery and residual hearing may be exploited further or enhanced in future therapies, making complete hearing preservation a desirable goal for all current CI surgeries. There is large variability in the amount of hearing preserved and the timeframe over which it is lost after CI. The increase in numbers of patients with high levels of residual hearing at implantation means that understanding the variables affecting its preservation is more important than ever. DATA SOURCES An English search term with generic and specific items concerning hearing preservation and cochlear implantation was searched on the Web of Science service. The search timeframe was limited to 2000 to 2014, with no language limitations on results. STUDY SELECTION Hearing preservation, retrospective CI outcome studies which reported pre- and post-surgical pure-tone audiometry (PTA) were identified and selected. DATA EXTRACTION PTA thresholds were extracted from audiograms or tables and converted into a low-frequency hearing preservation (LFHP) score. Data for 21 factors associated with hearing preservation were collected from studies. DATA SYNTHESIS Factors were included in a hearing preservation model if they had both a significant bivariate correlation with LFHP and a significant Kruskal-Wallis H test result (for ordinal data) or a significant multiple regression analysis result (for scale data). CONCLUSIONS Seven factors were found to have a significant effect on hearing preservation: insertion site, progressive versus stable hearing loss, insertion angle of electrode, use of intraoperative topical steroids, use of steroids (via any route/timing), hearing etiology, and electrode array type. The best hearing preservation options are given.
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Torres R, Kazmitcheff G, Bernardeschi D, De Seta D, Bensimon JL, Ferrary E, Sterkers O, Nguyen Y. Variability of the mental representation of the cochlear anatomy during cochlear implantation. Eur Arch Otorhinolaryngol 2015; 273:2009-18. [DOI: 10.1007/s00405-015-3763-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
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Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window. BIOMED RESEARCH INTERNATIONAL 2015; 2015:236364. [PMID: 26236719 PMCID: PMC4509501 DOI: 10.1155/2015/236364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/23/2015] [Accepted: 03/04/2015] [Indexed: 11/17/2022]
Abstract
Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane. Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation. Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arrays in situ. The resulting images were analyzed for signs of intracochlear trauma. Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion. Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.
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Helbig S, Helbig M, Leinung M, Stöver T, Baumann U, Rader T. Hearing Preservation and Improved Speech Perception With a Flexible 28-mm Electrode. Otol Neurotol 2015; 36:34-42. [DOI: 10.1097/mao.0000000000000614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mechatronic feasibility of minimally invasive, atraumatic cochleostomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:181624. [PMID: 25110661 PMCID: PMC4109217 DOI: 10.1155/2014/181624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/29/2014] [Indexed: 11/17/2022]
Abstract
Robotic assistance in the context of lateral skull base surgery, particularly during cochlear implantation procedures, has been the subject of considerable research over the last decade. The use of robotics during these procedures has the potential to provide significant benefits to the patient by reducing invasiveness when gaining access to the cochlea, as well as reducing intracochlear trauma when performing a cochleostomy. Presented herein is preliminary work on the combination of two robotic systems for reducing invasiveness and trauma in cochlear implantation procedures. A robotic system for minimally invasive inner ear access was combined with a smart drilling tool for robust and safe cochleostomy; evaluation was completed on a single human cadaver specimen. Access to the middle ear was successfully achieved through the facial recess without damage to surrounding anatomical structures; cochleostomy was completed at the planned position with the endosteum remaining intact after drilling as confirmed by microscope evaluation.
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Obholzer RJ, Gibson WPR. Cochlear function following implantation with a full electrode array. Cochlear Implants Int 2013; 12:44-7. [DOI: 10.1179/146701010x486525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Stanisławek-Sut O, Morawski K, Niemczyk K. [Hearing preservation results after cochlear implantation in short-term and long-term observation]. Otolaryngol Pol 2013; 67:135-8. [PMID: 23719269 DOI: 10.1016/j.otpol.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/12/2012] [Accepted: 01/09/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To estimate a residual hearing preservation in cochlear implant patients in short-, and long-term observation. MATERIAL AND METHODS A group of 40 subjects with preserved residual hearing were included to this study. In all of them cochlear implant was provided due to a neurosensonal hearing loss. In all subjects hearing was tested using traditional audiological test battery. Cochlear implant surgery was performed typically. After minimal retroauricular incision antromastoidectomy was performed, and then, tympanotomy posterior to get a good access to the tympanum and to identify the round window and the promontory. Cochlear implant electrode was inserted to the scala tympani by cochleostomy approach. In some patients "soft technique" of cochlear implant surgery was done. I these cases a surgeon specially focused on a very careful and precise surgical maneuvers specially during elaboration of the cochleostomy and insertion of the electrode into the scala tympani. RESULTS In investigated group of 40 cochlear implant patients generally a 5-10dB worsening of hearing threshold was observed in the first 3-12 months following surgery, and 10-15dB in long-term observation. In a group of patients with residual hearing in whom the straight electrode inserted into the cochlea in the first 12 months hearing threshold increased 10dB, and in longer than 12 months observation 10-20dB. Analogous analysis in patients with perimodiolar electrode inserted revealed respectively 10.0-12.5dB and 2.5-12.5dB. I traditional technique of cochlear implant surgery hearing worsening in short-term period was 10dB while in long-term period 15-20dB. In soft technique of cochlear implant surgery hearing worsening was for short-term and long-term as follows: 5-10dB and respectively 10-20dB. CONCLUSIONS Observation of post-surgery hearing preservation showed that hearing threshold after cochlear implant insertion is unstable and getting worse in both short-, and long-term observation. During long-term period the hearing worsening is slower than in the first 12 months of observation.
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Postelmans JTF, Stokroos RJ, van Spronsen E, Grolman W, Tange RA, Maré MJ, Dreschler WA. Comparison of two cochlear implantation techniques and their effects on the preservation of residual hearing. Is the surgical approach of any importance? Eur Arch Otorhinolaryngol 2013; 271:997-1005. [DOI: 10.1007/s00405-013-2438-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
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Eshraghi AA, Gupta C, Van De Water TR, Bohorquez JE, Garnham C, Bas E, Talamo VM. Molecular mechanisms involved in cochlear implantation trauma and the protection of hearing and auditory sensory cells by inhibition of c-jun-N-terminal kinase signaling. Laryngoscope 2013; 123 Suppl 1:S1-14. [DOI: 10.1002/lary.23902] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 01/20/2023]
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Nguyen Y, Mosnier I, Borel S, Ambert-Dahan E, Bouccara D, Bozorg-Grayeli A, Ferrary E, Sterkers O. Evolution of electrode array diameter for hearing preservation in cochlear implantation. Acta Otolaryngol 2013; 133:116-22. [PMID: 23216055 DOI: 10.3109/00016489.2012.723824] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONCLUSION Residual hearing could be preserved with various arrays ranging from 16 to 18 mm in insertion length and 0.25 to 0.5 mm tip diameter. Whether array insertion is performed through a cochleostomy or a round window, tip diameter is an essential criterion for the array design to improve hearing preservation results. OBJECTIVES The goal of this study was to report the outcome of patients implanted with electric acoustic cochlear implants with various surgical techniques and array designs. METHODS Thirty-two implanted ears (30 patients) were included in this retrospective study. Three array models were inserted: Contour Advance implant (n = 16), Nucleus Hybrid-L (n = 12), and Med-El Flex EAS (n = 4). Postoperative pure tone audiometry was performed at 3 and 12 months after implantation. RESULTS Three months postoperatively, hearing preservation within 30 dB was achieved in 50%, 50%, and 84% cases of patients implanted with a Contour Advance, Flex-EAS, and Hybrid-L, respectively. Two patients (Hybrid-L group) had a delayed sudden hearing loss (> 30 dB) 3 months postoperatively and three patients (Contour Advance group) had total hearing loss at 1 year. Best results were achieved using arrays with small tip diameters. Cochleostomy or round window insertion did not affect hearing preservation results.
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Affiliation(s)
- Yann Nguyen
- Univ Paris Diderot, Sorbonne Paris Cité, Laboratoire UMR-S 867, Paris, France.
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Bas E, Dinh CT, Garnham C, Polak M, Van de Water TR. Conservation of hearing and protection of hair cells in cochlear implant patients' with residual hearing. Anat Rec (Hoboken) 2012; 295:1909-27. [DOI: 10.1002/ar.22574] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/13/2022]
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Eshraghi AA, Nazarian R, Telischi FF, Rajguru SM, Truy E, Gupta C. The cochlear implant: historical aspects and future prospects. Anat Rec (Hoboken) 2012; 295:1967-80. [PMID: 23044644 DOI: 10.1002/ar.22580] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 02/06/2023]
Abstract
The cochlear implant (CI) is the first effective treatment for deafness and severe losses in hearing. As such, the CI is now widely regarded as one of the great advances in modern medicine. This article reviews the key events and discoveries that led up to the current CI systems, and we review and present some among the many possibilities for further improvements in device design and performance. The past achievements include: (1) development of reliable devices that can be used over the lifetime of a patient; (2) development of arrays of implanted electrodes that can stimulate more than one site in the cochlea; and (3) progressive and large improvements in sound processing strategies for CIs. In addition, cooperation between research organizations and companies greatly accelerated the widespread availability and use of safe and effective devices. Possibilities for the future include: (1) use of otoprotective drugs; (2) further improvements in electrode designs and placements; (3) further improvements in sound processing strategies; (4) use of stem cells to replace lost sensory hair cells and neural structures in the cochlea; (5) gene therapy; (6) further reductions in the trauma caused by insertions of electrodes and other manipulations during implant surgeries; and (7) optical rather electrical stimulation of the auditory nerve. Each of these possibilities is the subject of active research. Although great progress has been made to date in the development of the CI, including the first substantial restoration of a human sense, much more progress seems likely and certainly would not be a surprise.
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Affiliation(s)
- Adrien A Eshraghi
- Department of Otolaryngology, University of Miami Ear Institute, University of Miami Miller School of Medicine, Miami, Florida 33136-1015, USA.
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Tobey EA, Britt L, Geers A, Loizou P, Loy B, Roland P, Warner-Czyz A, Wright CG. Cochlear implantation updates: the Dallas Cochlear Implant Program. J Am Acad Audiol 2012; 23:438-45. [PMID: 22668764 DOI: 10.3766/jaaa.23.6.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report provides an overview of many research projects conducted by the Dallas Cochlear Implant Program, a joint enterprise between the University of Texas at Dallas, the University of Texas Southwestern Medical Center, and Children's Medical Center. The studies extend our knowledge of factors influencing communication outcomes in users of cochlear implants. Multiple designs and statistical techniques are used in the studies described including both cross sectional and longitudinal analyses. Sample sizes vary across the studies, and many of the samples represent large populations of children from North America. Multiple statistical techniques are used by the team to analyze outcomes. The team has provided critical information regarding electrode placement, signal processing, and communication outcomes in users of cochlear implants.
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Affiliation(s)
- Emily A Tobey
- Dallas Cochlear Implant Program, Dallas, TX 75235, USA.
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Souter M, Eastwood H, Marovic P, Kel G, Wongprasartsuk S, Ryan AF, O’Leary SJ. Systemic immunity influences hearing preservation in cochlear implantation. Otol Neurotol 2012; 33:532-8. [PMID: 22470051 PMCID: PMC3897157 DOI: 10.1097/mao.0b013e31824bac44] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HYPOTHESIS To determine whether a systemic immune response influences hearing thresholds and tissue response after cochlear implantation of hearing guinea pigs. METHODS Guinea pigs were inoculated with sterile antigen (Keyhole limpet hemocyanin) 3 weeks before cochlear implantation. Pure-tone auditory brainstem response thresholds were performed before implantation and 1 and 4 weeks later. Dexamethasone phosphate 20% was adsorbed onto a hyaluronic acid carboxymethylcellulose sponge and was applied to the round window for 30 minutes before electrode insertion. Normal saline was used for controls. Cochlear histology was performed at 4 weeks after implantation to assess the tissue response to implantation. To control for the effect of keyhole limpet hemocyanin priming, a group of unprimed animals underwent cochlear implantation with a saline-soaked pledget applied to the round window. RESULTS Keyhole limpet hemocyanin priming had no significant detrimental effect on thresholds without implantation. Thresholds were elevated after implantation across all frequencies tested (2-32 kHz) in primed animals but only at higher frequencies (4-32 kHz) in unprimed controls. In primed animals, dexamethasone treatment significantly reduced threshold shifts at 2 and 8 kHz. Keyhole limpet hemocyanin led to the more frequent observation of lymphocytes in the tissue response to the implant. CONCLUSION Systemic immune activation at the time of cochlear implantation broadened the range of frequencies experiencing elevated thresholds after implantation. Local dexamethasone provides partial protection against this hearing loss, but the degree and extent of protection are less compared to previous studies with unprimed animals.
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Affiliation(s)
- Melanie Souter
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Otolaryngology, Christchurch Hospital, Christchurch, New Zealand
| | - Hayden Eastwood
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Paul Marovic
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery, Monash University, Clayton, Australia
| | - Gordana Kel
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Sarin Wongprasartsuk
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery, Monash University, Clayton, Australia
| | - Allen F. Ryan
- Departments of Otolaryngology and Neurosciences, University of California at San Diego
- San Diego VA Healthcare System, San Diego, California, U.S.A
| | - Stephen John O’Leary
- Department of Otolaryngology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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The Role of Hearing Preservation on Electrical Thresholds and Speech Performances in Cochlear Implantation. Otol Neurotol 2012; 33:343-7. [DOI: 10.1097/mao.0b013e3182487dbb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE The goal of the overall project is to develop knowledge about cochlear physiology during cochlear implantation and develop procedures for assessing its status during hearing preservation surgery. As a step toward this goal, for this study, we established an animal model of sloping high frequency sensorineural hearing loss that mimics the hearing condition of candidates for combined electric-acoustic stimulation. METHODS Mongolian gerbils were exposed to band-pass noise using various cutoff frequencies, intensities, exposure times, and survival times. Hearing loss was assessed in far-field recording using preexposure and postexposure auditory brainstem responses (ABRs), and in acute, near-field recordings of the cochlear microphonic and compound action potential from an electrode on the round window. Anatomic loss of hair cells was assessed from dissections. RESULTS Postexposure ABRs and near-field recordings from the round window revealed sensorineural hearing loss that varied with the overall noise exposure. Loss of hair cells ranged from relatively sparse to large areas of complete absence depending on the noise exposure. Cases with high intensity (120 dB SPL) and long exposure times (3 h) showed sloping patterns of hearing loss with profound high-frequency loss and mild-to-moderate low-frequency loss. These cases showed complete loss of hair cells in the basal cochlea and preserved hair cells in the apical cochlea. The frequencies comprising the slope in the ABRs and the location of the transition zone between preserved and lost hair cells varied according to the cutoff frequency used. CONCLUSION We were able to reliably induce sensorineural hearing loss and loss of hair cells in the gerbil that is comparable to candidates for hearing preservation surgery. This model can be used to evaluate the effects of electrode introduction in a system with a hearing condition similar to that in cases of hearing preservation operations.
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Postelmans JTF, van Spronsen E, Grolman W, Stokroos RJ, Tange RA, Maré MJ, Dreschler WA. An evaluation of preservation of residual hearing using the suprameatal approach for cochlear implantation. Laryngoscope 2011; 121:1794-9. [DOI: 10.1002/lary.21866] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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von Ilberg CA, Baumann U, Kiefer J, Tillein J, Adunka OF. Electric-Acoustic Stimulation of the Auditory System: A Review of the First Decade. ACTA ACUST UNITED AC 2011; 16 Suppl 2:1-30. [DOI: 10.1159/000327765] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 02/21/2011] [Indexed: 11/19/2022]
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Abstract
HYPOTHESIS An optimal insertion trajectory during cochlear implantation may be determined from the anatomic relationship between the facial nerve and round window. BACKGROUND Cochlear implantation functional outcomes improve with insertion of the implant into the scala tympani. This depends on creating a cochleostomy in the proper position and inserting the electrode along a trajectory coaxial with the centerline of the scala tympani. The anatomic landmarks for this insertion trajectory have not been described. METHODS Clinical computed tomography and micro-computed tomographic analysis of 8 cadaveric temporal bones. RESULTS Appropriate insertion vectors pass inferior or anteroinferior to the round window membrane. In many individuals, the facial nerve interrupts all or most of the insertion vectors coaxial to the centerline of the scala tympani. CONCLUSION A cochleostomy placed inferior or anteroinferior to the round window membrane may facilitate atraumatic insertion of a cochlear implant along the centerline of the scala tympani. The lateral and anterior wall of the fallopian canal must be adequately thinned to achieve an optimal insertion trajectory. This is particularly true when inserting through cochleostomies placed away from the round window along the basal turn of the cochlea.
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Kang SY, Colesa DJ, Swiderski DL, Su GL, Raphael Y, Pfingst BE. Effects of hearing preservation on psychophysical responses to cochlear implant stimulation. J Assoc Res Otolaryngol 2009; 11:245-65. [PMID: 19902297 DOI: 10.1007/s10162-009-0194-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 10/01/2009] [Indexed: 10/20/2022] Open
Abstract
Previous studies have shown that residual acoustic hearing supplements cochlear implant function to improve speech recognition in noise as well as perception of music. The current study had two primary objectives. First, we sought to determine how cochlear implantation and electrical stimulation over a time period of 14 to 21 months influence cochlear structures such as hair cells and spiral ganglion neurons. Second, we sought to investigate whether the structures that provide acoustic hearing also affect the perception of electrical stimulation. We compared psychophysical responses to cochlear implant stimulation in two groups of adult guinea pigs. Group I (11 animals) received a cochlear implant in a previously untreated ear, while group II (ten animals) received a cochlear implant in an ear that had been previously infused with neomycin to destroy hearing. Psychophysical thresholds were measured in response to pulse-train and sinusoidal stimuli. Histological analysis of all group I animals and a subset of group II animals was performed. Nine of the 11 group I animals showed survival of the organ of Corti and spiral ganglion neurons adjacent to the electrode array. All group I animals showed survival of these elements in regions apical to the electrode array. Group II animals that were examined histologically showed complete loss of the organ of Corti in regions adjacent and apical to the electrode array and severe spiral ganglion neuron loss, consistent with previous reports for neomycin-treated ears. Behaviorally, group II animals had significantly lower thresholds than group I animals in response to 100 Hz sinusoidal stimuli. However, group I animals had significantly lower thresholds than group II animals in response to pulse-train stimuli (0.02 ms/phase; 156 to 5,000 pps). Additionally, the two groups showed distinct threshold versus pulse rate functions. We hypothesize that the differences in detection thresholds between groups are caused by the electrical activation of the hair cells in group I animals and/or differences between groups in the condition of the spiral ganglion neurons.
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Affiliation(s)
- Stephen Y Kang
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109-5616, USA
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Tsuji RK, Goffi-Gomez MVS, Peralta CO, Guedes MC, Magalhães AT, Neto RB, Bento RF. Neural response thresholds in the Nucleus Contour cochlear implant before and after stylet removal. Acta Otolaryngol 2009; 129:1330-6. [PMID: 19863333 DOI: 10.3109/00016480802629457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The study shows that there are differences in the measurement of the action potentials with and without the stylet in the Nucleus Freedom Contour Advance that are higher in the apex than in the base of the cochlea. OBJECTIVES To determine if there are differences in the intraoperative impedances and in the neural response telemetry threshold values in the Nucleus Freedom Contour Advance before and after stylet removal. SUBJECTS AND METHODS This was a prospective clinical study. Intraoperative impedances and neural response telemetry in users of the Freedom Contour Advance Cochlear Implant were measured before and after stylet removal. RESULTS There was a significant reduction in the impedance values of an average 1.5 kOmega+/-2.3 in common ground mode and 1.3 kOmega+/-2.3 for all monopolar modes after the stylet removal (p < 0.001). When analyzing the apical, medium, and basal electrodes, there was a statistically significant reduction in the neural response thresholds after stylet removal only in the apical electrodes (p = 0.001).
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Affiliation(s)
- Robinson Koji Tsuji
- ENT Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, rua Capote Valente 432, São Paulo, Brazil.
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Abstract
Recent advances in cochlear implant technology have focused renewed attention on the preservation of residual hearing. The focus on preservation of residual hearing is driven by the concept of electroacoustic stimulation. This option depends on the insertion of a short cochlear implant electrode into the basal region of the cochlea while preserving native function in the apical region. The desire to preserve residual hearing has led to the development of the soft-surgery cochlear implantation technique. Here, the authors evaluate its various components. Avoiding entry of blood into the cochlea and the use of hyaluronate seem to be reasonably supported, whereas the use of topical steroids is unlikely to be beneficial. The site of entry into the cochlea, the use of contoured or straight devices, and the depth of insertion are also evaluated. The authors highlight the importance of systematic recording of outcomes and surgical events.
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Affiliation(s)
- David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Abstract
BACKGROUND The most pressing problem facing cochlear implant research is no longer making artificial hearing a reality. Instead, it is to develop devices that can more clearly reflect the capabilities of the human auditory system. Current cochlear implants rarely provide adequate pitch perception. As hearing loss commonly affects higher, more than lower frequencies, a possible solution is to preserve acoustic hearing at low frequencies by inserting a short electrode array and thus deliver combined electro-acoustic stimulation (EAS). OBJECTIVE OF REVIEW To determine whether individuals with severe-to-profound high-frequency hearing loss have realised this predicted benefit of combined EAS, over conventional cochlear implants, with respect to pitch. TYPE OF REVIEW A systematic review of publications pertaining to the benefits of combined EAS over conventional cochlear implantation, with specific reference to pitch perception. SEARCH STRATEGY A systematic literature search was conducted across multiple databases and supplemented by searching the reference lists of relevant trials and identified reviews. RESULTS The included studies suggest an overall benefit of combined EAS, over conventional cochlear implants, with respect to pitch. In addition, (i) 13% sustained a total loss of low-frequency hearing post-implantation of the short electrode array and, (ii) 24% had >20 dB hearing loss across all frequencies and/or total hearing loss. CONCLUSIONS For patients with severe-to-profound high-frequency hearing loss combined EAS appears to offer a significant, everyday, long-term benefit. However, further clinical trials with larger numbers of candidates are necessary to confirm this finding. The risks involved cannot be ignored, but there is potential for a variety of strategies to improve the safety margin.
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Affiliation(s)
- K N Talbot
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
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