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Lorens A, Skarzynski PH, Obrycka A, Skarzynski H. Can an individual with low frequency hearing in the candidate ear benefit from a cochlear implant even if they have normal hearing in the other ear? Eur Arch Otorhinolaryngol 2023; 280:4895-4902. [PMID: 37221309 PMCID: PMC10562342 DOI: 10.1007/s00405-023-08011-y] [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: 03/01/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE To determine hearing preservation and subjective benefit after cochlear implant (CI) surgery in patients with low frequency hearing in the ear to be implanted (i.e., they have partial deafness, PD) and close to normal hearing in the other. METHODS There were two study groups. The test group was made up of 12 adult patients (mean age 43.4 years; SD 13.6) with normal hearing or mild hearing loss in one ear, and with PD in the ear to be implanted. The reference group consisted of 12 adult patients (mean age 44.5 years; SD 14.1) who had PD in both ears and who underwent unilateral implantation in their worse ear. Hearing preservation was assessed 1 and 14 months after CI surgery using the Skarzynski Hearing Preservation Classification System. The APHAB questionnaire was used to evaluate the benefit from the CI. RESULTS The differences in HP% between the groups were not significant: mean hearing preservation (HP%) in the test group was 82% one month after CI surgery and 75% some 14 months after implantation; corresponding results in the reference group were 71% and 69%. However, on the APHAB background noise subscale, the benefit in the test group was significantly larger than in the reference group. CONCLUSION To a large extent it was possible to preserve low-frequency hearing in the implanted ear. This means that individuals with low frequency hearing in the implanted ear (partial deafness) and with normal hearing in the other generally received more benefits from cochlear implantation than did patients with partial deafness in both ears. We conclude that residual low frequency hearing in the ear to be implanted should not be considered a contraindication for a CI in a patient with single-sided deafness.
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Affiliation(s)
- Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Piotr Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
| | - Anita Obrycka
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland.
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
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Aljazeeri I, Alturaiki S, Abdelsamad Y, Alzhrani F, Hagr A. Various approaches to the round window for cochlear implantation: a systematic review. J Laryngol Otol 2023; 137:1064-1082. [PMID: 35729690 DOI: 10.1017/s0022215122001438] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Round window approaches are used to insert a cochlear implant electrode array into the scala tympani. This study aimed to review the literature to find the reported round window approaches. METHOD This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses ('PRISMA') guidelines. Articles that described their surgical approach to the round window were included. The PubMed, Scopus, Web of Science and Cochrane Library electronic databases were searched through to June 2021. The study protocol was registered on Prospero (reference number: CRD42021226940). RESULTS A total of 42 reports were included. The following approaches were documented: the standard facial recess, keyhole, retrofacial, modified suprameatal, transaditus, combined posterior tympanotomy and endomeatal, modified Veria, canal wall down approaches, and endoscopically assisted technique. CONCLUSION This review suggested that there are numerous distinct round window approaches, providing alternatives when the round window is inaccessible through the standard facial recess.
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Affiliation(s)
- I Aljazeeri
- Aljaber Ophthalmology and Otolaryngology Specialized Hospital, Ministry of Health, Ahsa, Saudi Arabia
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - S Alturaiki
- Aljaber Ophthalmology and Otolaryngology Specialized Hospital, Ministry of Health, Ahsa, Saudi Arabia
| | - Y Abdelsamad
- Research Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | - F Alzhrani
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - A Hagr
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Távora-Vieira D, Voola M, Kuthubutheen J, Friedland P, Gibson D, Acharya A. Evaluation of the Performance of OTOPLAN-Based Cochlear Implant Electrode Array Selection: A Retrospective Study. J Pers Med 2023; 13:1276. [PMID: 37623526 PMCID: PMC10455663 DOI: 10.3390/jpm13081276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Otoplan is a surgical planning software designed to assist with cochlear implant surgery. One of its outputs is a recommendation of electrode array type based on imaging parameters. In this retrospective study, we evaluated the differences in auditory outcomes between patients who were implanted with arrays corresponding to those recommended by the Otoplan software versus those in which the array selection differed from the Otoplan recommendation. Pre-operative CT images from 114 patients were imported into the software, and array recommendations were generated. These were compared to the arrays which had actually been implanted during surgery, both in terms of array type and length. As recommended, 47% of patients received the same array, 34% received a shorter array, and 18% received a longer array. For reasons relating to structure and hearing preservation, 83% received the more flexible arrays. Those who received stiffer arrays had cochlear malformations or ossification. A negative, although non-statistically significant correlation was observed between the CNC scores at 12 months and the absolute value of the difference between recommended array and implanted array. In conclusion, clinicians may be slightly biased toward shorter electrode arrays due to their perceived greater ability to achieve full insertion. Using 3D imaging during the pre-operative planning may improve clinicians' confidence to implant longer electrode arrays, where appropriate, to achieve optimum hearing outcomes.
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Affiliation(s)
- Dayse Távora-Vieira
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Faculty of Health Sciences, School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Marcus Voola
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
| | - Jafri Kuthubutheen
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
| | - Peter Friedland
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
| | - Daren Gibson
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Aanand Acharya
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
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Kostevich IV, Kuzovkov VE, Lilenko AS, Sugarova SB. [The significance of microanatomy of the round window in terms of cochlear implantation]. Vestn Otorinolaringol 2021; 86:42-47. [PMID: 34783472 DOI: 10.17116/otorino20218605142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sensoneural hearing loss is a polyetiological disease, which is often a secondary reflection of systemic pathology and is associated with damage of the cochlea and auditory nerve receptors. An important point in the surgical stage of cochlear implantation is the introduction of an implant active electrode into the cochleostomy spiral channel through the cochleostoma or round window. However, the issue of intra-cochlear structures surgical trauma in such surgical intervention seems to be very important, as it may reduce the success of subsequent rehabilitation. Therefore, the study of the anatomy of the round window and adjuscent areas was the objective of this work.
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Affiliation(s)
- I V Kostevich
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - V E Kuzovkov
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - A S Lilenko
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - S B Sugarova
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
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Underwater Endoscopic Ear Surgery for Closure of Cholesteatomatous Labyrinthine Fistula With Preservation of Auditory Function. Otol Neurotol 2021; 42:e1669-e1676. [PMID: 34172658 DOI: 10.1097/mao.0000000000003241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the outcomes of the underwater endoscopic ear surgery (UWEES) technique for closure of cholesteatomatous labyrinthine fistula (LF) with preservation of auditory function. STUDY DESIGN Retrospective case review study. SETTING Tertiary referral center. PATIENTS A total of 12 patients with cholesteatomatous LF. INTERVENTION Surgical method of closure using UWEES for cholesteatomatous LF to minimize inner ear damage. Artificial cerebrospinal fluid (CSF) was used as the perfusate, except for earlier cases when saline was employed. MAIN OUTCOME MEASURES Comparison of bone conductance hearing level (BCHL) before and after surgery. A change of BCHL less than 10 dB was defined as successful preservation of bone conductance hearing. RESULTS All cases of LF were treated successfully by closure using the UWEES technique. Seven cases were type I, one was type IIa, and four were type III according to the Milewski and Dornhoffer classification of LF. The average LF size was 3.1 mm (1-7 mm). Eleven patients were evaluated and their bone conductance hearing was well preserved in all of them (11/11). One patient was too young for preoperative evaluation of BCHL, but hearing preservation was verified 2 years later at the age of 6 years. Remarkably, none of the patients complained of vertigo, except for only a slight manifestation on postoperative day 1. CONCLUSION The UWEES technique was effective for closure of cholesteatomatous LF with preservation of auditory function.
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Spitzer ER, Waltzman SB, Landsberger DM, Friedmann DR. Acceptance and Benefits of Electro-Acoustic Stimulation for Conventional-Length Electrode Arrays. Audiol Neurootol 2020; 26:17-26. [PMID: 32721977 DOI: 10.1159/000507975] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prior studies have shown an advantage for electro-acoustic stimulation (EAS) in cochlear implant (CI) patients with residual hearing, but the degree of benefit can vary. The objective was to explore which factors relate to performance with and acceptance of EAS for CI users with conventional-length electrodes. METHODS A retrospective chart review was conducted for adults with an average threshold of 75 dB hearing loss or better across 250 and 500 Hz preoperatively (n = 83). All patients underwent cochlear implantation with a conventional-length electrode. Low-frequency audiometric thresholds were measured at initial activation as well as 3 and 12 months postoperatively to determine who met the criteria for EAS. Speech perception for CNC words and AzBio sentences in quiet and +10 dB SNR noise was evaluated 3 and 12 months after activation. RESULTS Speech perception in quiet and noise was similar regardless of whether or not the patient was eligible for EAS. Less than half of the patients who met the EAS criteria chose to use it, citing reasons such as physical discomfort or lack of perceived benefit. EAS users performed better on CNC words but not sentence recognition than EAS nonusers. CONCLUSIONS EAS use is dependent on audiologic and nonaudiologic issues. Hearing preservation is possible with conventional electrodes, but hearing preservation alone does not guarantee superior speech perception.
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Affiliation(s)
- Emily R Spitzer
- Department of Otolaryngology - Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Susan B Waltzman
- Department of Otolaryngology - Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - David M Landsberger
- Department of Otolaryngology - Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - David R Friedmann
- Department of Otolaryngology - Head and Neck Surgery, New York University School of Medicine, New York, New York, USA,
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Schart-Morén N, Erixon E, Li H, Rask-Andersen H. Cochlear implantation and residual hearing preservation long-term follow-up of the first consecutively operated patients using the round window approach in Uppsala, Sweden. Cochlear Implants Int 2020; 21:246-259. [PMID: 32515304 DOI: 10.1080/14670100.2020.1755102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We conducted a long-term follow-up study to investigate the time course of residual hearing in our first 21 consecutively operated cochlear implant (CI) patients using the round window (RW) approach . The study may provide additional information about the influence of a flexible lateral wall electrode array on cochlear function. Methods: Data were available for long-term follow-up (>5 years) in 15 patients. Pure tone audiometry (PTA) was assessed at 0.125-8 kHz preoperatively, and at one, three and >5 years postoperatively. Insertion angle, number of electrodes inside the cochlea, user-time of the processor and stimulation strategy were documented. Results: Twelve out of 15 patients had residual hearing after a follow-up period of five years (mean 86 months, range: 61-103 months). Four out of 15 patients had >75% complete hearing preservation (HP), 8 out of 15 had 25-75% partial HP and 3 out of 15 patients had complete loss of hearing. There was a high correlation between insertion angle and HP. Conclusion: Long-term HP was possible in 12 out of 15 cases. Even patients with complete hearing loss at long-term follow-up showed high performance in speech understanding and were full-time users.
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Affiliation(s)
- Nadine Schart-Morén
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
| | - Elsa Erixon
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
| | - Hao Li
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Section of Otolaryngology, Head and Neck Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
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Mamelle E, Granger B, Sterkers O, Lahlou G, Ferrary E, Nguyen Y, Mosnier I. Long-term residual hearing in cochlear implanted adult patients who were candidates for electro-acoustic stimulation. Eur Arch Otorhinolaryngol 2019; 277:705-713. [PMID: 31802226 DOI: 10.1007/s00405-019-05745-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/27/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the long-term hearing outcomes in cochlear implanted adults with residual hearing at low frequencies, and the proportion of patients using electro-acoustic stimulation (EAS). METHODS A monocentric retrospective cohort study was performed in a tertiary referral center. Population demographics, surgical approach, pre- and postoperative hearing at low frequencies, in the implanted and contralateral ear, were recorded as well as duration of EAS use. The percentage hearing preservation was calculated according to the formula S (HEARRING group). RESULTS In total, 63 adults (81 ears) with residual hearing underwent cochlear implantation with intent to use EAS processors. Six different types of electrode array were implanted. The mean pure tone audiometry (PTA) shift after cochlear implantation was 16 ± 15 dB HL (range 0-59 dB HL). Half of the implanted ears had minimal hearing preservation or total hearing loss (HL) at 5.5 years and the cumulative risk of total HL was 50% at 7 years. During the follow-up, total HL occurred in 22 ears. The decrease in hearing levels was similar in both implanted and contralateral ear during follow-up (ns, F = 2.46 ± 3, Linear Mixed Model (LMM)). Only 44 patients found a benefit from EAS at the first fitting. At the last visit, EAS processors were fitted in 30% of the cases. The pre- and postoperative mean PTA thresholds were not predictive of EAS use (Cox's proportional hazards analysis). CONCLUSIONS Postoperative residual hearing was observed in 93% of implanted ears, but only half of them had an initial benefit from EAS. No predictive factors were found to influence the use of EAS processors.
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Affiliation(s)
- Elisabeth Mamelle
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France.
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France.
| | - Benjamin Granger
- Public Health Department, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Olivier Sterkers
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France
| | - Ghizlene Lahlou
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France
| | - Evelyne Ferrary
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France
| | - Yann Nguyen
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France
| | - Isabelle Mosnier
- Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France
- Otolaryngology Department, Otology, Auditory Implants and Skull Base Surgery Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Bâtiment Paul Castaigne, 50-52 boulevard Vincent Auriol, 75013, Paris, France
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Snels CWM, Huinck WJ, Swinnen FKR, Dhooge I, Mylanus EAM. Short and long term preservation of hearing thresholds corrected for natural hearing loss in cochlear implant recipients using a straight electrode. Cochlear Implants Int 2019; 21:110-116. [PMID: 31648613 DOI: 10.1080/14670100.2019.1680168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The aim of this study is to investigate short and long term residual hearing preservation (HP), corrected for the natural progress of hearing loss, in cochlear implant (CI) patients receiving a straight electrode array using a round window (RW) approach.Methods: A retrospective and cross-sectional analysis on patients who received a CI with a straight electrode using a RW approach (n = 60) was performed. Audiometric data were obtained at three time points, preoperatively, at first fitting, and one year or more postoperatively. The HP outcome was calculated according to the HP definition as reported by Skarzynski with a PTA of 250, 500, and 1000 Hz (PTA3) and a PTA of 250, 500, 1000, and 2000 Hz (PTA4).Results: The HP outcome at first fitting and at long term follow up fell into the partial HP category, 63.5% (PTA3) and 40.5% (PTA4), respectively according to the Skarzynski definition. A decline in pure-tone average (PTA) was found in the CI ear and in the contralateral ear over time (p < 0.05). Interaural differences remained relatively stable at all frequencies on the long term, except for the frequency 250 Hz (p < 0.05).Discussion: After the initial loss of residual hearing, the hearing thresholds of the CI ear remain relatively stable at long term follow up when corrected for the natural course of hearing loss, except at 250 Hz.Conclusion: CI candidates should be counseled on the risk of long term deterioration of the residual hearing in both the CI ear and the contralateral ear.
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Affiliation(s)
- Chantal W M Snels
- Department of Otorhinolaryngology, Ghent University, Corneel Heymanslaan 10 1P1, 9000, Ghent, Belgium
| | - Wendy J Huinck
- Department of Otorhinolaryngology, Radboud university medical center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Freya K R Swinnen
- Department of Otorhinolaryngology, Ghent University, Corneel Heymanslaan 10 1P1, 9000, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University, Corneel Heymanslaan 10 1P1, 9000, Ghent, Belgium
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology, Ghent University, Corneel Heymanslaan 10 1P1, 9000, Ghent, Belgium.,Department of Otorhinolaryngology, Radboud university medical center, Nijmegen, Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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Manrique-Huarte R, Calavia D, Gallego MA, Manrique M. Cochlear Implant Electrode Array From Partial to Full Insertion in Non-Human Primate Model. J Int Adv Otol 2019; 14:5-9. [PMID: 29764773 DOI: 10.5152/iao.2018.5233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To determine the feasibility of progressive insertion (two sequential surgeries: partial to full insertion) of an electrode array and to compare functional outcomes. MATERIAL AND METHODS 8 normal-hearing animals (Macaca fascicularis (MF)) were included. A 14 contact electrode array, which is suitably sized for the MF cochlea was partially inserted (PI) in 16 ears. After 3 months of follow-up revision surgery the electrode was advanced to a full insertion (FI) in 8 ears. Radiological examination and auditory testing was performed monthly for 6 months. In order to compare the values a two way repeated measures ANOVA was used. A p-value below 0.05 was considered as statistically significant. IBM SPSS Statistics V20 was used. RESULTS Surgical procedure was completed in all cases with no complications. Mean auditory threshold shift (ABR click tones) after 6 months follow-up is 19 dB and 27 dB for PI and FI group. For frequencies 4, 6, 8, 12, and 16 kHz in the FI group, tone burst auditory thresholds increased after the revision surgery showing no recovery thereafter. Mean threshold shift at 6 months of follow- up is 19.8 dB ranging from 2 to 36dB for PI group and 33.14dB ranging from 8 to 48dB for FI group. Statistical analysis yields no significant differences between groups. CONCLUSION It is feasible to perform a partial insertion of an electrode array and progress on a second surgical time to a full insertion (up to 270º). Hearing preservation is feasible for both procedures. Note that a minimal threshold deterioration is depicted among full insertion group, especially among high frequencies, with no statistical differences.
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Affiliation(s)
- Raquel Manrique-Huarte
- Department of Otorhinolaryngology, University of Navarra Clinic, Pamplona/Navarra, Spain
| | - Diego Calavia
- Department of Otorhinolaryngology, University of Navarra Clinic, Pamplona/Navarra, Spain
| | - Maria Antonia Gallego
- Department of Otorhinolaryngology, University of Navarra Clinic, Pamplona/Navarra, Spain
| | - Manuel Manrique
- Department of Otorhinolaryngology, University of Navarra Clinic, Pamplona/Navarra, Spain
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Effects of Various Trajectories on Tissue Preservation in Cochlear Implant Surgery: A Micro-Computed Tomography and Synchrotron Radiation Phase-Contrast Imaging Study. Ear Hear 2019; 40:393-400. [PMID: 29952804 DOI: 10.1097/aud.0000000000000624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the three-dimensional (3D) anatomy and potential damage to the hook region of the human cochlea following various trajectories at cochlear implantation (CI). The goal was to determine which of the approaches can avoid lesions to the soft tissues, including the basilar membrane and its suspension to the lateral wall. Currently, there is increased emphasis on conservation of inner ear structures, even in nonhearing preservation CI surgery. DESIGN Micro-computed tomography and various CI approaches were made in an archival collection of macerated and freshly fixed human temporal bones. Furthermore, synchrotron radiation phase-contrast imaging was used to reproduce the soft tissues. The 3D anatomy was investigated using bony and soft tissue algorithms, and influences on inner ear structures were examined. RESULTS Micro-computed tomography with 3D rendering demonstrated the topography of the round window (RW) and osseous spiral laminae, while synchrotron imaging allowed reproduction of soft tissues such as the basilar membrane and its suspension around the RW membrane. Anterior cochleostomies and anteroinferior cochleostomies invariably damaged the intracochlear soft tissues while inferior cochleostomies sporadically left inner ear structures unaffected. CONCLUSIONS Results suggest that cochleostomy approaches often traumatize the soft tissues at the hook region at CI surgery. For optimal structural preservation, the RW approach is, therefore, recommended.
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Sierra C, Calderón M, Bárcena E, Tisaire A, Raboso E. Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays. Otol Neurotol 2019; 40:e373-e380. [DOI: 10.1097/mao.0000000000002170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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SKARZYNSKI H, MATUSIAK M, FURMANEK M, PILKA A, WLODARCZYK E, OLDAK M, SKARZYNSKI P. Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:468-475. [PMID: 30498276 PMCID: PMC6265667 DOI: 10.14639/0392-100x-1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.
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Affiliation(s)
- H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. MATUSIAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. FURMANEK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - A. PILKA
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - E. WLODARCZYK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. OLDAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - P.H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Kondratowicza, Warszawa, Poland
- Institute of Sensory Organs, Mokra, Kajetany, Poland
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16
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The Human Cochlear Aqueduct and Accessory Canals: a Micro-CT Analysis Using a 3D Reconstruction Paradigm. Otol Neurotol 2018; 39:e429-e435. [DOI: 10.1097/mao.0000000000001831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Effects of dexamethasone on intracochlear inflammation and residual hearing after cochleostomy: A comparison of administration routes. PLoS One 2018; 13:e0195230. [PMID: 29601595 PMCID: PMC5877881 DOI: 10.1371/journal.pone.0195230] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/06/2018] [Indexed: 12/20/2022] Open
Abstract
Preservation of residual hearing after cochlear implant is an important issue with regards to hearing performance. Various methods of steroid administration have been widely used in clinical practice to reduce inflammation and preserve residual hearing. Here we compare the effect of different routes of dexamethasone administration on intracochlear inflammation and residual hearing in guinea pig ears. Dexamethasone was delivered into the guinea pigs either through intracochlear, intratympanic or systemic route. The intracochlear concentration of dexamethasone, residual hearing, inflammatory cytokines and histopathologic changes were evaluated over time. A higher intracochlear dexamethasone concentration was observed after intracochlear administration than through the other routes. Residual hearing was better preserved with local dexamethasone administration as was supported by the reduced inflammatory cytokines, more hair cell survival and less severe intracochlear fibrosis and ossification concurrently seen in the local delivery group than in the systemic group. The results demonstrate that local dexamethasone delivery can reduce intracochlear inflammation and preserve residual hearing better than in systemically administered dexamethasone.
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18
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O’Connell BP, Dedmon MM, Haynes DS. Hearing Preservation Cochlear Implantation: a Review of Audiologic Benefits, Surgical Success Rates, and Variables That Impact Success. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0176-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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19
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Spiral Form of the Human Cochlea Results from Spatial Constraints. Sci Rep 2017; 7:7500. [PMID: 28790422 PMCID: PMC5548794 DOI: 10.1038/s41598-017-07795-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/29/2017] [Indexed: 01/10/2023] Open
Abstract
The human inner ear has an intricate spiral shape often compared to shells of mollusks, particularly to the nautilus shell. It has inspired many functional hearing theories. The reasons for this complex geometry remain unresolved. We digitized 138 human cochleae at microscopic resolution and observed an astonishing interindividual variability in the shape. A 3D analytical cochlear model was developed that fits the analyzed data with high precision. The cochlear geometry neither matched a proposed function, namely sound focusing similar to a whispering gallery, nor did it have the form of a nautilus. Instead, the innate cochlear blueprint and its actual ontogenetic variants were determined by spatial constraints and resulted from an efficient packing of the cochlear duct within the petrous bone. The analytical model predicts well the individual 3D cochlear geometry from few clinical measures and represents a clinical tool for an individualized approach to neurosensory restoration with cochlear implants.
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20
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Dai C, Lehar M, Sun DQ, Rvt LS, Carey JP, MacLachlan T, Brough D, Staecker H, Della Santina AM, Hullar TE, Della Santina CC. Rhesus Cochlear and Vestibular Functions Are Preserved After Inner Ear Injection of Saline Volume Sufficient for Gene Therapy Delivery. J Assoc Res Otolaryngol 2017. [PMID: 28646272 DOI: 10.1007/s10162-017-0628-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Sensorineural losses of hearing and vestibular sensation due to hair cell dysfunction are among the most common disabilities. Recent preclinical research demonstrates that treatment of the inner ear with a variety of compounds, including gene therapy agents, may elicit regeneration and/or repair of hair cells in animals exposed to ototoxic medications or other insults to the inner ear. Delivery of gene therapy may also offer a means for treatment of hereditary hearing loss. However, injection of a fluid volume sufficient to deliver an adequate dose of a pharmacologic agent could, in theory, cause inner ear trauma that compromises functional outcome. The primary goal of the present study was to assess that risk in rhesus monkeys, which closely approximates humans with regard to middle and inner ear anatomy. Secondary goals were to identify the best delivery route into the primate ear from among two common surgical approaches (i.e., via an oval window stapedotomy and via the round window) and to determine the relative volumes of rhesus, rodent, and human labyrinths for extrapolation of results to other species. We measured hearing and vestibular functions before and 2, 4, and 8 weeks after unilateral injection of phosphate-buffered saline vehicle (PBSV) into the perilymphatic space of normal rhesus monkeys at volumes sufficient to deliver an atoh1 gene therapy vector. To isolate effects of injection, PBSV without vector was used. Assays included behavioral observation, auditory brainstem responses, distortion product otoacoustic emissions, and scleral coil measurement of vestibulo-ocular reflexes during whole-body rotation in darkness. Three groups (N = 3 each) were studied. Group A received a 10 μL transmastoid/trans-stapes injection via a laser stapedotomy. Group B received a 10 μL transmastoid/trans-round window injection. Group C received a 30 μL transmastoid/trans-round window injection. We also measured inner ear fluid space volume via 3D reconstruction of computed tomography (CT) images of adult C57BL6 mouse, rat, rhesus macaque, and human temporal bones (N = 3 each). Injection was well tolerated by all animals, with eight of nine exhibiting no signs of disequilibrium and one animal exhibiting transient disequilibrium that resolved spontaneously by 24 h after surgery. Physiologic results at the final, 8-week post-injection measurement showed that injection was well tolerated. Compared to its pretreatment values, no treated ear's ABR threshold had worsened by more than 5 dB at any stimulus frequency; distortion product otoacoustic emissions remained detectable above the noise floor for every treated ear (mean, SD and maximum deviation from baseline: -1.3, 9.0, and -18 dB, respectively); and no animal exhibited a reduction of more than 3 % in vestibulo-ocular reflex gain during high-acceleration, whole-body, passive yaw rotations in darkness toward the treated side. All control ears and all operated ears with definite histologic evidence of injection through the intended site showed similar findings, with intact hair cells in all five inner ear sensory epithelia and intact auditory/vestibular neurons. The relative volumes of mouse, rat, rhesus, and human inner ears as measured by CT were (mean ± SD) 2.5 ± 0.1, 5.5 ± 0.4, 59.4 ± 4.7 and 191.1 ± 4.7 μL. These results indicate that injection of PBSV at volumes sufficient for gene therapy delivery can be accomplished without destruction of inner ear structures required for hearing and vestibular sensation.
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Affiliation(s)
- Chenkai Dai
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA. .,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.
| | - Mohamed Lehar
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Daniel Q Sun
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Lani Swarthout Rvt
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - John P Carey
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Tim MacLachlan
- Novartis Institutes for Biomedical Research, 250 Massachusetts Ave, Cambridge, MA, 02139, USA
| | - Doug Brough
- GenVec, 910 Clopper Rd #220n, Gaithersburg, MD, 20878, USA
| | - Hinrich Staecker
- Dept of Otolaryngology, Head & Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Alexandra M Della Santina
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
| | - Timothy E Hullar
- Department of Otolaryngology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Department of Anatomy and Neurobiology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.,Department of Audiology and Communication Sciences, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Charles C Della Santina
- Vestibular NeuroEngineering Lab, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross Bldg Rm 830, Baltimore, MD, 21205, USA
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21
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Angeli RD, Lavinsky J, Setogutti ET, Lavinsky L. The Crista Fenestra and Its Impact on the Surgical Approach to the Scala Tympani during Cochlear Implantation. Audiol Neurootol 2017. [DOI: 10.1159/000471840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: The aim of this work was to describe the dimensions of the crista fenestra and determine its presence by means of high-resolution computed tomography (CT) for the purpose of cochlear implantation via the round window approach. Methods: A series of 10 adult human temporal bones underwent high-resolution CT scanning and were further dissected for microscopic study of the round window niche. Results: In all of the specimens, the round window membrane was fully visualized after the complete removal of bony overhangs. The crista fenestra was identified as a sharp bony crest located in the anterior and inferior borders of the niche; its area ranged from 0.28 to 0.80 mm2 (mean 0.51 ± 0.18). The proportion of the area occupied by the crista fenestra in the whole circumference of the round window ranged from 23 to 50% (mean 36%). We found a moderate positive correlation between the area of the niche and the dimensions of the crista fenestra (Spearman rho: 0.491). In every case, high-resolution CT scanning was unable to determine the presence of the crista fenestra. Conclusion: The crista fenestra occupies a variable but expressive area within the bony round window niche. Narrower round window niches tended to house smaller crests. The presence of the crista fenestra is an important obstacle to adequate access to the scala tympani. Nevertheless, a high-resolution CT scan provides no additional preoperative information with regard to its presence for the purpose of surgical access to the scala tympani via the round window niche.
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22
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Wanna GB, O'Connell BP, Francis DO, Gifford RH, Hunter JB, Holder JT, Bennett ML, Rivas A, Labadie RF, Haynes DS. Predictive factors for short- and long-term hearing preservation in cochlear implantation with conventional-length electrodes. Laryngoscope 2017. [PMID: 28643327 DOI: 10.1002/lary.26714] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aims of this study were to investigate short- and long-term rates of hearing preservation after cochlear implantation and identify factors that impact hearing preservation. STUDY DESIGN Retrospective review. METHODS Patients undergoing cochlear implantation with conventional-length electrodes and air-conduction thresholds ≤80 dB HL at 250 Hz preoperatively were included. Hearing preservation was defined as air-conduction thresholds ≤80 dB HL at 250 Hz. RESULTS The sample included 196 patients (225 implants). Overall, the rate of short-term hearing preservation was 38% (84/225), with 18% (33/188) of patients preserving hearing long term. Multivariate analysis showed better preoperative hearing was predictive of hearing preservation at short (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.91-0.95, P < .001) and long-term follow-up (OR: 0.94, 95% CI: 0.91-0.97, P < .001). Lateral wall electrodes and mid-scala electrodes had 3.4 (95% CI: 1.4-8.6, P = .009) and 5.6-times (95% CI: 1.8-17.3, P = .003) higher odds of hearing preservation than perimodiolar arrays at short-term follow-up, respectively. Long-term data revealed better hearing preservation for lateral wall (OR: 7.6, 95% CI: 1.6-36.1, P = .01), but not mid-scala (OR: 3.1, 95% CI: 0.4-23.1, P = .28), when compared to perimodiolar electrodes. Round window/extended round window (RW/ERW) approaches were associated with higher rates of long-term hearing preservation (21%) than cochleostomy approaches (0%) (P = 0.002) on univariate analysis. CONCLUSIONS Better preoperative residual hearing, lateral wall electrodes, and RW/ERW approaches are predictive of higher rates of long-term functional hearing preservation. LEVEL OF EVIDENCE 4. Laryngoscope, 128:482-489, 2018.
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Affiliation(s)
- George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - David O Francis
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Rene H Gifford
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Alejandro Rivas
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
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23
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The Effect of Round Window Sealants on Delayed Hearing Loss in a Guinea Pig Model of Cochlear Implantation. Otol Neurotol 2016; 37:1024-31. [DOI: 10.1097/mao.0000000000001132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation. Otol Neurotol 2016; 37:1006-15. [DOI: 10.1097/mao.0000000000001110] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
Visualizing structures deep inside opaque biological tissues is one of the central challenges in biomedical imaging. Optical imaging with visible light provides high resolution and sensitivity; however, scattering and absorption of light by tissue limits the imaging depth to superficial features. Imaging with shortwave infrared light (SWIR, 1-2 μm) shares many advantages of visible imaging, but light scattering in tissue is reduced, providing sufficient optical penetration depth to noninvasively interrogate subsurface tissue features. However, the clinical potential of this approach has been largely unexplored because suitable detectors, until recently, have been either unavailable or cost prohibitive. Here, taking advantage of newly available detector technology, we demonstrate the potential of SWIR light to improve diagnostics through the development of a medical otoscope for determining middle ear pathologies. We show that SWIR otoscopy has the potential to provide valuable diagnostic information complementary to that provided by visible pneumotoscopy. We show that in healthy adult human ears, deeper tissue penetration of SWIR light allows better visualization of middle ear structures through the tympanic membrane, including the ossicular chain, promontory, round window niche, and chorda tympani. In addition, we investigate the potential for detection of middle ear fluid, which has significant implications for diagnosing otitis media, the overdiagnosis of which is a primary factor in increased antibiotic resistance. Middle ear fluid shows strong light absorption between 1,400 and 1,550 nm, enabling straightforward fluid detection in a model using the SWIR otoscope. Moreover, our device is easily translatable to the clinic, as the ergonomics, visual output, and operation are similar to a conventional otoscope.
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Hearing and Patient Satisfaction Among 19 Patients Who Received Implants Intended for Hybrid Hearing: A Two-Year Follow-Up. Ear Hear 2016; 36:e271-8. [PMID: 25932703 PMCID: PMC4547730 DOI: 10.1097/aud.0000000000000171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: To measure patient satisfaction and correlate to hearing results in partially deaf patients, after hearing preservation cochlear implant surgery with hybrid hearing strategy, and to evaluate the stability of residual low-frequency hearing (LFH) over time. Design: A patient satisfaction survey and a retrospective, 2-year follow-up journal study. Nineteen partially deaf patients intended for hybrid hearing responded to a questionnaire when they had used their cochlear implants for at least a year. The questionnaire consisted of the International Outcome Inventory for Hearing Aids, EuroQol Group visual analogue scale and nine questions about hybrid hearing. Pure-tone audiometry, monosyllables, and hearing in noise test results from the patients’ medical records were evaluated and compared with the results from the patient satisfaction survey. Results: All of the patients were satisfied with their CIs. The mean International Outcome Inventory for Hearing Aids score was 29. The CIs provided a major contribution to the speech comprehension of these partially deaf patients. Two years after surgery, the patients’ mean binaural score on tests of monosyllables was 58%, and the mean signal to noise ratio was 4.6 dB. We observed ongoing deteriorations in the residual hearing of the operated ears that surpassed the deteriorations observed in the contralateral ears. One month after surgery, the LFH loss (125–500 Hz) was 17 dB, and after 2 years, this loss was 24 dB compared with 5 dB in the nonoperated ear. There were no significant correlations between preserved LFH and patient satisfaction or speech perception results. Conclusions: Electric stimulation provided a major contribution to speech comprehension of partially deaf patients. The gain reached in speech understanding widely exceeded the downside in losing some residual hearing. All the patients showed a high degree of satisfaction with their CIs regardless of varying hearing preservation. Electric stimulation contributes to speech perception in partially deaf patients. Here patient satisfaction after cochlear implantation with hybrid hearing strategy is compared to preserved hearing and also to monosyllables and hearing in noise test results. There is an ongoing deterioration of residual hearing, but the gain reached in speech discrimination while the patients receive cochlear implants widely exceeds the downside in losing some residual hearing. All the patients were very satisfied with their implants. Supplemental Digital Content is available in the text.
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27
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Kuthubutheen J, Smith L, Hwang E, Lin V. Preoperative steroids for hearing preservation cochlear implantation: A review. Cochlear Implants Int 2016; 17:63-74. [PMID: 26913646 DOI: 10.1080/14670100.2016.1148319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.
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Affiliation(s)
- Jafri Kuthubutheen
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada.,b Department of Otolaryngology - Head and Neck Surgery , School of Surgery, University of Western Australia , Perth , Australia
| | - Leah Smith
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Euna Hwang
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Vincent Lin
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
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28
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A Retrospective Analysis of the Contribution of Reported Factors in Cochlear Implantation on Hearing Preservation Outcomes. Otol Neurotol 2016; 36:1137-45. [PMID: 25853614 DOI: 10.1097/mao.0000000000000753] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Preservation of residual hearing is essential to perceive acoustic stimulation from hybrid cochlear implants (CI). Preservation is a good marker of atraumatic surgery and residual hearing may be exploited further or enhanced in future therapies, making complete hearing preservation a desirable goal for all current CI surgeries. There is large variability in the amount of hearing preserved and the timeframe over which it is lost after CI. The increase in numbers of patients with high levels of residual hearing at implantation means that understanding the variables affecting its preservation is more important than ever. DATA SOURCES An English search term with generic and specific items concerning hearing preservation and cochlear implantation was searched on the Web of Science service. The search timeframe was limited to 2000 to 2014, with no language limitations on results. STUDY SELECTION Hearing preservation, retrospective CI outcome studies which reported pre- and post-surgical pure-tone audiometry (PTA) were identified and selected. DATA EXTRACTION PTA thresholds were extracted from audiograms or tables and converted into a low-frequency hearing preservation (LFHP) score. Data for 21 factors associated with hearing preservation were collected from studies. DATA SYNTHESIS Factors were included in a hearing preservation model if they had both a significant bivariate correlation with LFHP and a significant Kruskal-Wallis H test result (for ordinal data) or a significant multiple regression analysis result (for scale data). CONCLUSIONS Seven factors were found to have a significant effect on hearing preservation: insertion site, progressive versus stable hearing loss, insertion angle of electrode, use of intraoperative topical steroids, use of steroids (via any route/timing), hearing etiology, and electrode array type. The best hearing preservation options are given.
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Preservation of cochlear structures and hearing when using the Nucleus Slim Straight (CI422) electrode in children. The Journal of Laryngology & Otology 2016; 130:332-9. [PMID: 26763105 DOI: 10.1017/s0022215115003436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In cochlear implantation, there are two crucial factors promoting hearing preservation: an atraumatic surgical approach and selection of an electrode that does not damage cochlear structures. This study aimed to evaluate hearing preservation in children implanted with the Nucleus Slim Straight (CI422) electrode. METHODS Nineteen children aged 6-18 years, with partial deafness, were implanted using the 6-step Skarzynski procedure. Electrode insertion depth was 20-25 mm. Hearing status was assessed with pure tone audiometry before surgery, and at 1, 5, 9, 12 and 24 months after surgery. Electrode placement was confirmed with computed tomography. RESULTS Mean hearing preservation in the study group at activation of the cochlear implant was 73 per cent (standard deviation = 37 per cent). After 24 months, it was 67 per cent (standard deviation = 45 per cent). On a categorical scale, hearing preservation was possible in 100 per cent of cases. CONCLUSION Hearing preservation in children implanted with the Nucleus CI422 slim, straight electrode is possible even with 25 mm insertion depth, although the recommended insertion depth is 20 mm. A round window approach using a soft, straight electrode is most conducive to hearing preservation.
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Shakeel M, Spielmann P, Jones S, Hussain S. Direct measurement of the round window niche dimensions using a 3-dimensional moulding technique - a human cadaveric temporal bone study. Clin Otolaryngol 2015; 40:657-61. [DOI: 10.1111/coa.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M. Shakeel
- Temporal Bone laboratory; Department of Otolaryngology; University of Dundee Medical School & Ninewells Hospital; Dundee UK
| | - P.M. Spielmann
- Temporal Bone laboratory; Department of Otolaryngology; University of Dundee Medical School & Ninewells Hospital; Dundee UK
| | - S.E. Jones
- Temporal Bone laboratory; Department of Otolaryngology; University of Dundee Medical School & Ninewells Hospital; Dundee UK
| | - S.S.M. Hussain
- Temporal Bone laboratory; Department of Otolaryngology; University of Dundee Medical School & Ninewells Hospital; Dundee UK
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31
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Wanna GB, Noble JH, Gifford RH, Dietrich MS, Sweeney AD, Zhang D, Dawant BM, Rivas A, Labadie RF. Impact of Intrascalar Electrode Location, Electrode Type, and Angular Insertion Depth on Residual Hearing in Cochlear Implant Patients: Preliminary Results. Otol Neurotol 2015; 36:1343-8. [PMID: 26176556 PMCID: PMC7187917 DOI: 10.1097/mao.0000000000000829] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the relationship between intrascalar electrode location, electrode type (lateral wall, perimodiolar, and midscala), and angular insertion depth on residual hearing in cochlear implant (CI) recipients. SETTING Tertiary academic hospital. PATIENTS Adult CI patients with functional preoperative residual hearing with preoperative and postoperative CT scans. INTERVENTION Audiological assessment after CI. MAIN OUTCOME MEASURES Electrode location, angular insertion depth, residual hearing post-CI, and word scores with CI (consonant-nucleus-consonant [CNC]). RESULTS Forty-five implants in 36 patients (9 bilateral) were studied. Thirty-eight electrode arrays (84.4%) were fully inserted in scala tympani (ST), 6 (13.3%) crossed from ST to scala vestibuli (SV), and 1 (2.2%) was completely in SV. Twenty-two of the 38 (57.9%) with full ST insertion maintained residual hearing at 1 month compared with 0 of the 7 (0%) with non-full ST insertion (p = 0.005). Three surgical approaches were used: cochleostomy (C) 6/44, extended round window (ERW) 8/44, and round window (RW) 30/44. C and ERW were small group to compare with RW approaches. However if we combine C + ERW, then RW has higher chance of full ST insertion (p = 0.014). Looking at the full ST group, neither age, sex, nor electrode type demonstrated statistically significant associations with hearing preservation (p = 0.646, p = 0.4, and p = 0.929, respectively). The median angular insertion depth was 429° (range, 373°-512°) with no significant difference between the hearing and nonhearing preserved groups (p = 0.287). CONCLUSION Scalar excursion is a strong predictor of losing residual hearing. However, neither age, sex, electrode type, nor angular insertion depth was correlated with hearing preservation in the full ST group. Techniques to decrease the risk of electrode excursion from ST are likely to result in improved residual hearing and CI performance.
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Affiliation(s)
- George B. Wanna
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Rene H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Mary S. Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Alex D. Sweeney
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Dongqing Zhang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Benoit M. Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Alejandro Rivas
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Robert F. Labadie
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A
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Abstract
HYPOTHESIS Human round window (RW) presents anatomic variations that may influence surgical approach. BACKGROUND The true shape of the human RW has been divisive since its first description in 1772 by Antonio Scarpa. Introduction of novel surgical strategies in recent years have raised its significance. Here, the human RW size and shape variations were documented in microdissected human temporal bones. METHODS An archival collection of human microdissected temporal bones was analyzed. RW rim could be delineated and photographed from the labyrinthine aspect and its topography assessed. RESULTS Human RW is seldom round but ovoid or orthogonal, skewed, and nonplanar (saddlelike). Membrane is fan shaped or conical with an anteroinferior and a posterosuperior part. The mean longest diameter was 1.90 mm, and the smallest one is 1.54 mm. The mean diameter from the crista fenestra was 1.31 mm. The mean area of the RW was 2.08 mm, which varied between 0.99 and 3.20 mm. The crista fenestrae of the anterior component form a "doorstep" that may limit the entry to the scala tympani from the RW niche. CONCLUSION The alternate anatomic features of the human RW may influence its surgical access and designs of implants aimed at targeting this region.
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Ryu KA, Lyu AR, Park H, Choi JW, Hur GM, Park YH. Intracochlear Bleeding Enhances Cochlear Fibrosis and Ossification: An Animal Study. PLoS One 2015; 10:e0136617. [PMID: 26308864 PMCID: PMC4550248 DOI: 10.1371/journal.pone.0136617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/12/2015] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to investigate the effects of intracochlear bleeding during cochleostomy on cochlear inflammatory response and residual hearing in a guinea pig animal model. Auditory brainstem response threshold shifts were greater in blood injected ears (p<0.05). Interleukin-1β, interleukin-10, tumor necrosis factor-α and nitric oxide synthase 2, cytokines that are related to early stage inflammation, were significantly increased in blood injected ears compared to normal and cochleostomy only ears at 1 day after surgery; with the increased IL-1β being sustained until 3 days after the surgery (p<0.05). Hair cells were more severely damaged in blood injected ears than in cochleostomy only ears. Histopathologic examination revealed more extensive fibrosis and ossification in blood injected ears than cochleostomy only ears. These results show that intracochlear bleeding enhanced cochlear inflammation resulting in increased fibrosis and ossification in an experimental animal model.
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Affiliation(s)
- Kyeung A. Ryu
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ah-Ra Lyu
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Heesung Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jin Woong Choi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Gang Min Hur
- Department of Pharmacology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yong-Ho Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- * E-mail:
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Liu W, Atturo F, Aldaya R, Santi P, Cureoglu S, Obwegeser S, Glueckert R, Pfaller K, Schrott-Fischer A, Rask-Andersen H. Macromolecular organization and fine structure of the human basilar membrane - RELEVANCE for cochlear implantation. Cell Tissue Res 2015; 360:245-62. [PMID: 25663274 PMCID: PMC4412841 DOI: 10.1007/s00441-014-2098-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cochlear micromechanics and frequency tuning depend on the macromolecular organization of the basilar membrane (BM), which is still unclear in man. Novel techniques in cochlear implantation (CI) motivate further analyses of the BM. MATERIALS AND METHODS Normal cochleae from patients undergoing removal of life-threatening petro-clival meningioma and an autopsy specimen from a normal human were used. Laser-confocal microscopy, high resolution scanning (SEM) and transmission electron microscopy (TEM) were carried out in combination. In addition, one human temporal bone was decellularized and investigated by SEM. RESULTS The human BM consisted in four separate layers: (1) epithelial basement membrane positive for laminin-β2 and collagen IV, (2) BM "proper" composed of radial fibers expressing collagen II and XI, (3) layer of collagen IV and (4) tympanic covering layer (TCL) expressing collagen IV, fibronectin and integrin. BM thickness varied both radially and longitudinally (mean 0.55-1.16 μm). BM was thinnest near the OHC region and laterally. CONCLUSIONS There are several important similarities and differences between the morphology of the BM in humans and animals. Unlike in animals, it does not contain a distinct pars tecta (arcuate) and pectinata. Its width increases and thickness decreases as it travels apically in the cochlea. Findings show that the human BM is thinnest and probably most vibration-sensitive at the outer pillar feet/Deiter cells at the OHCs. The inner pillar and IHCs seem situated on a fairly rigid part of the BM. The gradient design of the BM suggests that its vulnerability increases apical wards when performing hearing preservation CI surgery.
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Affiliation(s)
- Wei Liu
- Department of Surgical Sciences, Head and Neck Surgery, section of Otolaryngology, Uppsala University Hospital, 751 85 Uppsala, Sweden
- Department of Neurology, Mental Health and Sensory Organs Otorhinolaryngologic Unit,, Medicine and Psychology Sapienza, Rome, Sweden
| | - Francesca Atturo
- Department of Neurology, Mental Health and Sensory Organs, Otorhinolaryngologic Unit, Medicine and Psychology, Sapienza, Rome
- Department of Surgical Sciences, Section of Otolaryngology Uppsala University Hospital, SE 751 85 Uppsala, Sweden
| | - Robair Aldaya
- Department of Otolaryngology, University of Minnesota, 121, Lions Research Bldg., 2001 Sixth St. SE, Minneapolis, MN 55455 USA
| | - Peter Santi
- Department of Otolaryngology, University of Minnesota, 121, Lions Research Bldg., 2001 Sixth St. SE, Minneapolis, MN 55455 USA
| | - Sebahattin Cureoglu
- Department of Otolaryngology, University of Minnesota, 121, Lions Research Bldg., 2001 Sixth St. SE, Minneapolis, MN 55455 USA
| | - Sabrina Obwegeser
- Department of Otolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
- University Hospital Innsbruck-Tirol Kliniken, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Kristian Pfaller
- Department of Histology and Molecular Cell Biology, Institute of Anatomy and Histology, Medical University of Innsbruck, Innsbruck, Austria
| | - Annelies Schrott-Fischer
- Department of Otolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Head and Neck Surgery, section of Otolaryngology, Uppsala University Hospital, 751 85 Uppsala, Sweden
- Department of Neurology, Mental Health and Sensory Organs Otorhinolaryngologic Unit,, Medicine and Psychology Sapienza, Rome, Sweden
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Deep electrode insertion and sound coding in cochlear implants. Hear Res 2015; 322:14-23. [DOI: 10.1016/j.heares.2014.10.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
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The inferior cochlear vein: surgical aspects in cochlear implantation. Eur Arch Otorhinolaryngol 2015; 273:355-61. [DOI: 10.1007/s00405-015-3549-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
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Brown KD, Melton MF, Shonfield H, Kraskin M, Wolf J. Preserved Low-Frequency Hearing Following 20-mm Cochlear Implantation. Otol Neurotol 2015; 36:240-3. [DOI: 10.1097/mao.0000000000000684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nordfalk KF, Rasmussen K, Bunne M, Jablonski GE. Deep round window insertion versus standard approach in cochlear implant surgery. Eur Arch Otorhinolaryngol 2014; 273:43-50. [DOI: 10.1007/s00405-014-3451-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
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Atturo F, Barbara M, Rask-Andersen H. On the anatomy of the 'hook' region of the human cochlea and how it relates to cochlear implantation. Audiol Neurootol 2014; 19:378-85. [PMID: 25377867 DOI: 10.1159/000365585] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The optimal insertion route for an electrode array in hearing preservation cochlear implantation (CI) surgery is still tentative. Both cochleostomy (CO) and round window (RW) techniques are used today. In the present study we analyzed size variations and topographic anatomy of the 'hook' region of the human cochlea to better comprehend the Testo effects of various electric array insertion modes. MATERIAL AND METHODS Size variations of the cochlear 'hook' region were assessed in 23 human, microdissected temporal bones by measuring the distances between the oval and round windows, also outlining the spiral ligament/spiral lamina. Influence of size variations on spiral ligament position and fundamentals for different surgical approaches were evaluated in a subset of 'small' and 'large' cochleae performing different types of CO. In addition, the relationship between the microdissected accessory canal housing the inferior cochlear vein and the RW was analyzed. RESULTS The lateral vestibular wall and the cochlear 'hook' displayed large anatomic variations that greatly influenced the size of the potential surgical area. RESULTS showed that only very inferiorly located CO entered the scala tympani without causing trauma to the spiral ligament and spiral lamina. An inferior approach may challenge the inferior cochlear vein. CONCLUSION Preoperative assessment of the distance between the round and oval windows may direct the surgeon before CI hearing-preservation surgery. CO techniques, especially in 'small' ears, may lead to frequent damage to the inner ear structures. In those cases with substantial residual hearing, CI surgery may be better performed through a RW approach.
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Affiliation(s)
- Francesca Atturo
- Department of Mental Health and Sensory Organs, Otorhinolaryngologic Unit, Medicine and Psychology, Sapienza University of Rome, Sapienza, Rome, Italy
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Jurawitz MC, Büchner A, Harpel T, Schüssler M, Majdani O, Lesinski-Schiedat A, Lenarz T. Hearing preservation outcomes with different cochlear implant electrodes: Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422. Audiol Neurootol 2014; 19:293-309. [PMID: 25277083 DOI: 10.1159/000360601] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/11/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In recent years, it has been possible to preserve hearing after cochlear implantation in patients with significant amounts of low-frequency residual hearing. Due to the dimensions and characteristics of the cochlear implants (CIs) Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422, both can be used to preserve residual hearing. The aim was to investigate the degree and progression of hearing preservation over a longitudinal postoperative period in a large consecutive cohort of implanted patients with preoperative residual hearing who received either the Nucleus Hybrid-L24 or the Nucleus Freedom CI422 implant. The intention was to examine potential characteristics and triggers of resulting postoperative hearing loss which may support a differentiation of CI candidacy criteria for a certain implant type. METHODS A retrospective data analysis of patient files on consecutively implanted subjects presenting with a severe-to-profound sensorineural hearing loss at frequencies>1,500 Hz and substantial residual hearing at frequencies≤1,500 Hz, implanted with a Nucleus Hybrid-L24 (n=97) or a CI422 implant (n=100), was undertaken. A single-subject repeated-measure design comparing the mean threshold shift for pure-tone thresholds under headphones up to 24 months after implantation was used. RESULTS Hearing preservation is observed in the majority of subjects with either implant (250-1,500 Hz frequency range). Hybrid-L24 patients exhibited a median hearing loss of 10 dB at initial fitting (n=97) and of 15 dB after 24 months (n=51). A 14.4-dB decrease in median hearing loss at initial fitting (n=100) and a 30-dB decrease after 24 months (n=28) was observed with the CI422 electrode. At initial fitting, 54.6% of the Hybrid-L24 (n=97) and 49.0% of the CI422 (n=100) subjects showed a mean threshold shift<15 dB. After 24 months, 58.8% (Hybrid-L24, n=51) and 28.6% (CI422, n=28) of the patients showed a mean threshold shift<15 dB. CONCLUSIONS The results indicate that residual hearing was preserved for the majority of implanted patients with the Hybrid-L24 and the CI422 implant. Patients implanted with the Hybrid-L24 implant demonstrate greater stability and less median hearing loss over time than those with the CI422 implant. Assessments of onset and stability of hearing loss prior to implantation are important factors to consider during candidacy evaluation for electrode selection to potentially maximize the performance outcome for each patient.
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Usami SI, Moteki H, Tsukada K, Miyagawa M, Nishio SY, Takumi Y, Iwasaki S, Kumakawa K, Naito Y, Takahashi H, Kanda Y, Tono T. Hearing preservation and clinical outcome of 32 consecutive electric acoustic stimulation (EAS) surgeries. Acta Otolaryngol 2014; 134:717-27. [PMID: 24834939 PMCID: PMC4086239 DOI: 10.3109/00016489.2014.894254] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Conclusions Our results indicated that electric acoustic stimulation (EAS) is beneficial for Japanese-speaking patients, including those with less residual hearing at lower frequencies. Comparable outcomes for the patients with less residual hearing indicated that current audiological criteria for EAS could be expanded. Successful hearing preservation results, together with the progressive nature of loss of residual hearing in these patients, mean that minimally invasive full insertion of medium/long electrodes in cochlear implantation (CI) surgery is a desirable solution. The minimally invasive concepts that have been obtained through EAS surgery are, in fact, crucial for all CI patients. Objectives This study was conducted to evaluate hearing preservation results and speech discrimination outcomes of hearing preservation surgeries using medium/long electrodes. Methods A total of 32 consecutive minimally invasive hearing preservation CIs (using a round window approach with deep insertion of a flexible electrode) were performed in 30 Japanese patients (two were bilateral cases), including patients with less residual hearing. Hearing preservation rates as well as speech discrimination/perception scores were investigated on a multicenter basis. Results Postoperative evaluation after full insertion of the flexible electrodes (24 mm, 31.5 mm) showed that residual hearing was well preserved in all 32 ears. In all patients, speech discrimination and perception scores were improved postoperatively.
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Migirov L, Shapira Y, Wolf M. The feasibility of endoscopic transcanal approach for insertion of various cochlear electrodes: a pilot study. Eur Arch Otorhinolaryngol 2014; 272:1637-41. [PMID: 24619204 DOI: 10.1007/s00405-014-2995-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/01/2014] [Indexed: 11/30/2022]
Abstract
To determine the feasibility of inserting various types of electrode arrays using an endoscopic transcanal approach into the cochlea via the round window membrane (RWM). All the procedures were performed by the first author and started with a cortical mastoidectomy. A six o'clock vertical incision was made in the meatal skin, and a posterior tympano-meatal flap was elevated transmeatally to expose the middle ear cavity using a rigid 0° endoscope (diameter 3 mm, length 14 cm). The chorda tympani nerve (CTN) and body of the incus were exposed. The RWM was incised, and the electrodes were passed through the tunnel from the mastoid to the epitympanum, medial to the CTN and lateral to the incus into the round window (RW) in seven procedures. In the other six cases, an open groove had been drilled, starting superiorly and laterally to the CTN and ending in the mastoid region. After electrodes insertion, the groove was filled with bone dust and covered with a large piece of fascia prior to repositioning of the tympano-meatal flap. Complete electrode insertion (7 Nucleus Contour Advance, 5 Concerto and 1 HiRes90K) via the RW was achieved in all 13 cases. Endoscopic CI was more feasible for insertion of concerto electrode followed by HiRes90K and Nucleus. An assistance of another surgeon was required for removal of stylet in the "off-the-stylet technique" utilized for implantation of nucleus electrode. Endoscopic transcanal implantation of different cochlear electrodes through the RW is feasible in both children and adults and can be used as first surgical option or as a complementary to the traditional posterior tympanotomy approach.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Aviv University, Affiliated to Sackler School of Medicine, 5262l, Tel Hashomer, Israel,
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Localization and interaural time difference (ITD) thresholds for cochlear implant recipients with preserved acoustic hearing in the implanted ear. Hear Res 2014; 312:28-37. [PMID: 24607490 DOI: 10.1016/j.heares.2014.02.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/15/2014] [Accepted: 02/26/2014] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to investigate horizontal plane localization and interaural time difference (ITD) thresholds for 14 adult cochlear implant recipients with hearing preservation in the implanted ear. Localization to broadband noise was assessed in an anechoic chamber with a 33-loudspeaker array extending from -90 to +90°. Three listening conditions were tested including bilateral hearing aids, bimodal (implant + contralateral hearing aid) and best aided (implant + bilateral hearing aids). ITD thresholds were assessed, under headphones, for low-frequency stimuli including a 250-Hz tone and bandpass noise (100-900 Hz). Localization, in overall rms error, was significantly poorer in the bimodal condition (mean: 60.2°) as compared to both bilateral hearing aids (mean: 46.1°) and the best-aided condition (mean: 43.4°). ITD thresholds were assessed for the same 14 adult implant recipients as well as 5 normal-hearing adults. ITD thresholds were highly variable across the implant recipients ranging from the range of normal to ITDs not present in real-world listening environments (range: 43 to over 1600 μs). ITD thresholds were significantly correlated with localization, the degree of interaural asymmetry in low-frequency hearing, and the degree of hearing preservation related benefit in the speech reception threshold (SRT). These data suggest that implant recipients with hearing preservation in the implanted ear have access to binaural cues and that the sensitivity to ITDs is significantly correlated with localization and degree of preserved hearing in the implanted ear.
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Edfeldt L, Strömbäck K, Grendin J, Bunne M, Harder H, Peebo M, Eeg-Olofsson M, Petersson CM, Konradsson K. Evaluation of cost-utility in middle ear implantation in the 'Nordic School': a multicenter study in Sweden and Norway. Acta Otolaryngol 2014; 134:19-25. [PMID: 24256038 DOI: 10.3109/00016489.2013.834459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Hearing restoration using an active middle ear implant (AMEI) is a highly cost-effective treatment for a selected group of patients with no other possibilities for auditory rehabilitation. OBJECTIVES To evaluate the cost-utility of using an AMEI for hearing rehabilitation. METHODS This was a prospective, multicenter, single-subject repeated study in six tertiary referral centers. Twenty-four patients with sensorineural (SNHL), conductive (CHL), and mixed hearing loss (MHL) were implanted with the AMEI Vibrant Soundbridge® (VSB) for medical reasons. All patients were previously rehabilitated with conventional hearing aids. Multiple validated quality of life patient questionnaires, Health Utilities Index (HUI 2 and 3), and Glasgow Hearing Aid Benefit Profile (GHABP) were used to determine the utility gain and quality adjusted life years (QALY). Directly related treatment costs for the implantation were calculated and related to utility gain and QALY. RESULTS The cost/QALY for patients with SNHL was estimated at €7260/QALY, and for patients with C/MHL at €12 503/QALY.
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Affiliation(s)
- Lennart Edfeldt
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital , Uppsala , Sweden
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Pau HW, Grünbaum A, Ehrt K, Dahl R, Just T, van Rienen U. Would an endosteal CI-electrode make sense? Comparison of the auditory nerve excitability from different stimulation sites using ESRT measurements and mathematical models. Eur Arch Otorhinolaryngol 2013; 271:1375-81. [PMID: 23657576 DOI: 10.1007/s00405-013-2543-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Regarding potential endosteal cochlear implant electrodes, the primary goal of this paper is to compare different intra- and extra-cochlear stimulation sites in terms of current strengths needed for stimulating the auditory nerve. Our study was performed during routine cochlear implantation using needle electrodes for electric stimulation and by visually recording electrically elicited stapedius reflexes (ESRT) as a measure for the stimulus transfer. Of course this rather simple setup only allows rough estimations, which, however, may provide further arguments whether or not to proceed with the concept of an endosteal electrode. In addition, a mathematical model is being developed. In a pilot study, intra-operative electric stimuli were applied via a needle electrode commonly used for the promontory stimulation test. Thus, stapedius reflex thresholds (ESRTs), electrically elicited via the needle from different points inside and outside the cochlea served as indicators for the suitability of different electrode positions towards the modiolus. Tests were performed on 11 CI-recipients. In addition, the extension of electrical fields from different stimulation sites is simulated in a mathematical cochlea model. In most patients ESRT measurements could be performed and evaluated. Thus an "endosteal" stimulation seems possible, although the current intensities must be higher than at intraluminal stimulation sites. Moreover, our model calculations confirm that the extension of electric fields is less favourable with increasing distance from the electrode to the ganglion nerve cells. In terms of hearing, the concept of an endosteal electrode should only be promoted, if its superiority for hearing preservation can be proven, e.g. in animal experiments. However, for other indications like the electric suppression of tinnitus, further research seems advisable. LEVELS OF EVIDENCE N/A.
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Affiliation(s)
- Hans Wilhelm Pau
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Doberaner Strasse, 137-139, 18057, Rostock, Germany,
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