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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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Haumann S, Timm ME, Büchner A, Lenarz T, Salcher RB. Intracochlear Recording of Electrocochleography During and After Cochlear Implant Insertion Dependent on the Location in the Cochlea. Trends Hear 2024; 28:23312165241248973. [PMID: 38717441 PMCID: PMC11080744 DOI: 10.1177/23312165241248973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.
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Affiliation(s)
- Sabine Haumann
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Max E. Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Rolf B. Salcher
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
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3
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Scheperle R, Etler C, Oleson J, Dunn C, Kashani R, Claussen A, Gantz BJ, Hansen MR. Evaluation of Real-Time Intracochlear Electrocochleography for Guiding Cochlear Implant Electrode Array Position. J Clin Med 2023; 12:7409. [PMID: 38068461 PMCID: PMC10707171 DOI: 10.3390/jcm12237409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 02/12/2024] Open
Abstract
This study evaluates intracochlear electrocochleography (ECochG) for real-time monitoring during cochlear implantation. One aim tested whether adjusting the recording electrode site would help differentiate between atraumatic and traumatic ECochG amplitude decrements. A second aim assessed whether associations between ECochG amplitude decrements and post-operative hearing loss were weaker when considering hearing sensitivity at the ECochG stimulus frequency compared to a broader frequency range. Eleven adult cochlear implant recipients who were candidates for electro-acoustic stimulation participated. Single-frequency (500-Hz) ECochG was performed during cochlear implantation; the amplitude of the first harmonic of the difference waveform was considered. Post-operative hearing preservation at 500 Hz ranged from 0 to 94%. The expected relationship between ECochG amplitude decrements and hearing preservation was observed, though the trend was not statistically significant, and predictions were grossly inaccurate for two participants. Associations did not improve when considering alternative recording sites or hearing sensitivity two octaves above the ECochG stimulus frequency. Intracochlear location of a moving recording electrode is a known confound to real-time interpretation of ECochG amplitude fluctuations, which was illustrated by the strength of the correlation with ECochG amplitude decrements. Multiple factors contribute to ECochG amplitude patterns and to hearing preservation; these results highlight the confounding influence of intracochlear recording electrode location on the ECochG.
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Affiliation(s)
- Rachel Scheperle
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Christine Etler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA
| | - Camille Dunn
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Rustin Kashani
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Alexander Claussen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Bruce J. Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Department of Molecular Physiology and Biophysics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Jia G, Song Z, Wu L, Sun Q, Sheng Y, Ni Y, Li H, Li W. An Accurate and Individualized Preoperative Estimation Method for the Linear Insertion Depth of Cochlear Implant Electrode Arrays Based on Computed Tomography. Ear Hear 2023; 44:1036-1042. [PMID: 36864593 DOI: 10.1097/aud.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Cochlear implantation or auditory brainstem implantation is currently the only accepted method for improving severe or profound sensorineural hearing loss. The length of the electrodes implanted during cochlear implantation is closely related to the degree of hearing improvement of hearing after the surgery. We aimed to explore new methods to accurately estimate the electrode array (EA) linear insertion depth based on computed tomography (CT) images prior surgery, which could help surgeons select the appropriate EA length for each patient. DESIGN Previous studies estimated the linear insertion depth by measuring the length of the lateral wall of the cochlea rather than the electrode's path in the cochlea duct. Here, we determined the actual position of the EA on the CT image after cochlear surgery in order to predict the path of the EA, and the length of the predicted EA path was measured by the contouring technique (CoT) to estimate the linear insertion depth of the EA. Because CoT can only measure the length of the estimated EA path on a two-dimensional plane, we further modified the measurement by weighting the height of the cochlea and the length of the EA tail (the length of the last stimulating electrode to the end, which cannot be displayed on the CT image), which we termed the modified CoT + height + tail (MCHT) measurement. RESULTS Based on our established method, MCHT could reduce the error to the submillimeter range (0.67 ± 0.37 mm) when estimating the linear insertion depth of various kinds of EAs compared with the actual implant length. The correlation coefficient between the linear insertion depth as predicted by MCHT and the actual was 0.958. The linear insertion depth estimated by this method was more accurate than that estimated using the classical CoT technique ( R = 0.442) and using the modified Escudé's method ( R = 0.585). CONCLUSIONS MCHT is a method based on CT images that can accurately predict the linear insertion depth of cochlear implants preoperatively. This is the first report that we are aware of a method for predicting linear insertion depth before cochlear implantation with only submillimeter errors and that is tailored to different types of EAs.
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Affiliation(s)
- Gaogan Jia
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- These authors contributed equally to this work
| | - Zijun Song
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- These authors contributed equally to this work
| | - Lingjie Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
| | - Qiushi Sun
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Yaru Sheng
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yusu Ni
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
| | - Huawei Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, People's Republic of China
| | - Wenyan Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
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5
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Schurzig D, Repp F, Timm ME, Batsoulis C, Lenarz T, Kral A. Virtual cochlear implantation for personalized rehabilitation of profound hearing loss. Hear Res 2023; 429:108687. [PMID: 36638762 DOI: 10.1016/j.heares.2022.108687] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
In cochlear implantation, current preoperative planning procedures allow for estimating how far a specific implant will reach into the inner ear of the patient, which is important to optimize hearing preservation and speech perception outcomes. Here we report on the development of a methodology that goes beyond current planning approaches: the proposed model does not only estimate specific outcome parameters but allows for entire, three-dimensional virtual implantations of patient-specific cochlear anatomies with different types of electrode arrays. The model was trained based on imaging datasets of 186 human cochleae, which contained 171 clinical computer tomographies (CTs) of actual cochlear implant patients as well as 15 high-resolution micro-CTs of cadaver cochleae to also reconstruct the refined intracochlear structures not visible in clinical imaging. The model was validated on an independent dataset of 141 preoperative and postoperative clinical CTs of cochlear implant recipients and outperformed all currently available planning approaches, not only in terms of accuracy but also regarding the amount of information that is available prior to the actual implantation.
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Affiliation(s)
- Daniel Schurzig
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; MED-EL Research Center, Hannover, Germany.
| | | | - Max E Timm
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | - Thomas Lenarz
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andrej Kral
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; Department of Otolaryngology, Hannover Medical School, Hannover, Germany; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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6
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Summating Potential as Marker of Intracochlear Position in Bipolar Electrocochleography. Ear Hear 2023; 44:118-134. [PMID: 35894668 DOI: 10.1097/aud.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cochlear implantation criteria include subjects with residual low-frequency hearing. To minimize implantation trauma and to avoid unwanted interactions of electric- and acoustic stimuli, it is often recommended to stop cochlear implantation before the cochlear implant (CI) reaches the cochlear partition with residual hearing, as determined by an audiogram. For this purpose, the implant can be used to record acoustically evoked signals during implantation, including cochlear compound action potentials (CAP), cochlear microphonics (CMs), and summating potentials (SPs). The former two have previously been used to monitor residual hearing in clinical settings. DESIGN In the present study we investigated the use of intracochlear, bipolar SP recordings to determine the exact cochlear position of the contacts of implanted CIs in guinea pig cochleae (n = 13). Polarity reversals of SPs were used as a functional marker of intracochlear position. Micro computed tomography (µCT) imaging and a modified Greenwood function were used to determine the cochleotopic positions of the contacts in the cochlea. These anatomical reconstructions were used to validate the SP-based position estimates. RESULTS The precision of the SP-based position estimation was on average within ± 0.37 octaves and was not impaired by moderate hearing loss caused by noise exposure after implantation. It is important to note that acute hearing impairment did not reduce the precision of the method. The cochleotopic position of CI accounted for ~70% of the variability of SP polarity reversals. Outliers in the dataset were associated with lateral CI positions. Last, we propose a simplified method to avoid implantation in functioning parts of the cochlea by approaching a predefined frequency region using bipolar SP recordings through a CI. CONCLUSIONS Bipolar SP recordings provide reliable information on electrode position in the cochlea. The position estimate remains reliable after moderate hearing loss. The technique presented here could be applied during CI surgery to monitor the CI approach to a predefined frequency region.
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Gantz BJ, Hansen M, Dunn CC. Clinical perspective on hearing preservation in cochlear implantation, the University of Iowa experience. Hear Res 2022; 426:108487. [PMID: 35410721 PMCID: PMC9482999 DOI: 10.1016/j.heares.2022.108487] [Citation(s) in RCA: 8] [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: 10/29/2021] [Revised: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 12/16/2022]
Abstract
Preservation of residual acoustic hearing has emerged as an important concept for those individuals undergoing cochlear implantation with residual low frequency hearing. Acoustic plus electric speech processing improves hearing outcomes in quiet, enables melody recognition, preserves spatial hearing if there is acoustic hearing in both ears and significantly improves hearing in noise. The development of our experience with acoustic plus electric processing is reviewed along with clinical trials and patient outcomes that our team has documented over the past twenty years.
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Affiliation(s)
- Bruce J Gantz
- The University of Iowa Cochlear Implant Clinical Research Center, Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA United States.
| | - Marlan Hansen
- The University of Iowa Cochlear Implant Clinical Research Center, Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA United States
| | - Camille C Dunn
- The University of Iowa Cochlear Implant Clinical Research Center, Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, IA United States
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Topsakal V, Agrawal S, Atlas M, Baumgartner WD, Brown K, Bruce IA, Dazert S, Hagen R, Lassaletta L, Mlynski R, Raine CH, Rajan GP, Schmutzhard J, Sprinzl GM, Staecker H, Usami SI, Van Rompaey V, Zernotti M, van de Heyning P. Minimally Traumatic Cochlear Implant Surgery: Expert Opinion in 2010 and 2020. J Pers Med 2022; 12:jpm12101551. [PMID: 36294690 PMCID: PMC9605439 DOI: 10.3390/jpm12101551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to discover expert opinion on the surgical techniques and materials most likely to achieve maximum postoperative residual hearing preservation in cochlear implant (CI) surgery and to determine how these opinions have changed since 2010. A previously published questionnaire used in a study published in 2010 was adapted and expanded. The questionnaire was distributed to an international group of experienced CI surgeons. Present results were compared, via descriptive statistics, to those from the 2010 survey. Eighteen surgeons completed the questionnaire. Respondents clearly favored the following: round window insertion, slow array insertion, and the peri- and postoperative use of systematic antibiotics. Insertion depth was regarded as important, and electrode arrays less likely to induce trauma were preferred. The usefulness of dedicated soft-surgery training was also recognized. A lack of agreement was found on whether the middle ear cavity should be flushed with a non-aminoglycoside antibiotic solution or whether a sheath or insertion tube should be used to avoid contaminating the array with blood or bone dust. In conclusion, this paper demonstrates how beliefs about CI soft surgery have changed since 2010 and shows areas of current consensus and disagreement.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology, Head and Neck Surgery, Brussels Health Campus, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel (VUB), 1090 Jette, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), University of Antwerp, 2610 Edegem, Belgium
- Correspondence: ; Tel.: +32-2477-6882; Fax: +32-2477-6880
| | - Sumit Agrawal
- London Canada Health Sciences Centre, Department of Otolaryngology–Head & Neck Surgery, Western University, London, ON N6G 2M3, Canada
| | - Marcus Atlas
- Ear Science Institute Australia, Subiaco, WA 6008, Australia
| | | | - Kevin Brown
- UNC Ear & Hearing Center at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Iain A. Bruce
- Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M15 6JA, UK
| | - Stefan Dazert
- St. Elisabeth Hospital, Ruhr University Bochum, 44787 Bochum, Germany
| | - Rudolf Hagen
- Würzburg ENT University Hospital, 97080 Würzburg, Germany
| | | | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, 18057 Rostock, Germany
| | - Christopher H. Raine
- Bradford Royal Infirmary Yorkshire Auditory Implant Service, Bradford BD9 6RJ, UK
| | | | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Hinrich Staecker
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), University of Antwerp, 2610 Edegem, Belgium
| | | | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), University of Antwerp, 2610 Edegem, Belgium
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9
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Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion? Otol Neurotol 2022; 43:789-796. [PMID: 35861647 DOI: 10.1097/mao.0000000000003588] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. STUDY DESIGN Prospective, randomized clinical trial. SETTING Ten high-volume, tertiary care CI centers. PATIENTS Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. METHODS Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. RESULTS Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. CONCLUSIONS Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."
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Illg A, Lenarz T. Cochlear Implantation in Hearing-Impaired Elderly: Clinical Challenges and Opportunities to Optimize Outcome. Front Neurosci 2022; 16:887719. [PMID: 35903809 PMCID: PMC9315238 DOI: 10.3389/fnins.2022.887719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Cochlear implant (CI) overall provides a very good outcome, but speech comprehension outcome in the elderly is more variable. Several clinical factors play an important role. The management of residual hearing, the presence of comorbidities, and especially the progression of cognitive decline seem to be the clinical parameters that strongly determine the outcome of cochlear implantation and need to be discussed prospectively in the consultation process with the elderly hearing impaired. In the context of this review article, strategies for dealing with these will be discussed. Timely cochlear implantation should already be considered by hearing aid acousticians or practicing otolaryngologists and communicated or initiated with the patient. This requires intensive cooperation between hearing aid acousticians and experts in the clinic. In addition, residual hearing and comorbidities in the elderly need to be considered to make realistic predictions about speech comprehension with CI. Long-term aftercare and its different implementations should be discussed preoperatively, so that the elderly person with hearing impairments feels well taken care of together with his or her relatives. Elderly patients with hearing impairments benefit most from a CI in terms of speech comprehension if there is a large cochlear coverage (electrical or acoustic electrical) and the therapy is not hampered by comorbidities, especially cognitive decline.
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Affiliation(s)
- Angelika Illg
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
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11
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Van de Heyning PH, Dazert S, Gavilan J, Lassaletta L, Lorens A, Rajan GP, Skarzynski H, Skarzynski PH, Tavora-Vieira D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Polak M. Systematic Literature Review of Hearing Preservation Rates in Cochlear Implantation Associated With Medium- and Longer-Length Flexible Lateral Wall Electrode Arrays. Front Surg 2022; 9:893839. [PMID: 36034377 PMCID: PMC9407249 DOI: 10.3389/fsurg.2022.893839] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe last two decades have demonstrated that preoperative functional acoustic hearing (residual hearing) can be preserved during cochlear implant (CI) surgery. However, the relationship between the electrode array length and postoperative hearing preservation (HP) with lateral wall flexible electrode variants is still under debate.Aims/ObjectivesThis is a systematic literature review that aims to analyze the HP rates of patients with residual hearing for medium-length and longer-length lateral wall electrodes.MethodA systematic literature review methodology was applied following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations to evaluate the HP rates of medium-length and longer-length lateral wall electrodes from one CI manufacturer (medium length FLEX 24, longer length FLEX 28 and FLEX SOFT, MED-EL, Innsbruck, Austria). A search using search engine PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) was performed using the search terms “hearing preservation” or “residual hearing” and “cochlear implant” in “All fields.” Articles published only in English between January 01, 2009 and December 31, 2020 were included in the search.ResultsThe HP rate was similar between medium-length (93.4%–93.5%) and longer (92.1%–86.8%) electrodes at 4 months (p = 0.689) and 12 months (p = 0.219). In the medium-length electrode group, patients under the age of 45 years had better HP than patients above the age of 45 years.ConclusionsBoth medium-length and longer electrode arrays showed high hearing preservation rates. Considering the hearing deterioration over time, implanting a longer electrode at primary surgery should be considered, thus preventing the need for future reimplantation.
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Affiliation(s)
- Paul H Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Correspondence: Paul H Van de Heyning
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos, III, (CIBERER-U761), Madrid, Spain
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
| | - Dayse Tavora-Vieira
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
- Audiology Department, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Vedat Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Belgium
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Marek Polak
- Department of Electrophysiology, R&D, MED-EL, Innsbruck, Austria
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Blebea CM, Ujvary LP, Necula V, Dindelegan MG, Perde-Schrepler M, Stamate MC, Cosgarea M, Maniu AA. Current Concepts and Future Trends in Increasing the Benefits of Cochlear Implantation: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:747. [PMID: 35744010 PMCID: PMC9229893 DOI: 10.3390/medicina58060747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 01/29/2023]
Abstract
Hearing loss is the most common neurosensory disorder, and with the constant increase in etiological factors, combined with early detection protocols, numbers will continue to rise. Cochlear implantation has become the gold standard for patients with severe hearing loss, and interest has shifted from implantation principles to the preservation of residual hearing following the procedure itself. As the audiological criteria for cochlear implant eligibility have expanded to include patients with good residual hearing, more attention is focused on complementary development of otoprotective agents, electrode design, and surgical approaches. The focus of this review is current aspects of preserving residual hearing through a summary of recent trends regarding surgical and pharmacological fundamentals. Subsequently, the assessment of new pharmacological options, novel bioactive molecules (neurotrophins, growth factors, etc.), nanoparticles, stem cells, and gene therapy are discussed.
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Affiliation(s)
- Cristina Maria Blebea
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Laszlo Peter Ujvary
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Violeta Necula
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
- County Clinical Emergency Hospital Cluj, 400347 Cluj Napoca, Romania
| | - Maximilian George Dindelegan
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | | | - Mirela Cristina Stamate
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Marcel Cosgarea
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
| | - Alma Aurelia Maniu
- Department of Otorhinolaryngology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj Napoca, Romania; (C.M.B.); (V.N.); (M.G.D.); (M.C.S.); (M.C.); (A.A.M.)
- County Clinical Emergency Hospital Cluj, 400347 Cluj Napoca, Romania
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Walia A, Shew MA, Lefler SM, Kallogjeri D, Wick CC, Holden TA, Durakovic N, Ortmann AJ, Herzog JA, Buchman CA. Is Characteristic Frequency Limiting Real-Time Electrocochleography During Cochlear Implantation? Front Neurosci 2022; 16:915302. [PMID: 35937872 PMCID: PMC9354607 DOI: 10.3389/fnins.2022.915302] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Electrocochleography (ECochG) recordings during cochlear implantation have shown promise in estimating the impact on residual hearing. The purpose of the study was (1) to determine whether a 250-Hz stimulus is superior to 500-Hz in detecting residual hearing decrement and if so; (2) to evaluate whether crossing the 500-Hz tonotopic, characteristic frequency (CF) place partly explains the problems experienced using 500-Hz. Design Multifrequency ECochG comprising an alternating, interleaved acoustic complex of 250- and 500-Hz stimuli was used to elicit cochlear microphonics (CMs) during insertion. The largest ECochG drops (≥30% reduction in CM) were identified. After insertion, ECochG responses were measured using the individual electrodes along the array for both 250- and 500-Hz stimuli. Univariate regression was used to predict whether 250- or 500-Hz CM drops explained low-frequency pure tone average (LFPTA; 125-, 250-, and 500-Hz) shift at 1-month post-activation. Postoperative CT scans were performed to evaluate cochlear size and angular insertion depth. Results For perimodiolar insertions (N = 34), there was a stronger linear correlation between the largest ECochG drop using 250-Hz stimulus and LFPTA shift (r = 0.58), compared to 500-Hz (r = 0.31). The 250- and 500-Hz CM insertion tracings showed an amplitude peak at two different locations, with the 500-Hz peak occurring earlier in most cases than the 250-Hz peak, consistent with tonotopicity. When using the entire array for recordings after insertion, a maximum 500-Hz response was observed 2-6 electrodes basal to the most-apical electrode in 20 cases (58.9%). For insertions where the apical insertion angle is >350 degrees and the cochlear diameter is <9.5 mm, the maximum 500-Hz ECochG response may occur at the non-apical most electrode. For lateral wall insertions (N = 14), the maximum 250- and 500-Hz CM response occurred at the most-apical electrode in all but one case. Conclusion Using 250-Hz stimulus for ECochG feedback during implantation is more predictive of hearing preservation than 500-Hz. This is due to the electrode passing the 500-Hz CF during insertion which may be misidentified as intracochlear trauma; this is particularly important in subjects with smaller cochlear diameters and deeper insertions. Multifrequency ECochG can be used to differentiate between trauma and advancement of the apical electrode beyond the CF.
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14
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Lenarz T, Buechner A, Gantz B, Hansen M, Tejani VD, Labadie R, O'Connell B, Buchman CA, Valenzuela CV, Adunka OF, Harris MS, Riggs WJ, Fitzpatrick D, Koka K. Relationship Between Intraoperative Electrocochleography and Hearing Preservation. Otol Neurotol 2022; 43:e72-e78. [PMID: 34739427 PMCID: PMC8671360 DOI: 10.1097/mao.0000000000003403] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare intraoperative intracochlear electrocochleography (ECochG) with hearing preservation outcomes in cochlear implant (CI) subjects. DESIGN Intraoperative electrocochleography was performed in adult CI subjects who were recipients of Advanced Bionics' Bionics LLC precurved HiFocus MidScala or straight HiFocus SlimJ electrode arrays. ECochG responses were recorded from the most apical electrode contact during insertion. No changes to the insertions were made due to ECochG monitoring. No information about insertion resistance was collected. ECochG drops were estimated as the change in amplitude from peak (defined as maximum amplitude response) to drop (largest drop) point after the peak during insertion was measured following the peak response. Audiometric thresholds from each subject were obtained before and approximately 1 month after CI surgery. The change in pure tone average for frequencies between 125 Hz and 500 Hz was measured after surgery. No postoperative CT scans were collected as part of this study. RESULTS A total of 68 subjects from five surgical centers participated in the study. The study sample included 30 MidScala and 38 SlimJ electrodes implanted by approximately 20 surgeons who contributed to the study. Although a wide range of results were observed, there was a moderate positive correlation (Pearson Correlation coefficient, r = 0.56, p < 0.01) between the size of the ECochG drop and the magnitude of pure tone average change. This trend was present for both the MidScala and SlimJ arrays. The SlimJ and MidScala arrays produced significantly different hearing loss after surgery. CONCLUSION Large ECochG amplitude drops observed during electrode insertion indicated poorer hearing preservation. Although the outcomes were variable, this information may be helpful to guide surgical decision-making when contemplating full electrode insertion and the likelihood of hearing preservation.
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Affiliation(s)
- Thomas Lenarz
- Hannover Medical School, Department of Otolaryngology, Hannover, Germany
| | - Andreas Buechner
- Hannover Medical School, Department of Otolaryngology, Hannover, Germany
| | - Bruce Gantz
- University of Iowa, Department of Otolaryngology, Iowa City, Iowa
| | - Marlan Hansen
- University of Iowa, Department of Otolaryngology, Iowa City, Iowa
| | - Viral D Tejani
- University of Iowa, Department of Otolaryngology, Iowa City, Iowa
| | - Robert Labadie
- Vanderbilt University and Medical Center, Department of Otolaryngology, Nashville, Tennessee
| | - Brendan O'Connell
- Charlotte Eye Ear Nose and Throat Associates, P.A., Charlotte, North Carolina
| | - Craig Alan Buchman
- Washington University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, St. Louis, Missouri
| | - Carla V Valenzuela
- Washington University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, St. Louis, Missouri
| | - Oliver F Adunka
- The Ohio State University, Department of Otolaryngology, Columbus, Ohio
| | | | - William J Riggs
- The Ohio State University, Department of Otolaryngology, Columbus, Ohio
| | - Douglas Fitzpatrick
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, North Carolina
| | - Kanthaiah Koka
- Advanced Bionics LLC, Research and Technology, Valencia, California, USA
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Avallone E, Lenarz T, Timm ME. On the Accuracy of Clinical Insertion Angle Predictions With a Surgical Planning Platform for Cochlear Implantation. Otol Neurotol 2021; 42:e1242-e1249. [PMID: 34282099 DOI: 10.1097/mao.0000000000003272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Various studies over the last few decades have shown that the cochlea is not a uniform structure, but that its size and shape may vary quite substantially in between subjects. The surgical planning platform enables the user to quickly approximate the size of a cochlea within clinical imaging data by measuring the basal cochlear diameters A and B. It also allows for contact specific insertion angle predictions for MED-EL cochlear implant electrode arrays based on this individual anatomy approximation. The proposed, retrospective study was performed to evaluate the accuracy of these predictions. METHODS Preoperative CBCT scans of N = 91 MED-EL cochlear implant patients with different types of FLEX electrode arrays (flexible, thin, and straight arrays) were evaluated using a planning module. Both the initial version (based on an equation proposed by Escudé et al.) as well as a novel, recently proposed approach (called elliptic-circular approximation) was employed. All predictions were then compared to the actual insertion angles which were derived from postoperative CBCT images of the same patient. RESULTS Most prediction deviations of the investigated cases stayed below 45deg for all electrode arrays and both prediction methods. In general, prediction deviations increased from base to apex were found to be larger for longer electrode arrays. Hardly any significant differences between the two prediction methods were observed. However, particularly large deviations were found for the Escudé method and could be substantially deceased with the updated elliptic-circular approximation approach. CONCLUSIONS The new platform version with its updated prediction module allows to reliably predict insertion angles even for cochlear anatomies with slightly unusual features and shapes.
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Affiliation(s)
| | - Thomas Lenarz
- Department of Otolaryngology
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany
| | - Max E Timm
- Department of Otolaryngology
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany
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Cochlear Implantation in Elderly Patients with Residual Hearing. J Clin Med 2021; 10:jcm10194305. [PMID: 34640325 PMCID: PMC8509733 DOI: 10.3390/jcm10194305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
This retrospective study aimed to investigate the range of hearing levels in a cochlear implant (CI) elderly population receiving electric-acoustic-stimulation (EAS) or electric-stimulation (ES) alone. The investigation evaluates the degree of hearing preservation (HP) and the speech comprehension resulting from EAS or ES-only to identify audiometric factors that predict adequate EAS and ES use. We analyzed the pure tone audiometry and speech perception in quiet and noise preoperatively and 12-months after activation of 89 elderly adults (age of 65 years old or older), yielding in total 97 CIs. Thirty-two (33.1%) patients were potential EAS candidates preoperatively, of which 18 patients used EAS at the time of first fitting and the other 14 patients continued to use their residual hearing for EAS at 12-months. Post-treatment, patients with EAS system and ES-only users’ with longer electrodes showed better results in monosyllable word scores in quiet than ES-only users with shorter electrodes. A similar trend was revealed for the speech recognition in noise. Patients with an EAS system benefit from maintaining their natural residual hearing. Nevertheless, strict preoperative patient selection is warranted particularly in elderly patients, in whom the hearing thresholds for EAS indication differ slightly from that in younger adults.
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Dietz A, Lenarz T. Cochlear implantation under local anesthesia in 117 cases: patients' subjective experience and outcomes. Eur Arch Otorhinolaryngol 2021; 279:3379-3385. [PMID: 34487218 PMCID: PMC8419376 DOI: 10.1007/s00405-021-07061-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Purpose To report the outcomes and the patients’ subjective experience of cochlear implantation (CI) performed under local anesthesia (LA). To describe a new form of intraoperative cochlear monitoring based on the patients subjective sound perception during CI. Methods In this retrospective case–cohort study, 117 patients underwent CI under LA with (n = 58) or without conscious sedation (n = 59). Included were primarily elderly patients with elevated risks for general anesthesia and recently patients with residual hearing eligible for electro-acoustic stimulation (EAS) (n = 27), in whom hearing could be monitored during the electrode insertion. A 500 Hz test tone was presented and the patient reported of subjective changes in loudness, leading to a modification of the insertion. A questionnaire was sent to all patients in which they assessed their subjective experience. Results All patients were successfully operated under LA without the need to intraoperatively convert to general anesthesia. 90% of the patients reported that the surgery was a positive experience. The vast majority, 90% of patients were satisfied with the overall treatment and with intraoperative pain management and 84% of the patients would opt for local anesthesia again. Cochlear monitoring by the patients’ subjective sound perception enabled for atraumatic insertions as all EAS patients could hear the test tone up to the end of the surgery. Conclusions CI under LA was well tolerated and recommended by the vast majority of patients. In addition, it offers the possibility to monitor the patients’ hearing during the electrode insertion, which may help to prevent insertion trauma.
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Affiliation(s)
- Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, PO. Box 100, 70029, Kuopio, Finland.
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
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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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19
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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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The Effect of Ultra-slow Velocities on Insertion Forces: A Study Using a Highly Flexible Straight Electrode Array. Otol Neurotol 2021; 42:e1013-e1021. [PMID: 33883518 DOI: 10.1097/mao.0000000000003148] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present study sought to 1) characterize insertion forces resulting from a flexible straight electrode array (EA) inserted at slow and ultra-slow insertion velocities, and 2) evaluate if ultra-slow velocities decrease insertion forces independent of other variables. BACKGROUND Low insertion forces are desirable in cochlear implant (CI) surgery to reduce trauma and preserve hearing. Recently, ultra-slow insertion velocities (lower than manually feasible) have been shown to produce significantly lower insertion forces using other EAs. METHODS Five flexible straight EAs were used to record insertion forces into an inelastic artificial scala tympani model. Eleven trial recordings were performed for each EA at five predetermined automated, continuous insertion velocities ranging from 0.03 to 1.6 mm/s. RESULTS An ultra-slow insertion velocity of 0.03 mm/s resulted in a median insertion force of 0.010 N at 20 mm of insertion depth, and 0.026 N at 24.3 mm-the final insertion depth. These forces represent only 24 to 29% of those measured using 1.6 mm/s. After controlling for insertion depth of the EA into the artificial scala tympani model and trial insertion number, decreasing the insertion velocity from 0.4 to 0.03 mm/s resulted in a 50% decrease in the insertion forces. CONCLUSION Using the tested EA ultra-slow velocities can decrease insertion forces, independent of variables like insertion depth. Our results suggest ultra-slow velocities can reduce insertion forces at least 60%, compared with humanly feasible continuous velocities (≥0.9 mm/s).
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Ludwig S, Riemann N, Hans S, Christov F, Ludwig JM, Saxe J, Arweiler-Harbeck D. Evaluation of hearing preservation in adults with a slim perimodiolar electrode. Eur Arch Otorhinolaryngol 2021; 279:1233-1242. [PMID: 33830367 PMCID: PMC8897335 DOI: 10.1007/s00405-021-06755-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Numerous endeavors have been undertaken to preserve hearing in cochlear implant (CI) patients. Particularly, optimization of electrode array design aims at preservation of residual hearing (RH). This study examines whether a slim perimodiolar (PM) electrode array could bear the capability to preserve hearing. METHODS A total of 47 patients underwent cochlear implantation receiving the PM electrode. (i) Patients with pure tone audiogram (PTA) thresholds better than 85 dB and/or hearing loss for Freiburg speech test numbers less than 60 dB and more than 50% maximum monosyllabic understanding were assigned to the RH group (n = 17), while all others belonged to the noRH group (n = 30). (ii) Another group implanted with a slim straight, lateral wall (LW) electrode was recruited for comparison. RESULTS We compared 17 RH-30 noRH patients all receiving the PM electrode. RH in PM recipients decreased faster than in LW recipients. No significant differences were observed between both (RH v/s noRH) groups in NRT thresholds, Freiburg speech test and A§E® phonemes. Analogous satisfaction levels were indicated through the questionnaires in terms of sound quality, hearing in silence, noise and directional hearing in both groups. CONCLUSIONS The results suggest that hearing preservation is influenced not only by electrode shape but various factors. This study opens an avenue for further investigations to elucidate and enumerate the causes for progressive hearing loss.
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Affiliation(s)
- Sonja Ludwig
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Niklas Riemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Hans
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Florian Christov
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- ENT Practice Cologne-Bonn, Wesseling, Germany
| | - Johannes Maximilian Ludwig
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Judith Saxe
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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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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Practicable assessment of cochlear size and shape from clinical CT images. Sci Rep 2021; 11:3448. [PMID: 33568727 PMCID: PMC7876007 DOI: 10.1038/s41598-021-83059-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
There is considerable interpersonal variation in the size and shape of the human cochlea, with evident consequences for cochlear implantation. The ability to characterize a specific cochlea, from preoperative computed tomography (CT) images, would allow the clinician to personalize the choice of electrode, surgical approach and postoperative programming. In this study, we present a fast, practicable and freely available method for estimating cochlear size and shape from clinical CT. The approach taken is to fit a template surface to the CT data, using either a statistical shape model or a locally affine deformation (LAD). After fitting, we measure cochlear size, duct length and a novel measure of basal turn non-planarity, which we suggest might correlate with the risk of insertion trauma. Gold-standard measurements from a convenience sample of 18 micro-CT scans are compared with the same quantities estimated from low-resolution, noisy, pseudo-clinical data synthesized from the same micro-CT scans. The best results were obtained using the LAD method, with an expected error of 8-17% of the gold-standard sample range for non-planarity, cochlear size and duct length.
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A cochlear scaling model for accurate anatomy evaluation and frequency allocation in cochlear implantation. Hear Res 2021; 403:108166. [PMID: 33453642 DOI: 10.1016/j.heares.2020.108166] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
The human cochlea has a highly individual microanatomy. Cochlear implantation therefore requires an evaluation of the individual cochlear anatomy to reduce surgical risk of implantation trauma. However, in-vivo cochlear imaging is limited in resolution. To overcome this issue, cochlear models based on exact anatomical data have been developed. These models can be fitted to the limited parameters available from clinical imaging to provide a prediction of the precise cochlear microanatomy. Recently, models have become available with improved precision that additionally allow predicting the 3D form of an individual cochlea. The present study has further improved the precision of modelling by incorporating microscopic details of a large set of 108 human cochleae from corrosion casts. The new model provides a more flexible geometric shape that can better predict local variations like vertical dips and jumps and provides an approximation of frequency allocation in the cochlea. The outcome of this and five other models have been quantified (validated) on an independent set of 20 µCTs of human cochleae. The new model outperformed previous models and is freely available for download and use.
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Konerding W, Arenberg JG, Kral A, Baumhoff P. Late electrically-evoked compound action potentials as markers for acute micro-lesions of spiral ganglion neurons. Hear Res 2020; 413:108057. [PMID: 32883545 DOI: 10.1016/j.heares.2020.108057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022]
Abstract
Cochlear implants (CIs) are the treatment of choice for profoundly hearing impaired people. It has been proposed that speech perception in CI users is influenced by the neural health (deafferentation, demyelination and degeneration) of the cochlea, which may be heterogeneous along an individual cochlea. Several options have been put forward to account for these local differences in neural health when fitting the speech processor settings, however with mixed results. The interpretation of the results is hampered by the fact that reliable markers of locally restricted changes in spiral ganglion neuron (SGN) health are lacking. The aim of the study was (i) to establish mechanical micro-lesions in the guinea pig as a model of heterogeneous SGN deafferentation and degeneration and (ii) to assess potential electrophysiological markers that can also be used in human subjects. First, we defined the extent of micro-lesions in normal hearing animals using acoustically-evoked compound action potentials (aCAPs); second, we measured electrically-evoked CAPs (eCAPs) before and after focal lesioning in neomycin-deafened and implanted animals. Therefore, we inserted guinea pig adjusted 6-contact CIs through a cochleostomy in the scala tympani. The eCAP was recorded from a ball electrode at the round window niche in response to monopolar or bipolar, 50 µs/phase biphasic pulses of alternating anodic- and cathodic-leading polarity. To exclude the large electrical artifact from the analysis, we focused on the late eCAP component. We systematically isolated the eCAP parameter that showed local pre- versus post-lesion changes and lesion-target specificity. Histological evaluation of the cleared cochleae revealed focal damage of an average size of 0.0036 mm3 with an apical-basal span of maximal 440 µm. We found that the threshold of the late N2P2 eCAP component was significantly elevated after lesioning when stimulating at basal (near the lesion), but not apical (distant to the lesion) CI contacts. To circumvent the potentially conflicting influence of the apical-basal gradient in eCAP thresholds, we used the polarity effect (PE=cathodic-anodic) as a relative measure. During monopolar stimulation, but not bipolar stimulation, the PE was sensitive to the lesion target and showed significantly better cathodic than anodic thresholds after soma lesions. We conclude that the difference in N2P2 thresholds in response to cathodic versus anodic-leading monopolar stimulation corresponds to the presence of SGN soma damage, and may therefore be a marker for SGN loss. We consider this electrophysiological estimate of local neural health a potentially relevant tool for human applications because of the temporal separation from the stimulation artifact and possible implementation into common eCAP measurements.
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Affiliation(s)
- Wiebke Konerding
- Department of Experimental Otology, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany.
| | - Julie G Arenberg
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Andrej Kral
- Department of Experimental Otology, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; Cluster of Excellence "Hearing4all", Germany.
| | - Peter Baumhoff
- Department of Experimental Otology, Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany.
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Yoshimura H, Moteki H, Nishio SY, Usami SI. Electric-acoustic stimulation with longer electrodes for potential deterioration in low-frequency hearing. Acta Otolaryngol 2020; 140:632-638. [PMID: 32498646 DOI: 10.1080/00016489.2020.1760351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Electric-acoustic stimulation (EAS) has emerged as a standard treatment for patients with high-frequency hearing loss. EAS is usually performed with shorter electrodes of 16-24 mm in length. As most EAS recipients gradually lose residual acoustic hearing in the implanted ear over time, EAS with longer electrodes without causing significant intra-cochlear damage might be ideal.Objective: The aim of this study was to investigate hearing preservation (HP) results after EAS surgery with longer electrodes.Methods: Ten patients (11 ears) with partial deafness that met the indications for EAS with a MED-EL FLEX28 electrode were included in this study. Auditory thresholds before and at 6 months after activation were examined.Results: In 100% of cases, HP was comfortably achieved, indicating that all patients could utilize acoustic amplification combined with electric stimulation.Conclusion: EAS with longer electrodes can offer broader cochlear coverage, resulting in natural frequency matching in comparison with shorter electrodes, even in EAS cases. The combination of advanced surgical techniques and flexible, long, straight electrodes permits deep insertion that reaches the apical region with little or no insertion trauma.
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Affiliation(s)
- Hidekane Yoshimura
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hideaki Moteki
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shin-ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Electrode Afterload: A Valuable Technique in a Case of Short Electrode Insertion. Case Rep Otolaryngol 2020; 2020:3910138. [PMID: 32110456 PMCID: PMC7042513 DOI: 10.1155/2020/3910138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/31/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction. The location of the electrode inside the cochlea is important for speech performance. However, many variables, including array length, insertion depth, and individual anatomy, may affect the intracochlear position of the electrode. Insertion deeper than 20 mm and revision surgery are critical situations in which residual hearing and electrode integrity may be at risk. This case report challenges this hypothesis and raises the following question: is it possible to achieve a better speech understanding with an electrode afterload without compromising residual hearing? Case Report. A 73-year-old female patient showed up for evaluation of hearing loss. The patient was operated four times in an external hospital due to cholesteatoma formation in the right ear. Related to a poor aided speech understanding, a CI-surgery was performed. 5 months after the surgery, the subject returned with poor speech understanding. A revision surgery was performed, where the first white marker of the electrode was seen in the round window (20 mm). The electrode was inserted 4 mm deeper into the cochlea. After six and twelve months, the results of the Freiburger monosyllabic speech test improved till 25% and 45%, respectively. Discussion. Hearing preservation is possible with a revisional deeper insertion from 20 mm to 24 mm. In this case, a partial obliteration of an open cavity made the electrode surgically easily accessible. This allowed the deeper insertion during the revision surgery. In a regular surgical field with a posterior tympanotomy, the revision surgery is more challenging and brings the electrode into the risk of an iatrogenic destruction. Conclusion. This case of an electrode afterload after having inserted the electrode initially to mm, demonstrates that hearing can be preserved and speech perception can improve after performing this maneuver.
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Psychoacoustic and electrophysiological electric-acoustic interaction effects in cochlear implant users with ipsilateral residual hearing. Hear Res 2020; 386:107873. [DOI: 10.1016/j.heares.2019.107873] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
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Weiss NM, Dhanasingh A, Schraven SP, Schulze M, Langner S, Mlynski R. Surgical approach for complete cochlear coverage in EAS-patients after residual hearing loss. PLoS One 2019; 14:e0223121. [PMID: 31557251 PMCID: PMC6762079 DOI: 10.1371/journal.pone.0223121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction In cases with residual-hearing (RH) loss after cochlear implantation, a safe method is needed to provide full spectral resolution and as much auditory information as possible without implant replacement. Aim of this study was to prove the feasibility of accessing a partially inserted cochlear-implant-electrode for complete insertion to its maximum length through the external ear canal using a transcanal approach. Methods Two CI electrodes were customized with 18 stimulating channels. The electrode design enables the use of 12 active channels available for electrical stimulation inside the cochlea both after partial and full insertion. 10 CI electrodes were implanted in 10 fresh human cadaveric temporal bones. After initial partial insertion by posterior tympanotomy, the electrode was inserted to its maximum length via a transcanal approach. Radiographs and CT scans were performed to confirm the electrode position. The electrodes were investigated via x-ray after removal. Results X-ray and CT-scans confirmed the electrode prototypes covering an angular insertion depth between 236° to 307° after initial insertion. Accessing the electrode in the middle ear space was feasible and insertion to its full length was successful. Post-insertion CT confirmed insertion of the 28mm and 31.5mm electrode arrays covering an angular insertion depth between 360° and 540° respectively. No tip foldovers were detected. Conclusion This study confirms the feasibility of extending the electrode insertion to its maximum insertion length using a transcanal approach in temporal bone specimens. This constitutes a second stage procedure on demand in EAS-surgery. This may be beneficial for EAS-patients providing electrical stimulation beyond the basal turn of the cochlea once the functional residual hearing is lost, without replacing the entire CI.
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Affiliation(s)
- Nora M. Weiss
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
- * E-mail:
| | | | - Sebastian P. Schraven
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Rostock University Medical Center, Institute of Anatomy Gertrudenstraße, Rostock, Germany
| | - Soenke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Robert Mlynski
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
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