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Wei C, Gao Z, Mau R, Eickner T, Jüttner G, Fiedler N, Seitz H, Lenarz T, Scheper V. Molded Round Window Niche Implant as a Dexamethasone Delivery System in a Cochlear Implant-Trauma Animal Model. Pharmaceutics 2024; 16:1236. [PMID: 39339272 PMCID: PMC11434969 DOI: 10.3390/pharmaceutics16091236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Preserving residual hearing after cochlear implant (CI) surgery remains a crucial challenge. The application of dexamethasone (DEX) has been proven to positively affect residual hearing. To deliver DEX in a localized and controlled way, a round window niche implant (RNI), allowing drug diffusion via the round window membrane into the cochlea, may be used. To prove this concept, an RNI for guinea pigs as a CI-trauma model was manufactured by molding and tested for its drug release in vitro and biological effects in vivo. METHODS The RNIs were molded using silicone containing 10% DEX. Release was analyzed over time using high-performance liquid chromatography (HPLC). Fourteen adult guinea pigs were randomly assigned to two groups (CI or CI + RNI group). All animals received a unilateral CI electrode insertion trauma followed by CI insertion. The CI + RNI group was additionally implanted with an RNI containing 10% DEX. Animals were followed up for 4 weeks. Acoustically evoked auditory brainstem response and impedance measurement, micro-computed tomography (µCT) imaging, and histology were performed for evaluation. RESULTS DEX was released for more than 250 days in vitro, with an initial burst followed by a slower release over time. Comparing the hearing threshold shift (from day 0 to day 28) of the CI and CI + RNI groups, significant differences were observed at 32 and 40 kHz. The impedance shift at basal contacts was lower in the CI + RNI group than in the CI group. Moreover, the fibrosis in the lower basal turn was reduced in the CI + RNI group in contrast to the CI group. CONCLUSIONS The RNI containing 10% DEX has anti-inflammatory potential concerning fibrosis inhibition and has beneficial effects on hearing preservation at high frequencies.
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Affiliation(s)
- Chunjiang Wei
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (C.W.); (Z.G.)
- Cluster of Excellence “Hearing4all”, German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Ziwen Gao
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (C.W.); (Z.G.)
- Cluster of Excellence “Hearing4all”, German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Robert Mau
- Microfluidics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Justus-von-Liebig Weg 6, 18059 Rostock, Germany
| | - Thomas Eickner
- Institute for Biomedical Engineering, University Medical Center Rostock, University of Rostock, Friedrich-Barnewitz Straße 4, 18119 Rostock, Germany
| | - Gabor Jüttner
- Kunststoff-Zentrum in Leipzig gGmbH, Erich-Zeigner-Allee 44, 04229 Leipzig, Germany
| | - Nicklas Fiedler
- Institute for Biomedical Engineering, University Medical Center Rostock, University of Rostock, Friedrich-Barnewitz Straße 4, 18119 Rostock, Germany
| | - Hermann Seitz
- Microfluidics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Justus-von-Liebig Weg 6, 18059 Rostock, Germany
- Department Life, Light & Matter, Interdisciplinary Faculty, University of Rostock, Albert-Einstein-Str. 25, 18059 Rostock, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (C.W.); (Z.G.)
- Cluster of Excellence “Hearing4all”, German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Verena Scheper
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (C.W.); (Z.G.)
- Cluster of Excellence “Hearing4all”, German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
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Gottfried TM, Galeazzi P, Föger A, Dejaco D, Tröger A, Fischer N, Innerhofer V, Di Trapani F, Weiss N, Seebacher J, Dierker A, Schmutzhard J. Evaluation of an impedance-based method to monitor the insertion of the electrode array during cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:4121-4131. [PMID: 38564010 PMCID: PMC11266372 DOI: 10.1007/s00405-024-08584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Cochlear implantation is a prevalent remedy for severe-to-profound hearing loss. Optimising outcomes and hearing preservation, and minimising insertion trauma, require precise electrode placement. Objective monitoring during the insertion process can provide valuable insights and enhance surgical precision. This study assesses the feasibility and performance of an impedance-based method for monitoring electrode insertion, compared to the surgeon's feedback. METHODS The study utilised the Insertion Monitoring Tool (IMT) research software, allowing for real-time measurement of impedance and evoked compound action potential (eCAP) during electrode insertion in 20 patient implantations. This enabled an impedance-based method to continuously assess the status of each electrode during the insertion process. The feasibility and performance was evaluated and compared to the surgeon's feedback approach. eCAP measurements focused merely on feasibility without searching specific responses. RESULTS The IMT demonstrated feasibility in measuring real-time impedances and eCAP during the insertion of the electrode array. The impedance-based method exhibited potential for accurately monitoring the insertion depth with a high success rate. However, further development is needed to improve the number of usable contacts. CONCLUSIONS Objective monitoring with the impedance-based method shows promise as a valuable tool to enhance the precision of cochlear implant electrode insertion respecting insertion distance estimation. The IMT research software proved feasible in recording real-time impedances and eCAP during electrode insertion. While this impedance-based method exhibits high success rates, further improvements are required to optimise the number of usable contacts. This study highlights the potential of objective monitoring techniques to enhance cochlear implantation outcomes.
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Affiliation(s)
- Timo M Gottfried
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Pablo Galeazzi
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Aline Föger
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Andrea Tröger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Veronika Innerhofer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Francesco Di Trapani
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Nora Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Bochum, North Rhine-Westphalia, Bleichstraße 15, 44787, Bochum, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Josef Seebacher
- Departement of Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria
| | - Angelika Dierker
- MED-EL Medical Electronics, Worldwide Headquarters, Fürstenweg 77a, Innsbruck, Tyrol, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Tyrol, Austria.
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Pimentel de Morais C, Branco P, Pereira A, Castelhano L, Donato M, Correia F, O'Neill A, Santos R, Escada P. The Role of Steroids in the Preservation of Hearing and Vestibular Function in Cochlear Implantation. Laryngoscope 2024; 134:3458-3465. [PMID: 38381055 DOI: 10.1002/lary.31360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Cochlear implant surgery is guided by principles of atraumatic insertion as to protect the inner ear. Previous studies suggest the potential benefit of steroids in patients undergoing cochlear implantation (CI), although the optimal route of administration has yet to be determined. We aim to systematically review the human studies of hearing and vestibular function preservation in patients undergoing CI receiving perioperative steroids and to discuss their role. DATA SOURCES Search performed in PubMed, EMBASE, and CENTRAL databases in December 2023. REVIEW METHODS Studies comparing several methods of steroid delivery and conventional management for patients undergoing CI were identified. Primary outcomes included hearing and vestibular function preservation. Secondary outcomes included reported adverse events, routes of steroid administration, and the presence of a control group without steroid administration. RESULTS A total of 15 studies (N = 659) met inclusion criteria. Methodology, doses, route of steroid administration, and follow-up duration differed between most studies. Audiometric, vestibular, and hearing preservation (HP) results were inconsistent. In 12 studies, perioperative steroids were associated with either increased HP or vestibular function preservation. Only two studies reported adverse events related to oral corticosteroid therapy. CONCLUSIONS There is a tendency for perioperative steroids to have a positive impact, at least in the short term, on hearing and vestibular function preservation in CI. Topical corticosteroid therapy appears to have a superior risk-benefit profile. There is a need for future carefully designed randomized controlled trials to determine the ideal route of steroid administration and its real impact in the long term. Laryngoscope, 134:3458-3465, 2024.
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Affiliation(s)
| | - Pedro Branco
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - André Pereira
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Luís Castelhano
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Mariana Donato
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Filipe Correia
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Assunção O'Neill
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Ricardo Santos
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Pedro Escada
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
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Fleet A, Nikookam Y, Radotra A, Gowrishankar S, Metcalfe C, Muzaffar J, Smith ME, Monksfield P, Bance M. Outcomes following cochlear implantation with eluting electrodes: A systematic review. Laryngoscope Investig Otolaryngol 2024; 9:e1263. [PMID: 38855776 PMCID: PMC11160184 DOI: 10.1002/lio2.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/22/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives To establish audiological and other outcomes following cochlear implantation in humans and animals with eluting electrodes. Methods Systematic review and narrative synthesis. Databases searched (April 2023): MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and Web of Science. Studies reporting outcomes in either humans or animals following cochlear implantation with a drug-eluting electrode were included. No limits were placed on language or year of publication. Risk of bias assessment was performed on all included studies using either the Brazzelli or Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) assessment tools. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Results Searches identified 146 abstracts and 108 full texts. Of these, 18 studies met the inclusion criteria, reporting outcomes in 523 animals (17 studies) and 24 humans (1 study). Eluting electrodes included dexamethasone (16 studies), aracytine (1 study), nicotinamide adenine dinucleotide (1 study), the growth factors insulin-like growth factor 1 (IGF1) and hepatocyte growth factor (HGF) (1 study), and neurotrophin-3 (1 study). All included studies compare outcomes following implantation with an eluting electrode with a control non-eluting electrode. In the majority of studies, audiological outcomes (e.g., auditory brainstem response threshold) were superior following implantation with an eluting electrode compared with a standard electrode. Most studies which investigated post-implantation impedance reported lower impedance following implantation with an eluting electrode. The influence of eluting electrodes on other reported outcomes (including post-implantation cochlear fibrosis and the survival of hair cells and spiral ganglion neurons) was more varied across the included studies. Conclusions Eluting electrodes have shown promise in animal studies in preserving residual hearing following cochlear implantation and in reducing impedance, though data from human studies remain lacking. Further in-human studies will be required to determine the clinical usefulness of drug-eluting cochlear implants as a future treatment for sensorineural hearing loss.
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Affiliation(s)
- Alex Fleet
- Department of Clinical Neurosciences, Addenbrooke's Health CampusUniversity of CambridgeCambridgeUK
| | - Yasmin Nikookam
- Department of Ear, Nose and Throat SurgeryUniversity Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn WayEdgbastonBirminghamUK
| | - Anshul Radotra
- The Royal Wolverhampton NHS Trust New Cross HospitalWolverhamptonUK
| | - Shravan Gowrishankar
- Department of Clinical Neurosciences, Addenbrooke's Health CampusUniversity of CambridgeCambridgeUK
| | | | - Jameel Muzaffar
- Department of Clinical Neurosciences, Addenbrooke's Health CampusUniversity of CambridgeCambridgeUK
- Department of Ear, Nose and Throat SurgeryUniversity Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn WayEdgbastonBirminghamUK
| | - Matthew E. Smith
- Department of Clinical Neurosciences, Addenbrooke's Health CampusUniversity of CambridgeCambridgeUK
| | - Peter Monksfield
- Department of Ear, Nose and Throat SurgeryUniversity Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn WayEdgbastonBirminghamUK
| | - Manohar Bance
- Department of Clinical Neurosciences, Addenbrooke's Health CampusUniversity of CambridgeCambridgeUK
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Zhang D, Chen D, Wang K, Pan J, Tang J, Zhang H. Electrical stimulation of cochlear implant promotes activation of macrophages and fibroblasts under inflammation. Laryngoscope Investig Otolaryngol 2023; 8:1390-1400. [PMID: 37899874 PMCID: PMC10601573 DOI: 10.1002/lio2.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives The implanted electrodes deliver electric signals to spiral ganglion neurons, conferring restored hearing of cochlear implantation (CI) recipients. Postimplantation intracochlear fibrosis, which is observed in most CI recipients, disturbs the electrical signals and impairs the long-term outcome of CI. The macrophages and fibroblasts activation is critical for the development of intracochlear fibrosis. However, the effect of electric stimulation of cochlear implant (ESCI) on the activity of macrophages and fibroblasts was unclear. In the present study, a human cochlear implant was modified to stimulate cultured macrophages and fibroblasts. Methods By measuring cellular marker and the expression level of cytokine production, the polarization and activity of macrophages and fibroblasts were examined with or without ESCI. Results Our data showed that ESCI had little effects on the morphology, density, and distribution of culturing macrophages and fibroblasts. Furthermore, ESCI alone did not affect the polarization of macrophages or the function of fibroblasts without the treatment of inflammatory factors. However, in the presence of LPS or IL-4, ESCI further promoted the polarization of macrophages, and increased the expression of pro-inflammatory or anti-inflammatory factors, respectively. For fibroblasts, ESCI further increased the collagen I synthesis induced by TGF-β1 treatment. Nifedipine inhibited ESCI induced calcium influx, and hereby abolished the promoted polarization and activation of macrophages and fibroblasts. Conclusion Our results suggest that acute inflammation should be well inhibited before the activation of cochlear implants to control the postoperative intracochlear fibrosis. The voltage-gated calcium channels could be considered as the targets for reducing postimplantation inflammation and fibrosis. Level of Evidence NA.
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Affiliation(s)
- Dingling Zhang
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Dongxiu Chen
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Kaiye Wang
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Jing Pan
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Jie Tang
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
- Department of PhysiologySouthern Medical University School of Basic Medical SciencesGuangzhouChina
- Key Laboratory of Mental Health of the Ministry of EducationSouthern Medical UniversityGuangzhouChina
- Hearing Research CenterSouthern Medical UniversityGuangzhouChina
| | - Hongzheng Zhang
- Department of Otolaryngology Head and Neck SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
- Hearing Research CenterSouthern Medical UniversityGuangzhouChina
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Mau R, Eickner T, Jüttner G, Gao Z, Wei C, Fiedler N, Senz V, Lenarz T, Grabow N, Scheper V, Seitz H. Micro Injection Molding of Drug-Loaded Round Window Niche Implants for an Animal Model Using 3D-Printed Molds. Pharmaceutics 2023; 15:1584. [PMID: 37376033 DOI: 10.3390/pharmaceutics15061584] [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: 04/14/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
A novel approach for the long-term medical treatment of the inner ear is the diffusion of drugs through the round window membrane from a patient-individualized, drug-eluting implant, which is inserted in the middle ear. In this study, drug-loaded (10 wt% Dexamethasone) guinea pig round window niche implants (GP-RNIs, ~1.30 mm × 0.95 mm × 0.60 mm) were manufactured with high precision via micro injection molding (µIM, Tmold = 160 °C, crosslinking time of 120 s). Each implant has a handle (~3.00 mm × 1.00 mm × 0.30 mm) that can be used to hold the implant. A medical-grade silicone elastomer was used as implant material. Molds for µIM were 3D printed from a commercially available resin (TG = 84 °C) via a high-resolution DLP process (xy resolution of 32 µm, z resolution of 10 µm, 3D printing time of about 6 h). Drug release, biocompatibility, and bioefficacy of the GP-RNIs were investigated in vitro. GP-RNIs could be successfully produced. The wear of the molds due to thermal stress was observed. However, the molds are suitable for single use in the µIM process. About 10% of the drug load (8.2 ± 0.6 µg) was released after 6 weeks (medium: isotonic saline). The implants showed high biocompatibility over 28 days (lowest cell viability ~80%). Moreover, we found anti-inflammatory effects over 28 days in a TNF-α-reduction test. These results are promising for the development of long-term drug-releasing implants for human inner ear therapy.
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Affiliation(s)
- Robert Mau
- Microfluidics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Justus-von-Liebig Weg 6, 18059 Rostock, Germany
| | - Thomas Eickner
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany
| | - Gábor Jüttner
- Kunststoff-Zentrum in Leipzig gGmbH (KUZ), Erich-Zeigner-Allee 44, 04229 Leipzig, Germany
| | - Ziwen Gao
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Cluster of Excellence "Hearing4all", Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Chunjiang Wei
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Cluster of Excellence "Hearing4all", Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nicklas Fiedler
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany
| | - Volkmar Senz
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany
| | - Thomas Lenarz
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Cluster of Excellence "Hearing4all", Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany
- Department Life, Light & Matter, Interdisciplinary Faculty, University of Rostock, Albert-Einstein-Str. 25, 18059 Rostock, Germany
| | - Verena Scheper
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Cluster of Excellence "Hearing4all", Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Hermann Seitz
- Microfluidics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Justus-von-Liebig Weg 6, 18059 Rostock, Germany
- Department Life, Light & Matter, Interdisciplinary Faculty, University of Rostock, Albert-Einstein-Str. 25, 18059 Rostock, Germany
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Skarżyńska MB, Kołodziejak A, Gos E, Walkowiak A, Lorens A, Pastuszak A, Plichta Ł, Skarżyński PH. The Clinical Effect of Steroids for Hearing Preservation in Cochlear Implantation: Conclusions Based on Three Cochlear Implant Systems and Two Administration Regimes. Pharmaceuticals (Basel) 2022; 15:1176. [PMID: 36297289 PMCID: PMC9609478 DOI: 10.3390/ph15101176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2023] Open
Abstract
The main aim of this study was to assess the clinical effect of steroids (dexamethasone and prednisone) on hearing preservation in patients who underwent cochlear implantation with different cochlear implant systems (Oticon®, Advanced Bionics®, Med-El®). 147 adult patients met the inclusion criteria and were enrolled to the study and divided into three groups depending on the brand of cochlear implant they received and participated in all follow-up visits regularly. They were also randomly divided into three subgroups depending on the steroid administration regime: (1) intravenous dexamethasone (0.1 mg/kg body weight twice a day for three days); (2) combined intravenous and oral steroids (dexamethasone 0.1 mg/kg body weight twice a day plus prednisone 1 mg/kg weight once a day); and (3) no steroids (control group). The results were measured by pure tone audiometry (PTA) at three time points: (i) before implantation, (ii) at processor activation, and (iii) 12 months after activation. A hearing preservation (HP) figure was also calculated by comparing the preoperative results and the results after 12 months. Further measures collected were electrode impedance and hearing threshold in the non-operated ear. The highest HP measures (partial and complete) were obtained in the subgroups who were given steroids. Of the 102 patients given steroids, HP was partial or complete in 63 of them (62%). In comparison, partial or complete HP was achieved in only 15 patients out of 45 (33%) who were not given steroids. There were differences between the three cochlear implant groups, with the Med-El and Advanced Bionics groups performing better than the Oticon group (45% and 43% of the former two groups achieved partial or complete HP compared to 20% in the latter). Hearing thresholds in the non-operated ear were stable over 12 months. Generally, impedance was slightly lower in the 12 month follow-up in comparison with the activation period, with the exception of the Oticon group. (4) Conclusions: Pharmacological treatment with steroids in patients undergoing cochlear implantation helps to preserve residual hearing.
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Affiliation(s)
- Magdalena B. Skarżyńska
- Institute of Sensory Organs, Mokra 1, 05-830 Kajetany, Poland
- Center of Hearing and Speech Medincus, Mokra 7, 05-830 Kajetany, Poland
| | - Aleksandra Kołodziejak
- World Hearing Center, Department of Teleaudiology of Hearing, Institute of Physiology and Pathology of Hearing, Mokra 17, 05-830 Kajetany, Poland
| | - Elżbieta Gos
- World Hearing Center, Department of Teleaudiology of Hearing, Institute of Physiology and Pathology of Hearing, Mokra 17, 05-830 Kajetany, Poland
| | - Adam Walkowiak
- World Hearing Center, Department of Cochlear Implants, Institute of Physiology and Pathology of Hearing, Mokra 17, 05-830 Kajetany, Poland
| | - Artur Lorens
- World Hearing Center, Department of Cochlear Implants, Institute of Physiology and Pathology of Hearing, Mokra 17, 05-830 Kajetany, Poland
| | - Andrzej Pastuszak
- World Hearing Center, Oto-Rhino-Laryngology Surgery Department, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland
| | - Łukasz Plichta
- World Hearing Center, Oto-Rhino-Laryngology Surgery Department, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland
| | - Piotr H. Skarżyński
- Institute of Sensory Organs, Mokra 1, 05-830 Kajetany, Poland
- Center of Hearing and Speech Medincus, Mokra 7, 05-830 Kajetany, Poland
- World Hearing Center, Department of Teleaudiology of Hearing, Institute of Physiology and Pathology of Hearing, Mokra 17, 05-830 Kajetany, Poland
- World Hearing Center, Oto-Rhino-Laryngology Surgery Department, Institute of Physiology and Pathology of Hearing, 05-830 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
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Skarzynska MB, Kolodziejak A, Gos E, Skarzynski PH, Lorens A, Walkowiak A. The Clinical Effect of Steroid Therapy on Preserving Residual Hearing after Cochlear Implantation with the Advanced Bionics HiRes Ultra 3D Cochlear Implant System. Life (Basel) 2022; 12:life12040486. [PMID: 35454977 PMCID: PMC9024713 DOI: 10.3390/life12040486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/01/2023] Open
Abstract
(1) Background: The main aim of this study was to assess the clinical effectiveness of two different schemes of administration of steroids ((1) dexamethasone administered intravenously in comparison with (2) combination of steroid treatments: orally administered prednisone and intravenously administered dexamethasone) in comparison with a control group (no steroid administration) on hearing preservation (HP) in patients who underwent an Advanced Bionics cochlear implantation. (2) Methods: Thirty-five adult patients met the inclusion criteria. All patients were randomly divided into three subgroups depending on the scheme of steroid administration: (1) the first subgroup with only intravenously administered dexamethasone (0.1 mg per kg body weight twice a day for three days), (2) the second subgroup with a combination of methods of administration of steroids (intravenous and oral steroid therapy (dexamethasone, 0.1 mg/kg body weight twice a day plus prednisone, 1 mg/kg weight once a day for three days before surgery and after administration of dexamethasone (4th, 5th, 6th day) and after this time the dose of prednisone was reduced)) and (3) the third subgroup without steroid therapy (control group). The results were measured by pure tone audiometry (PTA) in three periods: (1) before implantation, (2) during activation of the processor (one month after implantation), and (3) 12 months after activation. Patients’ hearing thresholds before implantation were on average 82 dB HL, 77 dB HL, and 88 dB HL, respectively. (3) Results: The majority of the patients from the first subgroup had hearing preserved partially (77.8%). A similar result was observed in the second study group (oral + i.v.) (partial hearing preservation was found in 61.5% of the participants). The opposite was true in the control group; a plurality of control patients (38.5%) had no measurable hearing 12 months after the activation of the processor. (4) Conclusions: Pharmacological treatment consisting of the administration of steroids in patients who had undergone cochlear implantation with the Advanced Bionics HiRes Ultra 3D cochlear implant system may be beneficial for preserving residual hearing in patients.
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Affiliation(s)
- Magdalena Beata Skarzynska
- Institute of Sensory Organs, Nadarzyn, 05-830 Warsaw, Poland;
- Center of Hearing and Speech Medincus, Kajetany, 05-830 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-463-527; Fax: +48-22-463-5596
| | - Aleksandra Kolodziejak
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, 05-830 Warsaw, Poland; (A.K.); (E.G.); (A.L.); (A.W.)
| | - Elżbieta Gos
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, 05-830 Warsaw, Poland; (A.K.); (E.G.); (A.L.); (A.W.)
| | - Piotr Henryk Skarzynski
- Institute of Sensory Organs, Nadarzyn, 05-830 Warsaw, Poland;
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, 05-830 Warsaw, Poland; (A.K.); (E.G.); (A.L.); (A.W.)
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Artur Lorens
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, 05-830 Warsaw, Poland; (A.K.); (E.G.); (A.L.); (A.W.)
| | - Adam Walkowiak
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, 05-830 Warsaw, Poland; (A.K.); (E.G.); (A.L.); (A.W.)
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Chen D, Luo Y, Pan J, Chen A, Ma D, Xu M, Tang J, Zhang H. Long-Term Release of Dexamethasone With a Polycaprolactone-Coated Electrode Alleviates Fibrosis in Cochlear Implantation. Front Cell Dev Biol 2021; 9:740576. [PMID: 34778254 PMCID: PMC8589109 DOI: 10.3389/fcell.2021.740576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023] Open
Abstract
Cochlear implantation (CI) is the major treatment for severe sensorineural hearing loss. However, the fibrotic tissue forming around the electrodes reduces the treatment effectiveness of CI. Dexamethasone (DEX) is usually applied routinely in perioperative treatment of cochlear implantation (CI), but its diffusion in the inner ear after systemic administration is limited. In the present study, an electrode coated with polycaprolactone (PCL) loaded with dexamethasone was developed with a simple preparation process to maintain the stability of the electrode itself. The DEX-loaded PCL coating has good biocompatibility and does not change the smoothness, flexibility, or compliance of the implant electrode. Stable and effective DEX concentrations were maintained for more than 9 months. Compared with the pristine electrode, decreasing intracochlear fibrosis, protection of hair cells and spiral ganglion cells, and better residual hearing were observed 5 weeks after PCL-DEX electrode implantation. The PCL-DEX electrode has great potential in preventing hearing loss and fibrosis by regulating macrophages and inhibiting the expression of the fibrosis-related factors IL-1β, TNF-α, IL-4, and TGF-β1. In conclusion, the PCL-DEX electrode coating shows promising application in CI surgery.
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Affiliation(s)
- Dongxiu Chen
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
| | - Yanjing Luo
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
| | - Jing Pan
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
| | - Anning Chen
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
| | - Dong Ma
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Muqing Xu
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
| | - Jie Tang
- Hearing Research Center, Southern Medical University, Guangzhou, China.,Department of Physiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Hongzheng Zhang
- Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Hearing Research Center, Southern Medical University, Guangzhou, China
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Dubashynskaya NV, Bokatyi AN, Skorik YA. Dexamethasone Conjugates: Synthetic Approaches and Medical Prospects. Biomedicines 2021; 9:341. [PMID: 33801776 PMCID: PMC8067246 DOI: 10.3390/biomedicines9040341] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Dexamethasone (DEX) is the most commonly prescribed glucocorticoid (GC) and has a wide spectrum of pharmacological activity. However, steroid drugs like DEX can have severe side effects on non-target organs. One strategy to reduce these side effects is to develop targeted systems with the controlled release by conjugation to polymeric carriers. This review describes the methods available for the synthesis of DEX conjugates (carbodiimide chemistry, solid-phase synthesis, reversible addition fragmentation-chain transfer [RAFT] polymerization, click reactions, and 2-iminothiolane chemistry) and perspectives for their medical application as GC drug or gene delivery systems for anti-tumor therapy. Additionally, the review focuses on the development of DEX conjugates with different physical-chemical properties as successful delivery systems in the target organs such as eye, joint, kidney, and others. Finally, polymer conjugates with improved transfection activity in which DEX is used as a vector for gene delivery in the cell nucleus have been described.
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Affiliation(s)
| | | | - Yury A. Skorik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia; (N.V.D.); (A.N.B.)
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