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Reiss LAJ, Lawrence MB, Omelchenko IA, He W, Kirk JR. Chronic Electro-Acoustic Stimulation May Interfere With Electric Threshold Recovery After Cochlear Implantation in the Aged Guinea Pig. Ear Hear 2024:00003446-990000000-00310. [PMID: 38992863 DOI: 10.1097/aud.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Electro-acoustic stimulation (EAS) combines electric stimulation via a cochlear implant (CI) with residual low-frequency acoustic hearing, with benefits for music appreciation and speech perception in noise. However, many EAS CI users lose residual acoustic hearing, reducing this benefit. The main objectives of this study were to determine whether chronic EAS leads to more hearing loss compared with CI surgery alone in an aged guinea pig model, and to assess the relationship of any hearing loss to histology measures. Conversely, it is also important to understand factors impacting efficacy of electric stimulation. If one contributor to CI-induced hearing loss is damage to the auditory nerve, both acoustic and electric thresholds will be affected. Excitotoxicity from EAS may also affect electric thresholds, while electric stimulation is osteogenic and may increase electrode impedances. Hence, secondary objectives were to assess how electric thresholds are related to the amount of residual hearing loss after CI surgery, and how EAS affects electric thresholds and impedances over time. DESIGN Two groups of guinea pigs, aged 9 to 21 months, were implanted with a CI in the left ear. Preoperatively, the animals had a range of hearing losses, as expected for an aged cohort. At 4 weeks after surgery, the EAS group (n = 5) received chronic EAS for 8 hours a day, 5 days a week, for 20 weeks via a tether system that allowed for free movement during stimulation. The nonstimulated group (NS; n = 6) received no EAS over the same timeframe. Auditory brainstem responses (ABRs) and electrically evoked ABRs (EABRs) were recorded at 3 to 4 week intervals to assess changes in acoustic and electric thresholds over time. At 24 weeks after surgery, cochlear tissue was harvested for histological evaluation, only analyzing animals without electrode extrusions (n = 4 per ear). RESULTS Cochlear implantation led to an immediate worsening of ABR thresholds peaking between 3 and 5 weeks after surgery and then recovering and stabilizing by 5 and 8 weeks. Significantly greater ABR threshold shifts were seen in the implanted ears compared with contralateral, non-implanted control ears after surgery. After EAS and termination, no significant additional ABR threshold shifts were seen in the EAS group compared with the NS group. A surprising finding was that NS animals had significantly greater recovery in EABR thresholds over time, with decreases (improvements) of -51.8 ± 33.0 and -39.0 ± 37.3 c.u. at 12 and 24 weeks, respectively, compared with EAS animals with EABR threshold increases (worsening) of +1.0 ± 25.6 and 12.8 ± 44.3 c.u. at 12 and 24 weeks. Impedance changes over time did not differ significantly between groups. After exclusion of cases with electrode extrusion or significant trauma, no significant correlations were seen between ABR and EABR thresholds, or between ABR thresholds with histology measures of inner/outer hair cell counts, synaptic ribbon counts, stria vascularis capillary diameters, or spiral ganglion cell density. CONCLUSIONS The findings do not indicate that EAS significantly disrupts acoustic hearing, although the small sample size limits this interpretation. No evidence of associations between hair cell, synaptic ribbon, spiral ganglion cell, or stria vascularis with hearing loss after cochlear implantation was seen when surgical trauma is minimized. In cases of major trauma, both acoustic thresholds and electric thresholds were elevated, which may explain why CI-only outcomes are often better when trauma and hearing loss are minimized. Surprisingly, chronic EAS (or electric stimulation alone) may negatively impact electric thresholds, possibly by prevention of recovery of the auditory nerve after CI surgery. More research is needed to confirm the potentially negative impact of chronic EAS on electric threshold recovery.
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Affiliation(s)
- Lina A J Reiss
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Melissa B Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Irina A Omelchenko
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Wenxuan He
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Geerardyn A, Zhu M, Klabbers T, Huinck W, Mylanus E, Nadol JB, Verhaert N, Quesnel AM. Human Histology after Structure Preservation Cochlear Implantation via Round Window Insertion. Laryngoscope 2024; 134:945-953. [PMID: 37493203 DOI: 10.1002/lary.30900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Current surgical techniques aim to preserve intracochlear structures during cochlear implant (CI) insertion to maintain residual cochlear function. The optimal technique to minimize damage, however, is still under debate. The aim of this study is to histologically compare insertional trauma and intracochlear tissue formation in humans with a CI implanted via different insertion techniques. METHODS One recent temporal bone from a donor who underwent implantation of a full-length CI (576°) via round window (RW) insertion was compared with nine cases implanted via cochleostomy (CO) or extended round window (ERW) approach. Insertional trauma was assessed on H&E-stained histological sections. 3D reconstructions were generated and virtually re-sectioned to measure intracochlear volumes of fibrosis and neo-ossification. RESULTS The RW insertion case showed electrode translocation via the spiral ligament. 2/9 CO/ERW cases showed no insertional trauma. The total volume of the cochlea occupied by fibro-osseous tissue was 10.8% in the RW case compared with a mean of 30.6% (range 8.7%-44.8%, N = 9) in the CO/ERW cases. The difference in tissue formation in the basal 5 mm of scala tympani, however, was even more pronounced when the RW case (12.3%) was compared with the cases with a CO/ERW approach (mean of 93.8%, range 81% to 100%, N = 9). CONCLUSIONS Full-length CI insertions via the RW can be minimally traumatic at the cochlear base without inducing extensive fibro-osseous tissue formation locally. The current study further supports the hypothesis that drilling of the cochleostomy with damage to the endosteum incites a local tissue reaction. LEVEL OF EVIDENCE 4: Case-control study Laryngoscope, 134:945-953, 2024.
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Affiliation(s)
- Alexander Geerardyn
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Tim Klabbers
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Nicolas Verhaert
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Yokoi J, Fujita T, Uehara N, Iwaki S, Kakigi A, Nibu KI. Vestibular function after simultaneous bilateral cochlear implantation in adults. Front Neurol 2023; 14:1304927. [PMID: 38020629 PMCID: PMC10657651 DOI: 10.3389/fneur.2023.1304927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Binaural hearing enhances speech intelligibility, source localization, and speech comprehension in noisy environments. Although bilateral cochlear implantation (CI) offers several benefits, concerns arise regarding the risk of bilateral postoperative vestibular dysfunction with simultaneous CI. This study aimed to longitudinally evaluate changes in vestibular function in adult patients who underwent simultaneous bilateral CI using minimally invasive electrodes and surgical techniques. Methods A retrospective review was conducted on 10 patients who underwent simultaneous bilateral CI at our hospital. Vertigo symptoms and vestibular function test results were examined preoperatively, 1-6 months postoperatively, and 1 year postoperatively. Nystagmus tests, caloric reflex tests, vestibular evoked myogenic potentials (VEMP) measurements, and static stabilometry were performed as vestibular function tests. Results Although an initial transient decline in vestibular function was observed, no significant long-term decline was observed in the caloric reflex test, ocular VEMP (oVEMP), or cervical VEMP (cVEMP). Moreover, regardless of the presence or absence of abnormalities in caloric reflex, oVEMP, or cVEMP, no significant deterioration was detected in the static stabilometer test. While two patients reported preoperative dizziness, all patients were symptom-free 1 year postoperatively. Discussion The findings suggest that using current minimally invasive electrodes and surgical techniques in simultaneous bilateral CI leads to temporary vestibular function decline postoperatively. However, most patients experience a recovery in function over time, highlighting the potential safety and efficacy of the procedure. Simultaneous bilateral CI surgery is viable, depending on the patient's auditory needs and burden.
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Affiliation(s)
| | - Takeshi Fujita
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Skarzynski PH, Lorens A, Gos E, Kolodziejak A, Obrycka A, Skarżyńska MB, Czajka N, Porowski M, Skarzynski H. Outcomes of Cochlear Implantation Using FLEX26 Electrode: Audiological Results and Quality of Life after 12 Months. Audiol Neurootol 2023; 28:458-465. [PMID: 37315543 DOI: 10.1159/000530883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/04/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The electrode length is one of the many factors impacted on results of cochlear implantation. Among lateral wall flexible electrode arrays the latest one is FLEX26 (MED-EL GmbH, Innsbruck, Austria). The main aim of the study was to evaluate the preservation of residual hearing, the level of speech understanding, and quality of life after cochlear implantation with FLEX26 electrode array. METHODS The study was conducted in a tertiary referral centre. Fifty-two patients implanted unilaterally with FLEX26, including 10 EAS patients (electric acoustic stimulation) and 42 ES patients (electric stimulation). The intervention was minimally invasive cochlear implantation via the round window. Pure-tone audiometry (0.125-8 kHz) was performed preoperatively and at 1, 6, and 12 months postoperatively. Twelve-month hearing preservation was established using HEARRING group formula. Quality of life was measured with AQoL-8D (Assessment of Quality of Life-8 Dimensions) pre- and postoperatively. RESULTS Residual hearing was preserved in 88.8% EAS patients. Quality of life was significantly better postoperatively in comparison to preoperative period (the effect size for overall quality of life was 0.49). Especially, it increased in relationships and senses dimensions (the effect sizes 0.47 and 0.44, respectively). CONCLUSION Preservation of residual hearing can be achieved in the majority of patients implanted with FLEX26. Improvement of quality of life was also documented. FLEX26 seems to be an option for surgeons who seek an electrode providing sufficient cochlear coverage.
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Affiliation(s)
| | - Artur Lorens
- Implant and Auditory Perception Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Elzbieta Gos
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Aleksandra Kolodziejak
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Anita Obrycka
- Implant and Auditory Perception Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Magdalena B Skarżyńska
- Institute of Sensory Organs, Warsaw, Poland
- Center of Hearing and Speech Medincus, Warsaw, Poland
- Pharmacy Department, Department of Pharmacotherapy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Czajka
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Marek Porowski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Henryk Skarzynski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
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Polymeric fiber sensors for insertion forces and trajectory determination of cochlear implants in hearing preservation. Biosens Bioelectron 2023; 222:114866. [PMID: 36463651 DOI: 10.1016/j.bios.2022.114866] [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: 08/15/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
The level of hearing restoration in patients with severe to profound sensorineural hearing loss by means of cochlear implants (CIs) has drastically risen since the introduction of these neuroprosthetics. The proposed CI integrated with polymer optical fiber Bragg gratings (POFBGs) enables real-time evaluation of insertion forces and trajectory determination during implantation irrespective of the speed of insertion, as well as provides high signal quality, low stiffness levels, minimum induced stress even under forces of high magnitudes and exhibits significant reduction of the risk of fiber breakage inside the constricted cochlear geometry. As such, the proposed device opens new avenues towards atraumatic cochlear implantations and provides a direct route for the next generation of CIs with intraoperative insertion force assessment and path planning capacity crucial for surgical navigation. Hence, adaptation of this technology to clinical reality holds promising prospects for the hearing impaired.
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Sangaletti R, Tamames I, Yahn SL, Choi JS, Lee JK, King C, Rajguru SM. Mild therapeutic hypothermia protects against inflammatory and proapoptotic processes in the rat model of cochlear implant trauma. Hear Res 2023; 428:108680. [PMID: 36586170 PMCID: PMC9840707 DOI: 10.1016/j.heares.2022.108680] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Mild therapeutic hypothermia (MTH) has been demonstrated to prevent residual hearing loss from surgical trauma associated with cochlear implant (CI) insertion. Here, we aimed to characterize the mechanisms of MTH-induced hearing preservation in CI in a well-established preclinical rodent model. APPROACH Rats were divided into four experimental conditions: MTH-treated and implanted cochleae, cochleae implanted under normothermic conditions, MTH only cochleae and un-operated cochleae (controls). Auditory brainstem responses (ABRs) were recorded at different time points (up to 84 days) to confirm long-term protection and safety of MTH locally applied to the cochlea for 20 min before and after implantation. Transcriptome sequencing profiling was performed on cochleae harvested 24 h post CI and MTH treatment to investigate the potential beneficial effects and underlying active gene expression pathways targeted by the temperature management. RESULTS MTH treatment preserved residual hearing up to 3 months following CI when compared to the normothermic CI group. In addition, MTH applied locally to the cochleae using our surgical approach was safe and did not affect hearing in the long-term. Results of RNA sequencing analysis highlight positive modulation of signaling pathways and gene expression associated with an activation of cellular inflammatory and immune responses against the mechanical damage caused by electrode insertion. SIGNIFICANCE These data suggest that multiple and possibly independent molecular pathways play a role in the protection of residual hearing provided by MTH against the trauma of cochlear implantation.
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Affiliation(s)
- Rachele Sangaletti
- Department of Otolaryngology, University of Miami, Miami, FL, 33136, USA
| | - Ilmar Tamames
- Department of Biomedical Engineering, University of Miami, Miami, FL, 33136, USA
| | - Stephanie Lynn Yahn
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - James Seungyeon Choi
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Jae K Lee
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, 33136, USA
| | | | - Suhrud M Rajguru
- Department of Otolaryngology, University of Miami, Miami, FL, 33136, USA; Department of Biomedical Engineering, University of Miami, Miami, FL, 33136, USA.
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Bhavana K, Timmaraju S, Kumar V, Kumar C, Bharti B, Prakash R, Sinha U. OTOPLAN-Based Study of Intracochlear Electrode Position Through Cochleostomy and Round Window in Transcanal Veria Technique. Indian J Otolaryngol Head Neck Surg 2022; 74:575-581. [PMID: 36514425 PMCID: PMC9741677 DOI: 10.1007/s12070-022-03228-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
To study the postoperative visualisation of the electrode array insertion angle through transcanal Veria approach in both round window and cochleostomy techniques. Retrospective study. Tertiary care centre. 26 subjects aged 2-15 years implanted with a MED-EL STANDARD electrode array (31.5 mm) through Veria technique were selected. 16 had the electrode insertion through the round window, 10 through anteroinferior cochleostomy. DICOM files of postoperative computer tomography (CT) scans were collected and analysed using the OTOPLAN 3.0 software. Examined parameters were cochlear duct length, average angle of insertion depth. Pearson's Correlation Test was utilized for statistical analysis. Average cochlear duct length was 38.12 mm, ranging from 34.2 to 43 mm. Average angle of insertion depth was 666 degrees through round window insertion and 670 degrees through cochleostomy insertion. Pearson's correlation showed no significant difference in average angle of insertion depth between subjects with cochleostomy and round window insertion. Detailed study on the OTOPLAN software has established that there remains no difference between round window insertion or cochleostomy insertion when it comes to electrode array position and placement in the scala tympani. It is feasible to perform round window insertion and cochleostomy insertion through transcanal Veria approach as this technique provides good visualisation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03228-5.
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Affiliation(s)
- Kranti Bhavana
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | | | - Vijay Kumar
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | | | - Bhartendu Bharti
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | - Rudra Prakash
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | - Upasana Sinha
- Department of Radiodiagnosis, AIIMS Patna, Patna, India
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Walia A, Shew MA, Ettyreddy A, Lefler SM, Jiramongkolchai P, Wick CC, Durakovic N, Buchman CA, Herzog JA. Early Hearing Preservation Outcomes Following Cochlear Implantation With New Slim Lateral Wall Electrode Using Electrocochleography. Otol Neurotol 2022; 43:443-451. [PMID: 35170555 PMCID: PMC8959404 DOI: 10.1097/mao.0000000000003475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe early hearing preservation (HP) cochlear implantation (CI) outcomes using a new slim lateral wall electrode (SLWE). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS Adult CI candidates with preoperative low-frequency pure-tone average (LFPTA; 125, 250, 500 Hz) ≤60 dB HL. INTERVENTION CI with and without intracochlear real-time electrocochleography (RT-ECochG). MAIN OUTCOME MEASURE HP (LFPTA ≤80 dB HL), LFPTA shift, speech-perception performance measures, postoperative CT reconstruction. RESULTS Forty-two subjects were implanted with the SLWE. Thirty patients underwent full insertion without RT-ECochG feedback, and HP was maintained at 3-months postactivation for 7 (23.3%) patients with mean LFPTA shift of 57.5 ± 25.6 dB HL. RT-ECochG feedback was utilized on 12 patients, of whom 6 patients had full insertions and 6 patients had anywhere from 1 to 3 electrodes left outside of the cochlea based on RT-ECochG feedback. At 3 months postoperatively, HP was achieved on 10 (83.3%) patients and mean LFPTA shift was 18.9 c 11.7 dB HL. Mean difference between LFPTA threshold shift at 3-months postactivation with and without RT-ECochG was 38.6 dB HL (95% CI, 25.6-51.67). There was an improvement in delta CNC from preoperative to 3-months postactivation when using RT-ECochG, with mean difference 20.7% (95% CI, 3.3-38.1). CONCLUSIONS Use of RT-ECochG monitoring during SLWE placement results in fewer full electrode insertions and significantly better HP rates and speech-perception outcomes when compared with unmonitored insertions. Further investigation is needed to evaluate long-term audiologic outcomes to better understand the relationships among ECochG, cochlear trauma, functional outcomes, and HP.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Matthew A. Shew
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Abhinav Ettyreddy
- Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shannon M. Lefler
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Pawina Jiramongkolchai
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Cameron C. Wick
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Craig A. Buchman
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Jacques A. Herzog
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
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Chen SL, Chan KC, Hu CY, Fang HY, Wu CM. Experience of adult cochlear implantation at a tertiary hospital. J Chin Med Assoc 2022; 85:469-477. [PMID: 35019869 DOI: 10.1097/jcma.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of adult cochlear implant (CI) surgery is increasing. However, the relevant adult CI data in Taiwan are insufficient due to the relatively small number of adult implant patients. The two main factors hindering adult implantation are the high cost of the surgery itself and inadequate knowledge regarding the effectiveness of CI for hearing and suppression of tinnitus. Here, we present data regarding adult CI outcomes from a single tertiary hospital. METHODS A total of 116 consecutive adult CI recipients (≥18 years old) who completed at least 12 months of speech perception tests (words and sentences) between January 1999 and December 2020 were enrolled in this retrospective population-based cohort study. Thirty patients completed speech perception (words and sentences) testing as well as three questionnaires relating to quality of life, and 71 completed full tinnitus suppression studies. Subjects' pre- and post-CI questionnaires were evaluated to assess overall CI outcome. RESULTS For auditory evaluation, the scores of easy sentences (ES), difficult sentences (DS), and phonetically balanced (PB) word recognition tests reached a plateau at 3 months post-CI (p = 0.005, 0.001, and 0.004, respectively) in most subjects. The post-CI scores of bodily pain, mental health, and social role functioning were significantly higher than corresponding pre-CI scores on the SF-36 Health Survey-Taiwan version (p = 0.036, 0.019, and 0.002, respectively). Furthermore, the post-CI scores of basic sound perception, speech production, and advanced sound perception were significantly higher than the corresponding pre-CI scores on the Nijmegen Cochlear Implant Questionnaire (p < 0.001, 0.013, and <0.001, respectively). Self-esteem was significantly correlated with the Categories of Auditory Performance scale and Speech Intelligibility Rating scale at 3, 6, and 9 months post-CI. CI improved tinnitus in approximately 65.1% of 71 adults. Based on the Tinnitus Handicap Inventory, 66.7% of patients were in grade 3-5 before surgery. However, after CI, only 34.4% of patients remained in THI grade 3-5. CONCLUSION This study confirmed that CI can improve speech perception (words and sentences), physical health, mental health, social interaction, and self-esteem in adult patients with profound hearing loss. CI also significantly alleviated tinnitus. The outcomes of ES, DS, and PB tests at 3 months post-CI were non-inferior to other longer post-CI periods and could be utilized as references for recovery and evaluation of prognosis.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kai-Chieh Chan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Yu Hu
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsuan-Yeh Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology & Head and Neck Surgery, Hsinchu Mackey Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Che-Ming Wu
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan, ROC
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Kostevich IV, Kuzovkov VE, Lilenko AS, Sugarova SB. [The significance of microanatomy of the round window in terms of cochlear implantation]. Vestn Otorinolaringol 2021; 86:42-47. [PMID: 34783472 DOI: 10.17116/otorino20218605142] [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: 11/17/2022]
Abstract
Sensoneural hearing loss is a polyetiological disease, which is often a secondary reflection of systemic pathology and is associated with damage of the cochlea and auditory nerve receptors. An important point in the surgical stage of cochlear implantation is the introduction of an implant active electrode into the cochleostomy spiral channel through the cochleostoma or round window. However, the issue of intra-cochlear structures surgical trauma in such surgical intervention seems to be very important, as it may reduce the success of subsequent rehabilitation. Therefore, the study of the anatomy of the round window and adjuscent areas was the objective of this work.
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Affiliation(s)
- I V Kostevich
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - V E Kuzovkov
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - A S Lilenko
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - S B Sugarova
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
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Abstract
Cochlear implant surgery is a successful procedure for auditory rehabilitation of patients with severe to profound hearing loss. However, cochlear implantation may lead to damage to the inner ear, which decreases residual hearing and alters vestibular function. It is now of increasing interest to preserve residual hearing during this surgery because this is related to better speech, music perception, and hearing in complex listening environments. Thus, different efforts have been tried to reduce cochlear implantation-related injury, including periprocedural glucocorticoids because of their anti-inflammatory properties. Different routes of administration have been tried to deliver glucocorticoids. However, several drawbacks still remain, including their systemic side effects, unknown pharmacokinetic profiles, and complex delivery methods. In the present review, we discuss the role of periprocedural glucocorticoid therapy to decrease cochlear implantation-related injury, thus preserving inner ear function after surgery. Moreover, we highlight the pharmacokinetic evidence and clinical outcomes which would sustain further interventions.
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Imsiecke M, Krüger B, Büchner A, Lenarz T, Nogueira W. Interaction Between Electric and Acoustic Stimulation Influences Speech Perception in Ipsilateral EAS Users. Ear Hear 2021; 41:868-882. [PMID: 31592902 PMCID: PMC7676483 DOI: 10.1097/aud.0000000000000807] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine electric-acoustic masking in cochlear implant users with ipsilateral residual hearing and different electrode insertion depths and to investigate the influence on speech reception. The effects of different fitting strategies-meet, overlap, and a newly developed masking adjusted fitting (UNMASKfit)-on speech reception are compared. If electric-acoustic masking has a detrimental effect on speech reception, the individualized UNMASKfit map might be able to reduce masking and thereby enhance speech reception. DESIGN Fifteen experienced MED-EL Flex electrode recipients with ipsilateral residual hearing participated in a crosssover design study using three fitting strategies for 4 weeks each. The following strategies were compared: (1) a meet fitting, dividing the frequency range between electric and acoustic stimulation, (2) an overlap fitting, delivering part of the frequency range both acoustically and electrically, and (3) the UNMASKfit, reducing the electric stimulation according to the individual electric-on-acoustic masking strength. A psychoacoustic masking procedure was used to measure the changes in acoustic thresholds due to the presence of electric maskers. Speech reception was measured in noise with the Oldenburg Matrix Sentence test. RESULTS Behavioral thresholds of acoustic probe tones were significantly elevated in the presence of electric maskers. A maximum of masking was observed when the difference in location between the electric and acoustic stimulation was around one octave in place frequency. Speech reception scores and strength of masking showed a dependency on residual hearing, and speech reception was significantly reduced in the overlap fitting strategy. Electric- acoustic stimulation significantly improved speech reception over electric stimulation alone, with a tendency toward a larger benefit with the UNMASKfit map. In addition, masking was significantly inversely correlated to the speech reception performance difference between the overlap and the meet fitting. CONCLUSIONS (1) This study confirmed the interaction between ipsilateral electric and acoustic stimulation in a psychoacoustic masking experiment. (2) The overlap fitting yielded poorer speech reception performance in stationary noise especially in subjects with strong masking. (3) The newly developed UNMASKfit strategy yielded similar speech reception thresholds with an enhanced acoustic benefit, while at the same time reducing the electric stimulation. This could be beneficial in the long-term if applied as a standard fitting, as hair cells are exposed to less possibly adverse electric stimulation. In this study, the UNMASKfit allowed the participants a better use of their natural hearing even after 1 month of adaptation. It might be feasible to transfer these results to the clinic, by fitting patients with the UNMASKfit upon their first fitting appointment, so that longer adaptation times can further improve speech reception.
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Affiliation(s)
- Marina Imsiecke
- Department of Otorhinolaryngology, Hanover Medical School, Hannover, Germany
| | - Benjamin Krüger
- Department of Otorhinolaryngology, Hanover Medical School, Hannover, Germany
- Cluster of Excellence ‘Hearing4all,' Hanover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hanover Medical School, Hannover, Germany
- Cluster of Excellence ‘Hearing4all,' Hanover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hanover Medical School, Hannover, Germany
- Cluster of Excellence ‘Hearing4all,' Hanover, Germany
| | - Waldo Nogueira
- Department of Otorhinolaryngology, Hanover Medical School, Hannover, Germany
- Cluster of Excellence ‘Hearing4all,' Hanover, Germany
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Imsiecke M, Büchner A, Lenarz T, Nogueira W. Amplitude Growth Functions of Auditory Nerve Responses to Electric Pulse Stimulation With Varied Interphase Gaps in Cochlear Implant Users With Ipsilateral Residual Hearing. Trends Hear 2021; 25:23312165211014137. [PMID: 34181493 PMCID: PMC8243142 DOI: 10.1177/23312165211014137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Amplitude growth functions (AGFs) of electrically evoked compound action
potentials (eCAPs) with varying interphase gaps (IPGs) were measured in cochlear
implant users with ipsilateral residual hearing (electric-acoustic stimulation
[EAS]). It was hypothesized that IPG effects on AGFs provide an objective
measure to estimate neural health. This hypothesis was tested in EAS users, as
residual low-frequency hearing might imply survival of hair cells and hence
better neural health in apical compared to basal cochlear regions. A total of 16
MED-EL EAS subjects participated, as well as a control group of 16 deaf cochlear
implant users. The IPG effect on the AGF characteristics of slope, threshold,
dynamic range, and stimulus level at 50% maximum eCAP amplitude
(level50%) was investigated. AGF threshold and
level50% were significantly affected by the IPG in both EAS and
control group. The magnitude of AGF characteristics correlated with electrode
impedance and electrode-modiolus distance (EMD) in both groups. In contrast, the
change of the AGF characteristics with increasing IPG was independent of these
electrode-specific measures. The IPG effect on the AGF level50% in
both groups, as well as on the threshold in EAS users, correlated with the
duration of hearing loss, which is a predictor of neural health. In EAS users, a
significantly different IPG effect on level50% was found between
apical and medial electrodes. This outcome is consistent with our hypothesis
that the influence of IPG effects on AGF characteristics provides a sensitive
measurement and may indicate better neural health in the apex compared to the
medial cochlear region in EAS users.
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Affiliation(s)
- Marina Imsiecke
- Clinic for Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Andreas Büchner
- Clinic for Otorhinolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing4All," Hannover, Germany
| | - Thomas Lenarz
- Clinic for Otorhinolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing4All," Hannover, Germany
| | - Waldo Nogueira
- Clinic for Otorhinolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence "Hearing4All," Hannover, Germany
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14
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Sosna-Duranowska M, Tacikowska G, Gos E, Krupa A, Skarzynski PH, Skarzynski H. Vestibular Function After Cochlear Implantation in Partial Deafness Treatment. Front Neurol 2021; 12:667055. [PMID: 34093414 PMCID: PMC8175845 DOI: 10.3389/fneur.2021.667055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cochlear implantation is a fully accepted method of treating individuals with profound hearing loss. Since the indications for cochlear implantation have broadened and include patients with low-frequency residual hearing, single-sided deafness, or an already implanted ear (meaning bilateral cochlear implantation), the emphasis now needs to be on vestibular protection. Materials and Methods: The research group was made up of 107 patients operated on in the otorhinolaryngosurgery department: 59 females and 48 males, aged 10.4–80.2 years (M = 44.4; SD = 18.4) with hearing loss lasting from 1.4 to 56 years (M = 22.7; SD = 13.5). The patients underwent cVEMP, oVEMP, a caloric test, and vHIT assessment preoperatively, and, postoperatively, cVEMP and oVEMP at 1–3 months and a caloric test and vHIT at 4–6 months. Results: After cochlear implantation, there was postoperative loss of cVEMP in 19.2% of the patients, oVEMP in 17.4%, reduction of caloric response in 11.6%, and postoperative destruction of the lateral, anterior, and posterior semicircular canal as measured with vHIT in 7.1, 3.9, and 4% respectively. Conclusions: Hearing preservation techniques in cochlear implantation are connected with vestibular protection, but the risk of vestibular damage in never totally eliminated. The vestibular preservation is associated with hearing preservation and the relation is statistically significant. Informed consent for cochlear implantation must include information about possible vestibular damage. Since the risk of vestibular damage is appreciable, preoperative otoneurological diagnostics need to be conducted in the following situations: qualification for a second implant, after otosurgery (especially if the opposite ear is to be implanted), having a history of vestibular complaints, and when there are no strict audiological or anatomical indications on which side to operate.
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Affiliation(s)
| | | | - Elzbieta Gos
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Anna Krupa
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
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15
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Spectral resolution and speech perception after cochlear implantation using the round window versus cochleostomy technique. The Journal of Laryngology & Otology 2021; 135:513-517. [PMID: 33958008 DOI: 10.1017/s0022215121001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the spectral resolution achieved with a cochlear implant in users who were implanted using round window route electrode insertion versus a traditional cochleostomy technique. METHODS Twenty-six patients were classified into two groups according to the surgical approach: one group (n = 13) underwent cochlear implantation via the round window technique and the other group (n = 13) underwent surgery via cochleostomy. RESULTS A statistically significant difference was found in spectral ripple discrimination scores between the round window and cochleostomy groups. The round window group performed almost two times better than the cochleostomy group. Differences between Turkish matrix sentence test scores were not statistically significant. CONCLUSION The spectral ripple discrimination scores of patients who had undergone round window cochlear implant electrode insertion were superior to those of patients whose cochlear implants were inserted using a classical cochleostomy technique.
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16
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Tsukada K, Usami SI. Vestibular Preservation After Cochlear Implantation Using the Round Window Approach. Front Neurol 2021; 12:656592. [PMID: 33986720 PMCID: PMC8110830 DOI: 10.3389/fneur.2021.656592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique. Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria). Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA. Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.
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Affiliation(s)
- Keita Tsukada
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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17
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Abstract
Electric-acoustic stimulation (EAS) is a special treatment modality for those patients who are profoundly deaf in the high-frequency (HF) region and retain usable hearing in the low-frequency (LF) region. Combining the electric stimulation with cochlear implant (CI) in the HF and acoustic amplification of residual hearing using a conventional hearing aid (HA) in the LF region defines EAS. The EAS concept was first proposed by C. von Ilberg from Frankfurt, Germany in the year 1997. In association with MED-EL, all the necessary safety studies were performed in non-human subjects before the first patient received it in 1997. In association with MED-EL, all the necessary safety studies were performed in non-human subjects before the first patient received it in 1999. For the patient to successfully use the EAS concept, the residual hearing needs to be preserved to a high extent and for several years. This requires a highly flexible electrode array in safeguarding the intra-cochlear structures during and after the CI electrode array insertion. Combining the HA unit with the audio processor unit of the CI was necessary for the convenient wearing of the unified audio processor. Fitting of the unified audio processor is another important factor that contributes to the overall success of the EAS treatment. The key translational research efforts at MED-EL were on the development of flexible electrodes, a unified audio processor, innovations in the fitting process, intra-operative monitoring of cochlear health during electrode insertion, pre-operative soft-ware tool to evaluate the cochlear size and electrode selection and some new innovations tried within EAS topic. This article covers the milestones of translational research from the first concept to the widespread clinical use of EAS.
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Affiliation(s)
| | - Ingeborg Hochmair
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
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18
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Lorens A, Walkowiak A, Polak M, Kowalczuk A, Furmanek M, Skarzynski H, Obrycka A. Cochlear Microphonics in Hearing Preservation Cochlear Implantees. J Int Adv Otol 2020; 15:345-351. [PMID: 31846910 DOI: 10.5152/iao.2019.6334] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The intracochlear electrocochleography (ECoG) could be recorded directly from the cochlear implant (CI) electrode in CI recipients with residual hearing. The primary objective of this study is to identify the most sensitive frequency to record cochlear microphonics (CM) in CI users with a wide degree of hearing abilities and deep electrode insertion. The secondary objective is to identify the optimum location within the cochlea to record intracochlear potentials. MATERIALS AND METHODS CMs were recorded from the CI electrodes in eight females and eight males implanted with CIs Pulsar, Concerto, or Sonata, Med-El Corp. RESULTS Among the tone pips of various frequencies, 1k or 500 Hz were the most sensitive for CI users. The most sensitive place in the cochlea to record the CM potentials depended on the tone frequency used. The deeper into the cochlea the mean maximum CM peak-to-peak amplitude was measured, the lower the stimulating tone frequency was. CONCLUSION The most optimal recording parameters identified for intracochlear CM recording can be useful for intraoperative and postoperative monitoring of cochlear health in CI users with residual hearing.
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Affiliation(s)
- Artur Lorens
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Adam Walkowiak
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | | | - Aleksandra Kowalczuk
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Mariusz Furmanek
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Anita Obrycka
- Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
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19
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Pringle MB, Konieczny KM. Anatomy of the Round Window Region With Relation to Selection of Entry Site Into the Scala Tympani. Laryngoscope 2020; 131:E598-E604. [PMID: 32415784 DOI: 10.1002/lary.28738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of cochlear implantation is to safely insert an electrode array into the scala tympani (ST) while avoiding damage to surrounding structures. There is disagreement on the optimal way of entering the ST-the round window (RW) approach versus cochleostomy. Regardless of the chosen approach, it is vital to understand the regional anatomy, which is complex, difficult to conceptualize, and rarely dissected in temporal bone courses. The goal of this study was to examine the anatomy of the RW to gain more in-depth knowledge on the local relationships of the anatomical structures and propose an approach for entering the ST in cochlear implant surgery tailored to the encountered anatomy. STUDY DESIGN Cadaveric prevalence study and expert opinion with literature review. METHODS Cadaveric temporal bone dissection (n = 13) by the first author assessing the RW anatomy. RESULTS The round window membrane (RWM) and the osseous spiral lamina (OSL) are curved structures, each with a horizontal and a vertical part. The two horizontal portions are very closely apposed. The relationship between the OSL and the RWM determines the best site for a cochleostomy, which if required is best placed anteroinferiorly to the RWM. The distance between the oval window inferior margin and the RW membrane is less than 2 to 3 mm. The ST initially extends inferiorly and medially to the RW. CONCLUSIONS The findings of our dissection have implications for cochlear implant surgery in aiming to avoid trauma to the OSL and basilar membrane and aid decision making in choosing the safest surgical approach. LEVEL OF EVIDENCE 5. Laryngoscope, 131:E598-E604, 2021.
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Affiliation(s)
- Michael B Pringle
- ENT Department, Portsmouth Hospitals NHS Foundation Trust, Portsmouth, United Kingdom
| | - Katarzyna M Konieczny
- ENT Department, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
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20
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Sosna M, Tacikowska G, Pietrasik K, Skarzynski H, Skarzynski PH. Vestibular status in partial deafness. Braz J Otorhinolaryngol 2019; 87:379-388. [PMID: 31874831 PMCID: PMC9422694 DOI: 10.1016/j.bjorl.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/31/2019] [Accepted: 09/26/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction The hair cells of the cochlea and the vestibulum are closely connected and may be susceptible to the same noxious factors. The relationship between their function has been a continuing field of investigation. The indications for cochlear implantation have been broadened and now include the patients with partial deafness. This raises the question of their vestibular status. Objective The aim of the study was to investigate whether there is any difference between the vestibular function of patients with low frequency residual hearing and those with totally deaf ears. Methods A total of 360 ears with profound sensorineural hearing loss were analysed before cochlear implantation. The patients were divided into four groups, according to their low frequency residual hearing (Group 1 ‒ normal or slightly elevated low frequency residual hearing; Group 2 ‒ elevated threshold but still usable hearing at low frequencies; Group 3 – non-functional residual hearing; Group 4 ‒ no detectable hearing threshold within the limits of the audiometer). The patients underwent vestibular tests: cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, caloric test and video-head impulse test. Results The rates of elicited responses in cervical vestibular evoked myogenic potential were as follows: in Group 1 (59.3 %); Group 2 (57.5 %); Group 3 (35.2 %); Group 4 (7.7 %). For ocular vestibular evoked myogenic potential the percentage of correct outcomes was: Group 1 (70.8 %); Group 2 (56.0 %); Group 3 (40.0 %); Group 4 (14.3 %). For the caloric test we counted normal responses in 88.9 % of Group 1; 81.6 % of Group 2; 57.9 % of Group 3; 53.3 % of Group 4. For video-head impulse test we also found markedly better results in Group1, followed by Group 2, and much worse in Group 3 and 4. Conclusion Patients with partial deafness not only have a better cochlea but also better vestibular function, which needs to be protected. In summary, the better the low frequency residual hearing, the better the vestibular status.
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Affiliation(s)
- Magdalena Sosna
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland.
| | - Grazyna Tacikowska
- Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Katarzyna Pietrasik
- Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Piotr H Skarzynski
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland; Institute of Sensory Organs, Kajetany, Poland; Medical University of Warsaw, Heart Failure and Cardiac Rehabilitation Department, Warsaw, Poland
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21
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Wiszomirska I, Zdrodowska A, Tacikowska G, Sosna M, Kaczmarczyk K, Skarżyński H. Does cochlear implantation influence postural stability in patients with hearing loss? Gait Posture 2019; 74:40-44. [PMID: 31442821 DOI: 10.1016/j.gaitpost.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cochlear implantation (CI) procedure carries the potential risk for vestibular system insult or stimulation with resultant dysfunction due to its proximity to the cochlea. The vestibular system plays an essential role in crucial tasks such as postural control, gaze stabilization and spatial orientation. RESEARCH QUESTION How does standard cochlear implantation influence postural stability in patients with hearing loss? METHODS The study included 21 individuals (age 51 ± 18 years) qualified to undergo CI due to severe or profound hearing loss. Participants were qualified for both groups by a physician based on an interview, an otoneurological examination and vestibular tests. The first group included patients without vestibular dysfunction, whereas the other group consisted of persons with vestibular dysfunction. The research methodology included medical examinations, anthropometric measurements and stabilometry on the Biodex Balance System SD (BBS) platform. The examinations were carried out twice, i.e. prior to and 3 months post implantation. The recorded data was compared between the first and the second examination using a non-parametric Wilcoxon test. The analysis of variance (ANOVA) and Tukey's post-hoc HSD unequal sample sizes were performed for patients with and without vestibular dysfunction. RESULTS AND SIGNIFICANCE Study showed that 52.4% of the participants obtained results within the norm, while 47.6% scored below it. The comparison of stability indices of the examined individuals, with and without vestibular dysfunction, did not reveal statistically significant differences. The only difference was the anterior-posterior stability index assessed in static conditions. Three months after the implantation, no changes in the majority of indices were noted, with the exception of anterior-posterior stability index, which improved following the implantation. CI does not affect postural stability changes in the study participants.
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Affiliation(s)
- Ida Wiszomirska
- Jozef Piłsudski University of Physical Education in Warsaw, Faculty of Rehabilitation, Poland.
| | - Agnieszka Zdrodowska
- Jozef Piłsudski University of Physical Education in Warsaw, Faculty of Rehabilitation, Poland.
| | - Grażyna Tacikowska
- Oto-Rhino-Laryngology Surgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland.
| | - Magdalena Sosna
- Oto-Rhino-Laryngology Surgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland.
| | - Katarzyna Kaczmarczyk
- Jozef Piłsudski University of Physical Education in Warsaw, Faculty of Rehabilitation, Poland.
| | - Henryk Skarżyński
- Oto-Rhino-Laryngology Surgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland; World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland.
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22
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Multicenter US Clinical Trial With an Electric-Acoustic Stimulation (EAS) System in Adults: Final Outcomes. Otol Neurotol 2019; 39:299-305. [PMID: 29342054 PMCID: PMC5821485 DOI: 10.1097/mao.0000000000001691] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To demonstrate the safety and effectiveness of the MED-EL Electric-Acoustic Stimulation (EAS) System, for adults with residual low-frequency hearing and severe-to-profound hearing loss in the mid to high frequencies.
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23
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Okada M, Quinkert A, Franck KH, Welling DB. The natural progression of low-frequency hearing loss in patients who meet hybrid implant system candidacy criteria. Laryngoscope 2019; 130:1299-1303. [PMID: 31393603 DOI: 10.1002/lary.28217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/26/2019] [Accepted: 07/15/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the natural progression of hearing loss in patients with high-frequency hearing loss whose audiograms met the criteria for a hybrid cochlear implant (CI). STUDY DESIGN Retrospective database review. METHODS We retrospectively identified patients who met the criteria for a hybrid CI from our audiometric database. We also recorded the etiology of hearing loss in each patient and excluded patients with retrocochlear etiologies, those age <6 years, duration of observation <1 year, or those with a mixed or conductive hearing loss. We calculated the pre-CI progression of residual low-frequency (LF) hearing level in decibels per year and investigated the risk factor of the progression of hearing loss. RESULTS A total of 1,083 ears of 944 patients were included in this study. The average rate of hearing loss progression for all etiologies was 1.70 ± 0.10 dB/yr at an average of 250 Hz, 500 Hz, and 1 kHz in the affected ear(s). The progression of hearing loss was 5.0 ± 0.93 dB/yr in patients with Meniere's disease and 3.5 ± 0.76 dB/yr in those with autoimmune disease, both of which were significantly faster than progression rates in other etiologies. In patients with idiopathic, genetic/hereditary, and congenital hearing loss, the progression of hearing loss was 1.46 ± 0.10 dB/yr. Patients with steeply sloping hearing loss experienced significantly faster progression in the ipsilateral ear compared to patients with another audiometric type. CONCLUSIONS It is suggested that Meniere's disease, autoimmune-mediated inner ear disease, and steeply sloping hearing loss in the ipsilateral ear are risk factors for faster progression of residual LF hearing level. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1299-1303, 2020.
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Affiliation(s)
- Masahiro Okada
- Department of Otolaryngology-Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan.,Department of Otolaryngology, Massachusetts Eye and Ear and Harvard University, Boston, Massachusetts, U.S.A
| | - Amy Quinkert
- Department of Otolaryngology, Massachusetts Eye and Ear and Harvard University, Boston, Massachusetts, U.S.A
| | - Kevin H Franck
- Department of Otolaryngology, Massachusetts Eye and Ear and Harvard University, Boston, Massachusetts, U.S.A
| | - D Bradley Welling
- Department of Otolaryngology, Massachusetts Eye and Ear and Harvard University, Boston, Massachusetts, U.S.A
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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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Rader T, Bohnert A, Matthias C, Koutsimpelas D, Kainz MA, Strieth S. Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma. HNO 2019; 66:56-62. [PMID: 30132125 PMCID: PMC7062660 DOI: 10.1007/s00106-018-0532-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. Objectives Short- and mid-term hearing preservation outcome in pediatric patients is investigated. Materials and methods A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. Results In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. Conclusions The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.
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Affiliation(s)
- T Rader
- Audiological Acoustics Division, Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - A Bohnert
- Audiological Acoustics Division, Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - C Matthias
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - D Koutsimpelas
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - M-A Kainz
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - S Strieth
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Bae SC, Shin YR, Chun YM. Cochlear Implant Surgery Through Round Window Approach Is Always Possible. Ann Otol Rhinol Laryngol 2019; 128:38S-44S. [PMID: 31092036 DOI: 10.1177/0003489419834311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The benefit of round window (RW) approach for cochlear implant (CI) has been well studied. Because the RW represents a natural door to scala tympani, it facilitates precise electrode insertion. Atraumatic electrode insertion can also be performed without drilling the cochlear lateral wall. However, the RW approach has several limitations. The purpose of this study is to describe successful CI surgeries utilizing the RW approach except for severe cases of temporal bone anomaly. The authors' successful surgical solution for cases involving difficult RW access is also described. MATERIALS AND METHODS We retrospectively analyzed 377 consecutive surgeries of cochlear implantation performed between June 2010 and December 2018 by a single experienced surgeon. Standard and alternative procedures were used according to anatomical variations. Standard procedures included modified techniques of mastoidectomy in the RW approach, opening of facial recess, exposure of RW membrane, and electrode insertion. Difficult cases involving severe rotated cochlea or hypoplastic mastoid were successfully treated with RW insertion using alternative procedures such as external auditory canal (EAC) wall mobilization and endomeatal approach. RESULTS We performed CI surgery through a reproducible RW technique in two cases involving endomeatal approach and three cases of EAC mobilization. Other cases were treated using the standard procedure. CONCLUSION Cochlear implant surgery through RW is reliable, safe, and effective. The RW technique is reproducible via several surgical procedures in most CI cases. Identification and safe exposure of RW membrane is a prerequisite for successful electrode insertion in cochlear implant surgery.
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Sosna M, Tacikowska G, Pietrasik K, Skarżyński H, Lorens A, Skarżyński PH. Effect on vestibular function of cochlear implantation by partial deafness treatment-electro acoustic stimulation (PDT-EAS). Eur Arch Otorhinolaryngol 2019; 276:1951-1959. [PMID: 31053967 PMCID: PMC6581932 DOI: 10.1007/s00405-019-05425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
Abstract
Purpose Although the cochlear implantation procedure does not interfere with vestibular structures directly, both the vestibulum and the cochlea share the same inner ear fluid space, and this fluid may be responsible for transferring possibly damaging forces from one to the other. The purpose of the study is to assess postoperative vestibular function after partial deafness treatment–electro-acoustic stimulation (PDT–EAS) cochlear implantation. Methods Fifty-five patients were included in the study (30 females, 25 males, age 11–80, mean 41.8 ± 19.35). cVEMP and oVEMP were performed preoperatively and 1–3 months after cochlear implantation. Caloric and vHIT tests were conducted preoperatively and 4–6 months after cochlear implantation. Results Our study shows that, based on a wide range of electrodes, use of PDT–EAS is protective in terms of preserving vestibular function. It gives a rate of saccular damage of 15.79%, utricular damage of 19.04%, and a horizontal semicircular canal response reduction of 15.79%. Conclusions PDT–EAS is protective in terms of preserving vestibular function. Nevertheless, it should be emphasized that the risk of vestibular damage cannot be totally eliminated even when hearing preservation techniques are adopted.
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Affiliation(s)
- Magdalena Sosna
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Grażyna Tacikowska
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Katarzyna Pietrasik
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Henryk Skarżyński
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Artur Lorens
- Department of Auditory Implant and Perception, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Piotr H Skarżyński
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland.
- Institute of Sensory Organs, Kajetany, Poland.
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland.
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Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography. Ear Hear 2019; 39:1146-1156. [PMID: 29554036 DOI: 10.1097/aud.0000000000000571] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion. DESIGN In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extracochlear position-either adjacent to the stapes or on the promontory just superior to the RW. Recording from the fixed, extracochlear position continued during insertion of the CI in 63 cases. RESULTS Before CI insertion, responses to low-frequency tones at the RW were roughly 6 dB larger than when recording at either extracochlear site, but the two extracochlear sites did not differ from one another. During CI insertion, response losses from the promontory or adjacent to the stapes stayed within 5 dB in ≈61% (38/63) of cases, presumably indicating atraumatic insertions. Among responses which dropped more than 5 dB at any time during CI insertion, 12 subjects showed no response recovery, while in 13, the drop was followed by partial or complete response recovery by the end of CI insertion. In cases with recovery, the drop in response occurred relatively early (<15 mm insertion) compared to those where there was no recovery. Changes in response phase during the insertion occurred in some cases; these may indicate a change in the distributions of generators contributing to the response. CONCLUSIONS Monitoring the electrocochleography during CI insertion from an extracochlear site reveals insertions that are potentially atraumatic, show interaction with cochlear structures followed by response recovery, or show interactions such that response losses persist to the end of recording.
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Sierra C, Calderón M, Bárcena E, Tisaire A, Raboso E. Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays. Otol Neurotol 2019; 40:e373-e380. [DOI: 10.1097/mao.0000000000002170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoon YS, Shin YR, Kim JM, Coltisor A, Chun YM. Optimizing maps for electric acoustic stimulation users. Cochlear Implants Int 2019; 20:106-115. [DOI: 10.1080/14670100.2019.1572939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yang-Soo Yoon
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX, USA
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SKARZYNSKI H, MATUSIAK M, FURMANEK M, PILKA A, WLODARCZYK E, OLDAK M, SKARZYNSKI P. Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:468-475. [PMID: 30498276 PMCID: PMC6265667 DOI: 10.14639/0392-100x-1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.
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Affiliation(s)
- H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. MATUSIAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. FURMANEK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - A. PILKA
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - E. WLODARCZYK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. OLDAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - P.H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Kondratowicza, Warszawa, Poland
- Institute of Sensory Organs, Mokra, Kajetany, Poland
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Hearing Preservation Outcomes After Cochlear Implantation Depending on the Angle of Insertion: Indication for Electric or Electric-Acoustic Stimulation. Otol Neurotol 2018; 39:834-841. [DOI: 10.1097/mao.0000000000001862] [Citation(s) in RCA: 13] [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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[Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma (German version)]. HNO 2018; 66:660-667. [PMID: 29971537 DOI: 10.1007/s00106-018-0530-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. OBJECTIVES Short- and mid-term hearing preservation outcome in pediatric patients is investigated. MATERIALS AND METHODS A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. RESULTS In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. CONCLUSIONS The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.
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Abstract
OBJECTIVE Electrical stimulation is normally performed on ears that have no hearing function, i.e., lack functional hair cells. The properties of electrically-evoked responses in these cochleae were investigated in several previous studies. Recent clinical developments have introduced cochlear implantation (CI) in residually-hearing ears to improve speech understanding in noise. The present study documents the known physiological differences between electrical stimulation of hair cells and of spiral ganglion cells, respectively, and reviews the mechanisms of combined electric and acoustic stimulation in the hearing ears. DATA SOURCES Literature review from 1971 to 2016. CONCLUSIONS Compared with pure electrical stimulation the combined electroacoustic stimulation provides additional low-frequency information and expands the dynamic range of the input. Physiological studies document a weaker synchronization of the evoked activity in electrically stimulated hearing ears compared with deaf ears that reduces the hypersynchronization of electrically-evoked activity. The findings suggest the possibility of balancing the information provided by acoustic and electric input using stimulus intensity. Absence of distorting acoustic-electric interactions allows exploiting these clinical benefits of electroacoustic stimulation.
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Preliminary Outcomes Report for CO2 Laser Assisted Electric-Acoustic Cochlear Implantation. Otol Neurotol 2018; 39:582-590. [PMID: 29649047 DOI: 10.1097/mao.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report on the safety/efficacy of a novel, carbon dioxide (CO2) laser-assisted protocol for hearing-preservation cochlear implantation (HPCI) and electric-acoustic stimulation (EAS). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Adult patients meeting established criteria for HPCI and EAS. INTERVENTION Therapeutic/rehabilitative. A standardized protocol used CO2 laser to achieve meticulous hemostasis and perform cochleostomy was evaluated. MAIN OUTCOME MEASURES Audiometric assessments included low-tone pure tone average (LtPTA), consonant-nucleus-consonant (CNC), and AzBio scores. Primary outcomes were low-tone hearing-preservation (LtHP) and EAS usage rates. Secondary outcomes included change in LtPTA, outcomes durability, and the rate/onset/presentation of delayed hearing loss (DHL). Subset analyses stratified data by presenting LtPTA and surgeon experience. RESULTS Forty-seven patients and 52 ears were included. Mean follow-up was 20.7 ± 12.6 months. When adjusted for preoperative LtPTA less than 60 dB, the LtHP rate was 77%. This was significantly better than for patients with LtPTA more than 60 dB (24%; p < 0.0001). Outcomes were highly durable. EAS usage was excellent in those with LtPTA less than 60 dB (100%). Nine patients developed DHL. Three additional patients (25%) were successfully salvaged via steroids. Both CNC and AzBio scores improved significantly (p < 0.0001) at definitive testing. Speech-hearing scores did not differ significantly between patients using/not using EAS. The complication rate was 3.8%; none were caused by the laser. Surgeon experience was associated with significantly better outcomes. CONCLUSION Use of a CO2 laser-assisted HPCI protocol was safe and effective. Outcomes were consistent with contemporary literature reporting. Patient selection and surgeon experience both significantly impacted outcomes.
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Imsiecke M, Krüger B, Büchner A, Lenarz T, Nogueira W. Electric-acoustic forward masking in cochlear implant users with ipsilateral residual hearing. Hear Res 2018; 364:25-37. [PMID: 29673567 DOI: 10.1016/j.heares.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 11/16/2022]
Abstract
In order to investigate the temporal mechanisms of the auditory system, psychophysical forward masking experiments were conducted in cochlear implant users who had preserved acoustic hearing in the ipsilateral ear. This unique electric-acoustic stimulation (EAS) population allowed the measurement of threshold recovery functions for acoustic or electric probes in the presence of electric or acoustic maskers, respectively. In the electric masking experiment, the forward masked threshold elevation of acoustic probes was measured as a function of the time interval after the offset of the electric masker, i.e. the masker-to-probe interval (MPI). In the acoustic masking experiment, the forward masked threshold elevation of electric probe stimuli was investigated under the influence of a preceding acoustic masker. Since electric pulse trains directly stimulate the auditory nerve, this novel experimental setup allowed the acoustic adaptation properties (attributed to the physiology of the hair cells) to be differentiated from the subsequent processing by more central mechanisms along the auditory pathway. For instance, forward electric masking patterns should result more from the auditory-nerve response to electrical stimulation, while forward acoustic masking patterns should primarily be the result of the recovery from adaptation at the hair-cell neuron interface. Electric masking showed prolonged threshold elevation of acoustic probes, which depended significantly on the masker-to-probe interval. Additionally, threshold elevation was significantly dependent on the similarity between acoustic stimulus frequency and electric place frequency, the electric-acoustic frequency difference (EAFD). Acoustic masking showed a reduced, but statistically significant effect of electric threshold elevation, which did not significantly depend on MPI. Lastly, acoustic masking showed longer decay times than electric masking and a reduced dependency on EAFD. In conclusion, the forward masking patterns observed for combined electric-acoustic stimulation provide further insights into the temporal mechanisms of the auditory system. For instance, the asymmetry in the amount of threshold elevation, the dependency on EAFD and the time constants for the recovery functions of acoustic and electric masking all indicate that there must be several processes with different latencies (e.g. neural adaptation, depression of spontaneous activity, efferent systems) that are involved in forward masking recovery functions.
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Affiliation(s)
- Marina Imsiecke
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.
| | - Benjamin Krüger
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany; Cluster of Excellence 'Hearing4All', Hanover, Germany.
| | - Andreas Büchner
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany; Cluster of Excellence 'Hearing4All', Hanover, Germany.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany; Cluster of Excellence 'Hearing4All', Hanover, Germany.
| | - Waldo Nogueira
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany; Cluster of Excellence 'Hearing4All', Hanover, Germany.
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Yanov YK, Kuzovkov VE, Lilenko AS, Kostevich IV, Sugarova SB, Amonov AS. [Topographic anatomy of the hook region and its significance for the choice of the surgical technique for the cochlear implantation]. Vestn Otorinolaringol 2017. [PMID: 28631670 DOI: 10.17116/otorino20178234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The mode of the introduction of the active electrode of a cochlear implant into the cochlea remains a key issue as far as cochlear implantation is concerned. Especially much attention has recently been given to the relationship between the anatomical features of the basal region of the cochlea (the so-called 'fish hook') and the possibility to approach it. We have undertaken the attempt to optimize the approach to the tympanic canal (scala tympanica) of the cochlea with a view to reducing to a minimum the risk of an injury to the cochlear structures in the course of cochlear implantation. A total of 35 cadaveric temporal bones were examined to measure the fine structures of the hook region and evaluate the risk of their damages associated with various approaches to the tympanic canal.
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Affiliation(s)
- Yu K Yanov
- Sankt-Petersburg Research Institute of Ear, Throat and Nose Diseases, Ministry of Health of the Russian Federation, Sankt-Petersburg, Russia, 190013
| | - V E Kuzovkov
- Sankt-Petersburg Research Institute of Ear, Throat and Nose Diseases, Ministry of Health of the Russian Federation, Sankt-Petersburg, Russia, 190013
| | - A S Lilenko
- Sankt-Petersburg Research Institute of Ear, Throat and Nose Diseases, Ministry of Health of the Russian Federation, Sankt-Petersburg, Russia, 190013
| | - I V Kostevich
- Sankt-Petersburg Research Institute of Ear, Throat and Nose Diseases, Ministry of Health of the Russian Federation, Sankt-Petersburg, Russia, 190013
| | - S B Sugarova
- Sankt-Petersburg Research Institute of Ear, Throat and Nose Diseases, Ministry of Health of the Russian Federation, Sankt-Petersburg, Russia, 190013
| | - A Sh Amonov
- Republican Research and Practical Medical Centre of Pediatrics, Tashkent, Uzbekistan, 100179
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Piotrowska A, Paradowska-Stankiewicz I, Skarżyński H. Rates of Vaccination against Streptococcus Pneumoniae in Cochlear Implant Patients. Med Sci Monit 2017; 23:4567-4573. [PMID: 28941358 PMCID: PMC5627539 DOI: 10.12659/msm.903188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae can cause life-threatening illness, with invasive pneumococcal diseases (IPD) like meningitis, sepsis, bacteremic pneumonia, and bacteremia being major causes of morbidity and mortality. Studies have shown that patients who have had a cochlear implant, particularly children, have an increased risk of bacterial (pneumococcal) meningitis. Vaccination in patients with cochlear implants is important and recommended universally. The World Health Organization recommends the use of pneumococcal conjugate vaccines in all countries and considers their use to be a priority in all national immunization programs. The objective of this study was to assess rates of vaccination against Streptococcus pneumoniae in patients with cochlear implants who were implanted at the Institute of Physiology and Pathology of Hearing, Poland. MATERIAL AND METHODS We analyzed data from questionnaires administered to 2,628 patients who visited the Implants and Auditory Perception Department (IAPD) of the Institute of Physiology and Pathology of Hearing between January 2014 and March 2016. RESULTS The percentage of vaccinated patients in the study group was 28.2%, most of whom (90.7%) were children. Among the children, 49.3% were vaccinated against S. pneumoniae, but the corresponding rate for adults was only 5.5%. CONCLUSIONS The percentage of patients with cochlear implants who received vaccination against S. pneumoniae was low, both in children and adults, but especially in adults comparing to available reports.
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Affiliation(s)
- Anna Piotrowska
- Department of Epidemiology and Screening, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | | | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
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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: 34] [Impact Index Per Article: 4.9] [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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Khater A, El-Anwar MW. Methods of Hearing Preservation during Cochlear Implantation. Int Arch Otorhinolaryngol 2017; 21:297-301. [PMID: 28680501 PMCID: PMC5495597 DOI: 10.1055/s-0036-1585094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/03/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Recent advances in surgical techniques and electrode design have made residual hearing preservation during cochlear implantation (CI) possible, achievable, and desirable. Objectives The objective of this study was to review the literature regarding methods used for hearing preservation during CI surgery. Data Synthesis We performed a search in the LILACS, MEDLINE, SciELO, PubMed databases, and Cochrane Library, using the keywords CI, hearing preservation, CI electrode design, and CI soft surgery. We fully read about 15 studies that met the criteria described in "study selection". The studies showed that several factors could contribute to possible cochlear damage during or after CI surgery and must be kept in mind; mechanical damage during electrode insertion, shock waves in the perilymph fluid due to implantation, acoustic trauma due to drilling, loss of perilymph and disruption of inner ear fluid homeostasis, potential bacterial infection, and secondary intracochlear fibrous tissue formation. The desire to preserve residual hearing has led to the development of the soft-surgery protocols with 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 questionable. The site of entry into the cochlea, electrode design, and the depth of insertion are also important contributing factors. Conclusion Hearing preservation would be useful for CI patients to benefit from the residual low frequency, as well as for the children who could be candidate for future regenerative hair cell therapy.
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Affiliation(s)
- Ahmed Khater
- Department of Otorhinolaryngology Head and Neck Surgery, Zagazig University, Zagazig, Egypt
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Mady LJ, Sukato DC, Fruit J, Palmer C, Raz Y, Hirsch BE, McCall AA. Hearing Preservation: Does Electrode Choice Matter? Otolaryngol Head Neck Surg 2017; 157:837-847. [PMID: 28608735 DOI: 10.1177/0194599817707167] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Evaluate if electrode design affects hearing preservation (HP) following cochlear implantation (CI) with full-length electrodes. Study Design Case series with chart review. Setting Tertiary referral academic center. Subjects and Methods Forty-five adults with low-frequency hearing (≤85 dB at 250 and 500 Hz) who underwent unilateral CI with full-length electrode arrays made by 1 manufacturer were included. HP was calculated with (1) mean low-frequency pure-tone average (LFPTA) at 250 and 500 Hz (MEAN method), (2) a percentile method across the audiometric frequency spectrum generating an S-value (HEARRING method), and (3) functional if hearing remained ≤85 dB at 250 and 500 Hz. Audiometric testing was performed approximately 1 month and 1 year postoperatively, yielding short-term and long-term results, respectively. Results Of 45 patients who underwent CI, 46.7% received lateral wall (LW) and 53.3% received perimodiolar (PM) electrodes. At short-term follow-up, LW electrodes were associated with significantly better HP than PM (LFPTA method: 27.7 vs 39.3 dB, P < .05; S-value method: 48.2 vs 21.8%, P < .05). In multivariate regression of short-term outcomes, LW electrode use was a significant predictor of better HP ( P < .05). At long-term follow-up, electrode type was not associated with HP. Younger patient age was the only significant predictor of long-term HP on multivariate analysis ( P < .05). Conclusion The LW electrode is associated with short-term HP, suggesting its design is favorable for limiting trauma to the cochlea during and directly following CI. Other factors, including age, are relevant for maintaining HP over the long term. The data support further investigation into what modifiable factors may promote long-term HP.
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Affiliation(s)
- Leila J Mady
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel C Sukato
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jenifer Fruit
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catherine Palmer
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania, USA
| | - Yael Raz
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,3 Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Barry E Hirsch
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania, USA
| | - Andrew A McCall
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Mirsalehi M, Mohebbi S, Ghajarzadeh M, Lenarz T, Majdani O. Impact of the round window membrane accessibility on hearing preservation in adult cochlear implantation. Eur Arch Otorhinolaryngol 2017; 274:3049-3056. [DOI: 10.1007/s00405-017-4628-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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Moteki H, Nishio SY, Miyagawa M, Tsukada K, Iwasaki S, Usami SI. Long-term results of hearing preservation cochlear implant surgery in patients with residual low frequency hearing. Acta Otolaryngol 2017; 137:516-521. [PMID: 27852135 DOI: 10.1080/00016489.2016.1252061] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION Differences were found between patients with stable hearing and those with progressive hearing loss in the lower frequencies with respect to the rate of progression in the contralateral ear. It is suggested that the electric acoustic stimulation (EAS) can provide improvement in hearing ability over the long-term if residual hearing might be lost to some extent. OBJECTIVE To evaluate the long-term threshold changes in the low frequency hearing of the implanted ear as compared with the non-implanted ear, and the hearing abilities with EAS along with the extent of residual hearing. METHODS Seventeen individuals were enrolled and received the EAS implant with a 24-mm FLEXeas electrode array. Hearing thresholds and speech perception were measured pre- and post-operatively for 1-5 years. Post-operative hearing preservation (HP) rates were calculated using the preservation numerical scale. RESULTS The average linear regression coefficient for the decline in hearing preservation score was -6.9 for the implanted ear and the patients were subsequently categorized into two groups: those with better than average, stable hearing; and those with worse than average, progressive hearing loss. EAS showed better results than electric stimulation alone, in spite of an absence of speech perception with acoustic stimulation.
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Affiliation(s)
- Hideaki Moteki
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Maiko Miyagawa
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keita Tsukada
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Iwasaki
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
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Hearing Preservation With a Midscalar Electrode Comparison of a Regular and Steroid/Pressure Optimized Surgical Approach in Patients With Residual Hearing. Otol Neurotol 2016; 37:e349-52. [DOI: 10.1097/mao.0000000000001068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Long-term Hearing Preservation Outcomes After Cochlear Implantation for Electric-Acoustic Stimulation. Otol Neurotol 2016; 37:e353-9. [DOI: 10.1097/mao.0000000000001066] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cochlear implant-related three-dimensional characteristics determined by micro-computed tomography reconstruction. Clin Anat 2016; 30:39-43. [DOI: 10.1002/ca.22770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/10/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
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The Effect of Round Window Sealants on Delayed Hearing Loss in a Guinea Pig Model of Cochlear Implantation. Otol Neurotol 2016; 37:1024-31. [DOI: 10.1097/mao.0000000000001132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation. Otol Neurotol 2016; 37:1006-15. [DOI: 10.1097/mao.0000000000001110] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Using the Implant Electrode Array to Conduct Real-time Intraoperative Hearing Monitoring During Pediatric Cochlear Implantation: Preliminary Experiences. Otol Neurotol 2016; 37:e148-53. [PMID: 26756149 DOI: 10.1097/mao.0000000000000950] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To present the preliminary experiences and findings from a pilot study evaluating a novel technique for monitoring cochlear electrophysiological function during electrode insertion in cochlear implantation surgery. STUDY DESIGN Prospective pilot cohort study. SETTING Tertiary academic neuro-otology center. PATIENTS Pediatric patients with residual hearing undergoing hearing preservation cochlear implant surgery. INTERVENTION Monitoring of intraoperative cochlear microphonics during cochlear implant surgery. MAIN OUTCOME MEASURE Intraoperative intracochlear microphonic measurement, preservation of these responses postoperatively and preservation of hearing as measured by audiometry. RESULTS Intracochlear microphonics could be identified in both patients presented and were preserved during the surgical procedure and postoperatively. The preservation of intracochlear microphonics correlates with preservation of hearing. CONCLUSION The novel approach using the electrode array to detect and measure intracochlear microphonics during cochlear implantation surgery shows promise as an instrument to alert the operating surgeon to hair cell damage during electrode insertion. Further refinement of the technique is required to better understand the measurements and correlate these with pre- and postoperative hearing and risk of hearing loss from surgery. Improvements in the software algorithm will reduce the time required for each measurement, leading to the development a more real-time monitoring technique.
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