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Geerardyn A, Zhu M, Verhaert N, Quesnel AM. Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes. Otol Neurotol 2024; 45:245-255. [PMID: 38270168 PMCID: PMC10922381 DOI: 10.1097/mao.0000000000004102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
HYPOTHESIS Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis. BACKGROUND The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this. METHODS Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point. RESULTS Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the -26 to -18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations. CONCLUSION OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
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Affiliation(s)
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Gupta A, Samdani S, Sharma S, Grover M, Soni S, Hada MS, Kumar A. Round Window Visibility in Cochlear Implantation : Pre-operative Prediction Using Various Radiological Parameters. Indian J Otolaryngol Head Neck Surg 2024; 76:781-787. [PMID: 38440579 PMCID: PMC10908965 DOI: 10.1007/s12070-023-04280-5] [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: 08/16/2023] [Accepted: 10/08/2023] [Indexed: 03/06/2024] Open
Abstract
Purpose The round window approach has become the most preferred route for electrode insertion in cochlear implant surgery; however, it is not possible at times due to difficult round window membrane (RWM) visibility. Our study aims to investigate the relationship between preoperative radiological parameters and the surgical visibility of the RWM in Cochlear implant patients. Methodology A prospective cross-sectional study of 31 patients, age < 6 years, with bilateral severe to profound sensorineural hearing loss was conducted at a tertiary care hospital. The preoperative HRCT temporal bone scan was studied, and the parameters evaluated were facial nerve location, facial recess width, and RWM visibility prediction. All patients were operated on via the posterior tympanotomy. The surgical RWM visibility was done after optimal drilling of the posterior tympanotomy recess. The relationship between the radiological parameters and surgical visibility of RWM was evaluated. Results The difference in the facial nerve location as per the type of RWM was found to be significant (p value < 0.05). However, the facial recess width was not significantly associated with RWM visibility. The radiological prediction of RWM visibility by tracing the prediction line over RWM was significantly associated with intraoperative RWM visibility. Conclusion The goal to look for preoperative scans is to predict the ease or difficulty of RWM visibility during surgery. The difficult visualization of the RWM, can result in dire intraoperative consequences. A comprehensive understanding of preoperative radiological parameters, coupled with meticulous surgical planning, is crucial to address these challenges effectively by focusing on enhancing RWM visualization.
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Affiliation(s)
- Anjali Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Sunil Samdani
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Shivam Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Mohnish Grover
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Samanvaya Soni
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Mahendra Singh Hada
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
| | - Amit Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, S.M.S. Medical College and Attached Hospitals, A-1, New Heera Bagh Flats, Jaipur, Rajasthan 302004 India
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Maccarrone F, Molinari G, Fermi M, Alicandri-Ciufelli M, Presutti L, Tassi S, Villari D, Negri M. Surgical anatomy of posterior tympanotomy: influence of the retrotympanum on round window exposure. J Laryngol Otol 2024; 138:142-147. [PMID: 37246511 DOI: 10.1017/s0022215123000944] [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: 05/30/2023]
Abstract
OBJECTIVES To describe how the retrotympanic structures could influence the visibility of the round window niche and the round window membrane during cochlear implant surgery, and to investigate if a round window approach is possible even in cases with unfavourable anatomy. METHODS Video recordings from 37 patients who underwent cochlear implantation were reviewed. The visibility of the round window niche and round window membrane at different timepoints was assessed according to a modified version of the Saint Thomas Hospital classification. The structures that concealed the round window niche and round window membrane were evaluated. RESULTS After posterior tympanotomy, 54 per cent of cases had limited exposure (classes IIa, IIb and III) of the round window niche. After remodelling the retrotympanum, round window niche visibility significantly increased, with 100 per cent class I and IIa cases. Following remodelling of the round window niche, visibility of more than 50 per cent of the round window membrane surface was achieved in 100 per cent of cases. CONCLUSION Remodelling the retrotympanum and the round window niche significantly increased exposure of the round window niche and round window membrane respectively, allowing round window insertion in all cases.
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Affiliation(s)
- Francesco Maccarrone
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
| | - Giulia Molinari
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - Sauro Tassi
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
| | - Domenico Villari
- Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Maurizio Negri
- Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale 'Ramazzini' di Carpi, Carpi (MO), Italy
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Geerardyn A, Zhu M, Klabbers T, Huinck W, Mylanus E, Nadol JB, Verhaert N, Quesnel AM. Human Histology after Structure Preservation Cochlear Implantation via Round Window Insertion. Laryngoscope 2024; 134:945-953. [PMID: 37493203 DOI: 10.1002/lary.30900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Current surgical techniques aim to preserve intracochlear structures during cochlear implant (CI) insertion to maintain residual cochlear function. The optimal technique to minimize damage, however, is still under debate. The aim of this study is to histologically compare insertional trauma and intracochlear tissue formation in humans with a CI implanted via different insertion techniques. METHODS One recent temporal bone from a donor who underwent implantation of a full-length CI (576°) via round window (RW) insertion was compared with nine cases implanted via cochleostomy (CO) or extended round window (ERW) approach. Insertional trauma was assessed on H&E-stained histological sections. 3D reconstructions were generated and virtually re-sectioned to measure intracochlear volumes of fibrosis and neo-ossification. RESULTS The RW insertion case showed electrode translocation via the spiral ligament. 2/9 CO/ERW cases showed no insertional trauma. The total volume of the cochlea occupied by fibro-osseous tissue was 10.8% in the RW case compared with a mean of 30.6% (range 8.7%-44.8%, N = 9) in the CO/ERW cases. The difference in tissue formation in the basal 5 mm of scala tympani, however, was even more pronounced when the RW case (12.3%) was compared with the cases with a CO/ERW approach (mean of 93.8%, range 81% to 100%, N = 9). CONCLUSIONS Full-length CI insertions via the RW can be minimally traumatic at the cochlear base without inducing extensive fibro-osseous tissue formation locally. The current study further supports the hypothesis that drilling of the cochleostomy with damage to the endosteum incites a local tissue reaction. LEVEL OF EVIDENCE 4: Case-control study Laryngoscope, 134:945-953, 2024.
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Affiliation(s)
- Alexander Geerardyn
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Tim Klabbers
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Nicolas Verhaert
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Kwok BYC, Young AS, Kong JHK, Birman CS, Flanagan S, Greenberg SL, Gibson WP, Argaet EC, Fratturo L, Pogson JM, Taylor RL, Rosengren SM, Halmagyi GM, Welgampola MS. Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics. Otol Neurotol 2024; 45:65-74. [PMID: 37853785 DOI: 10.1097/mao.0000000000004037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). STUDY DESIGN Retrospective and prospective case series. PATIENTS Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. INTERVENTIONS Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. MAIN OUTCOME MEASURES Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. RESULTS Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s).VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. CONCLUSION High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
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Affiliation(s)
| | | | | | | | - Sean Flanagan
- Department of Otolaryngology, Head and Neck, and Skull Base Surgery, St Vincent's Public Hospital, Sydney
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Espina González C, Morant Ventura A, Pla Gil I, Aragonés Redó M, Pérez Carbonell T, Marco Algarra J. Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:23-30. [PMID: 38224870 DOI: 10.1016/j.otoeng.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/29/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The maximum comfort level (MCL), threshold level (THR) and electrical impedance change in the postoperative period of the cochlear implant for months until they stabilize. The objective of this article is to establish the variation during 5 post-surgical years of impedance, and its relationship with MCL in unilaterally implanted adults. METHODS Retrospective study over 5 years, with 78 adult patients implanted with MED-EL in a tertiary hospital from the year 2000 to 2015. The variation in impedance, MCL and the relationship between them were analyzed in basal (9-12), medial (5-8) and apical electrodes (1-4), performing an inferential ANOVA analysis of repeated measures with comparisons between consecutive times, corrected with Bonferroni criteria. RESULTS 33 men (42.3%) and 45 women (57.7%), with a mean age of 52.7±14.6 years. "Stability" was considered the time of follow-up without statistically significant differences between one visit and the next. Changes in impedance in medial electrodes ceased to be statistically significant at 3 months, and in apicals at 6 months, with mean values of 5.84 and 6.43kΩ. MCL stabilized at 2 years in basal and apical electrodes, and at 3 years in medial, with mean values of 24.9, 22.7, and 25.6qu. There was a correlation between MCL and impedance in medium electrodes up to 3 months and in apical ones up to one year. CONCLUSIONS Electrical impedance drops significantly in medial and apical electrodes up to 3 and 6 months. MCL increases significantly up to two years. Impedance is related to MCL up to 6 months.
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Affiliation(s)
- Clara Espina González
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Servicio de Otorrinolaringología, Hospital del Mar, Barcelona, Spain.
| | - Antonio Morant Ventura
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Ignacio Pla Gil
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - María Aragonés Redó
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Servicio de Otorrinolaringología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Tomás Pérez Carbonell
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Jaime Marco Algarra
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
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Donati G, Nassif N, Redaelli de Zinis LO. Osteoneogenesis at the Round Window: A Possible Cause of Cochlear Implant Failure? Audiol Res 2023; 14:1-8. [PMID: 38391764 PMCID: PMC10886216 DOI: 10.3390/audiolres14010001] [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: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
Surgery for cochlear implant is a traumatic procedure, with inflammatory responses leading to immediate and delayed intracochlear changes, resulting in newly formed fibrous and bony tissue. This newly formed tissue is thought to affect speech perception with cochlear implants and can also play a role in causing device malfunctioning and soft failures. We present a case of left cochlear implant explantation and reimplantation in a 15-year-old girl, who experienced deterioration of speech perception and device failure associated with osteoneogenesis of the round window, which could represent a cause of cochlear implant failure. To avoid surgical trauma of the cochlear lateral wall, enlarged round window insertion rather than a cochleostomy, soft surgical techniques, and the application of steroids are all important issues to prevent new tissue formation, although special attention should also be given to the trauma of round window borders.
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Affiliation(s)
- Giulia Donati
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Audiology, University of Brescia, 25100 Brescia, Italy
| | - Nader Nassif
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Audiology, University of Brescia, 25100 Brescia, Italy
| | - Luca Oscar Redaelli de Zinis
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Audiology, University of Brescia, 25100 Brescia, Italy
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Park KW, Kullar P, Malhotra C, Stankovic KM. Current and Emerging Therapies for Chronic Subjective Tinnitus. J Clin Med 2023; 12:6555. [PMID: 37892692 PMCID: PMC10607630 DOI: 10.3390/jcm12206555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
IMPORTANCE Chronic subjective tinnitus, the perception of sound without an external source for longer than six months, may be a greatly debilitating condition for some people, and is associated with psychiatric comorbidities and high healthcare costs. Current treatments are not beneficial for all patients and there is a large need for new therapies for tinnitus. OBSERVATIONS Unlike rarer cases of objective tinnitus, chronic subjective tinnitus often has no obvious etiology and a diverse pathophysiology. In the absence of objective testing, diagnosis is heavily based on clinical assessment. Management strategies include hearing aids, sound masking, tinnitus retraining therapy, cognitive behavioral therapy, and emerging therapies including transcranial magnetic stimulation and electrical stimulation. CONCLUSIONS AND RELEVANCE Although current treatments are limited, emerging diagnostics and treatments provide promising avenues for the management of tinnitus symptoms.
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Affiliation(s)
- Ki Wan Park
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Peter Kullar
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Charvi Malhotra
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Konstantina M. Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA
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Sagi V, Kosaraju N, Moore LS, Mulders JY, Solyali M, Ma X, Regula DP, Hooper JE, Stankovic KM. Mortui vivos docent: a modern revival of temporal bone plug harvests. Front Neurosci 2023; 17:1242831. [PMID: 37886674 PMCID: PMC10598599 DOI: 10.3389/fnins.2023.1242831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 10/28/2023] Open
Abstract
Human temporal bones (HTBs) are invaluable resources for the study of otologic disorders and for evaluating novel treatment approaches. Given the high costs and technical expertise required to collect and process HTBs, there has been a decline in the number of otopathology laboratories. Our objective is to encourage ongoing study of HTBs by outlining the necessary steps to establish a pipeline for collection and processing of HTBs. In this methods manuscript, we: (1) provide the design of a temporal bone plug sawblade that can be used to collect specimens from autopsy donors; (2) establish that decalcification time can be dramatically reduced from 9 to 3 months if ethylenediaminetetraacetic acid is combined with microwave tissue processing and periodic bone trimming; (3) show that serial sections of relatively-rapidly decalcified HTBs can be successfully immunostained for key inner ear proteins; (4) demonstrate how to drill down a HTB to the otic capsule within a few hours so that subsequent decalcification time can be further reduced to only weeks. We include photographs and videos to facilitate rapid dissemination of the developed methods. Collected HTBs can be used for many purposes, including, but not limited to device testing, imaging studies, education, histopathology, and molecular studies. As new technology develops, it is imperative to continue studying HTBs to further our understanding of the cellular and molecular underpinnings of otologic disorders.
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Affiliation(s)
- Varun Sagi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Nikitha Kosaraju
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Lindsay S. Moore
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Jip Y. Mulders
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Mehmet Solyali
- Department of Physics, Stanford University School of Humanities and Sciences, Stanford, CA, United States
| | - Xiaojie Ma
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, United States
| | - Donald P. Regula
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jody E. Hooper
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Konstantina M. Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, United States
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Hashemi SB, Janipour M, Jahangiri R, Babaei A. The effect of cochlear implant insertion technique on post-operative neural response telemetry and impedance in paediatric patients. J Laryngol Otol 2023; 137:363-367. [PMID: 35445650 DOI: 10.1017/s0022215122000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to compare neural response telemetry and impedance between the round window and cochleostomy approaches for cochlear implantation. METHODS In this case-control study, 64 patients aged less than 3.5 years underwent cochlear implantation via the round window or cochleostomy approach. Post-operative neural response telemetry and impedance were measured. RESULTS The impedance measurements at electrodes 1, 11 and 22 showed no significant differences between the two groups three months after implantation (p = 0.90, p = 0.08 and p = 0.37, respectively). Similar results were observed six months after implantation (p = 0.71, p = 0.65 and p = 0.70, respectively). There was no significant difference in neural response telemetry between the two groups after three months. The neural response telemetry of electrode 1 in the cochleostomy group (171.26 ± 19.81 μV) was significantly higher in comparison with that of electrode 1 in the round window group (161.97 ± 12.71 μV) after six months (p = 0.03). The neural response telemetry values for electrodes 11 and 22 did not show any significant difference after six months (p = 0.14 and p = 0.48, respectively). CONCLUSION Both approaches provide equal stimulation of the cochlear nerve and impedance.
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Affiliation(s)
- S B Hashemi
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Janipour
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R Jahangiri
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Babaei
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Kataria T, Sharma S, Lakhawat RS, Grover M, Sharma S, Kanodia A, Agarwal S, Samdani S. A Study of Round Window and its Adjacent Anatomy to Guide the Cochlear Implant Electrode Insertion. Indian J Otolaryngol Head Neck Surg 2023; 75:163-169. [PMID: 37206735 PMCID: PMC10188745 DOI: 10.1007/s12070-022-03288-7] [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: 09/27/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Residual hearing preservation has gained attention now which has brought round window membrane into the light, as a port for cochlear implantation. Atraumatic insertion of electrodes can be achieved by study of anatomical variations of round window and its forms which can guide the surgeon. Objective This study was undertaken to examine the anatomical variations of round window and its adjacent structures and their impact on surgical approach during cochlear implantation. Methods A series of 40 adult human temporal bones underwent high-resolution CT scanning and were further dissected for microscopic study of the round window. Results The antero posterior dimensions of RW ranged from 1.22 to 2.51 mm on radiology and on dissection 1.76 mm +/- 0.3 mm. Shape of round window in 72.5% of bones was oval, and in 27.5% bones it was round shaped. As per Saint Thomas hospital classification for Round window visualization we found 82.5% bones had type I RW visualization and 17.5% had type IIa RW visualization. Area of crista fenestra on dissection was ranging from 0.41 to 0.69 mm2. Conclusion Residual hearing preservation has become a new motto for surgeons. Therefore thorough anatomic knowledge of round window is must for careful insertion, as round window is closely related to the sensitive inner ear structures.
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Affiliation(s)
- Tanmaya Kataria
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
| | - Shitanshu Sharma
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
| | - Rajendra Singh Lakhawat
- Department of Otorhinolaryngology, RVRS Government Medical College, Bhilwara, Rajasthan India
| | - Mohnish Grover
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
- 8/250, Sector 8, Malviya Nagar Jaipur, Rajasthan 302017 Jaipur, India
| | - Shivam Sharma
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
| | | | - Srishti Agarwal
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
| | - Sunil Samdani
- Department of Otorhinolaryngology, SMS Medical college, Jaipur, Rajasthan India
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12
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Ishiyama P, Ishiyama G, Lopez IA, Ishiyama A. Archival Human Temporal Bone: Anatomical and Histopathological Studies of Cochlear Implantation. J Pers Med 2023; 13:352. [PMID: 36836587 PMCID: PMC9959196 DOI: 10.3390/jpm13020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Since being FDA approved in 1984, cochlear implantation has been used successfully to restore hearing in those with severe to profound hearing loss with broader applications including single-sided deafness, the use of hybrid electroacoustic stimulation, and implantation at all extremes of age. Cochlear implants have undergone multiple changes in the design aimed at improving the processing technology, while simultaneously minimizing the surgical trauma and foreign body reaction. The following review examines the human temporal bone studies regarding the anatomy of the human cochlea and how the anatomy relates to cochlear implant design, the factors related to complications after implantation, and the predictors of new tissue formation and osteoneogenesis. Histopathological studies are reviewed which aim to understand the potential implications of the effects of new tissue formation and inflammation following implantation.
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Affiliation(s)
- Paul Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Ivan A. Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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13
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Jwair S, Ramekers D, Thomeer HGXM, Versnel H. Acute effects of cochleostomy and electrode-array insertion on compound action potentials in normal-hearing guinea pigs. Front Neurosci 2023; 17:978230. [PMID: 36845413 PMCID: PMC9945226 DOI: 10.3389/fnins.2023.978230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Electrocochleography (ECochG) is increasingly used in cochlear implant (CI) surgery, in order to monitor the effect of insertion of the electrode array aiming to preserve residual hearing. However, obtained results are often difficult to interpret. Here we aim to relate changes in ECochG responses to acute trauma induced by different stages of cochlear implantation by performing ECochG at multiple time points during the procedure in normal-hearing guinea pigs. Materials and methods Eleven normal-hearing guinea pigs received a gold-ball electrode that was fixed in the round-window niche. ECochG recordings were performed during the four steps of cochlear implantation using the gold-ball electrode: (1) Bullostomy to expose the round window, (2) hand-drilling of 0.5-0.6 mm cochleostomy in the basal turn near the round window, (3) insertion of a short flexible electrode array, and (4) withdrawal of electrode array. Acoustical stimuli were tones varying in frequency (0.25-16 kHz) and sound level. The ECochG signal was primarily analyzed in terms of threshold, amplitude, and latency of the compound action potential (CAP). Midmodiolar sections of the implanted cochleas were analyzed in terms of trauma to hair cells, modiolar wall, osseous spiral lamina (OSL) and lateral wall. Results Animals were assigned to cochlear trauma categories: minimal (n = 3), moderate (n = 5), or severe (n = 3). After cochleostomy and array insertion, CAP threshold shifts increased with trauma severity. At each stage a threshold shift at high frequencies (4-16 kHz) was accompanied with a threshold shift at low frequencies (0.25-2 kHz) that was 10-20 dB smaller. Withdrawal of the array led to a further worsening of responses, which probably indicates that insertion and removal trauma affected the responses rather than the mere presence of the array. In two instances, CAP threshold shifts were considerably larger than threshold shifts of cochlear microphonics, which could be explained by neural damage due to OSL fracture. A change in amplitudes at high sound levels was strongly correlated with threshold shifts, which is relevant for clinical ECochG performed at one sound level. Conclusion Basal trauma caused by cochleostomy and/or array insertion should be minimized in order to preserve the low-frequency residual hearing of CI recipients.
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Affiliation(s)
- Saad Jwair
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Dyan Ramekers
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Huib Versnel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands,UMC Utrecht Brain Center, Utrecht University, Utrecht, Netherlands,*Correspondence: Huib Versnel,
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14
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Geerardyn A, Zhu M, Wu P, O'Malley J, Nadol JB, Liberman MC, Nakajima HH, Verhaert N, Quesnel AM. Three-dimensional quantification of fibrosis and ossification after cochlear implantation via virtual re-sectioning: Potential implications for residual hearing. Hear Res 2023; 428:108681. [PMID: 36584546 PMCID: PMC10942756 DOI: 10.1016/j.heares.2022.108681] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Hearing preservation may be achieved initially in the majority of patients after cochlear implantation, however, a significant proportion of these patients experience delayed hearing loss months or years later. A prior histological report in a case of delayed hearing loss suggested a potential cochlear mechanical origin of this hearing loss due to tissue fibrosis, and older case series highlight the frequent findings of post-implantation fibrosis and neoosteogenesis though without a focus on the impact on residual hearing. Here we present the largest series (N = 20) of 3-dimensionally reconstructed cochleae based on digitally scanned histologic sections from patients who were implanted during their lifetime. All patients were implanted with multichannel electrodes via a cochleostomy or an extended round window insertion. A quantified analysis of intracochlear tissue formation was carried out via virtual re-sectioning orthogonal to the cochlear spiral. Intracochlear tissue formation was present in every case. On average 33% (SD 14%) of the total cochlear volume was occupied by new tissue formation, consisting of 26% (SD 12%) fibrous and 7% (SD 6%) bony tissue. The round window was completely covered by fibro-osseous tissue in 85% of cases and was associated with an obstruction of the cochlear aqueduct in 100%. The basal part of the basilar membrane was at least partially abutted by the electrode or new tissue formation in every case, while the apical region, corresponding with a characteristic frequency of < 500 Hz, appeared normal in 89%. This quantitative analysis shows that after cochlear implantation via extended round window or cochleostomy, intracochlear fibrosis and neoossification are present in all cases at anatomical locations that could impact normal inner ear mechanics.
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Affiliation(s)
- A Geerardyn
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA; ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - M Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - P Wu
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, USA
| | - J O'Malley
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - J B Nadol
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - M C Liberman
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, USA
| | - H H Nakajima
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, USA
| | - N Verhaert
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - A M Quesnel
- Department of Otolaryngology - Head & Neck Surgery, Harvard Medical School, Boston, MA, USA; Otopathology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA.
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15
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Elafandi H, Khalifa MA, Elnaggar A, Gamea M, Ebeid K, Tomoum MO. A modified form of the St Thomas' Hospital (STH) classification to improve cochlear implantation outcomes. Int J Pediatr Otorhinolaryngol 2023; 164:111375. [PMID: 36401999 DOI: 10.1016/j.ijporl.2022.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES re-evaluation and modification of the St Thomas' Hospital (STH) classification to improve cochlear implantation outcomes. STUDY DEIGN: a prospective cohort study. PATIENTS children (n = 20) between 2 to 8 years old who received a unilateral cochlear implant, all had difficult round window visibility and/or accessibility for electrode insertion. 10 had a round window insertion through the endoscopic assisted cochlear implantation and the remaining 10 had the same insertion using the retro-facial approach. THE SURGERY: two alternative techniques were used to overcome the difficult cases of round window electrode insertion: 1Endoscopic assisted cochlear implantation 2Transmastoid retro-facial approach RESULTS: both techniques proved to be effective and practical to overcome cases with difficult round window visibility and/or accessibility for electrode insertion. CONCLUSION Round window insertion is associated with superior cochlear implantation outcomes, so we recommend a new modification to the STH classification to bypass the cochleostomy insertion.
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Affiliation(s)
| | | | | | - Mohamed Gamea
- Misr University for Science and Technology, College of Medicine, Egypt.
| | - Kamal Ebeid
- Tanta University Faculty of Medicine, Tanta, Egypt.
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16
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Wong YT, Lopez IA, Wichova H, Ishiyama A, Miller ME. Endolymphatic Hydrops in the Setting of Vestibular Schwannoma: A Temporal Bone Study. Otol Neurotol 2023; 44:81-85. [PMID: 36509446 PMCID: PMC9757844 DOI: 10.1097/mao.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
HYPOTHESIS Vestibular schwannoma (VS) may be associated with endolymphatic hydrops (EH). EH may account for symptomatology in a subset of patients with VS. BACKGROUND Presenting symptoms of VS and EH overlap, and MRI evaluation of the membranous labyrinth in some patients with VS demonstrates EH. The aim of the current study is to evaluate whether EH is present in temporal bones of patients with VS. METHODS The NIDCD and House Temporal Bone Laboratory at UCLA Eccles database was queried for the diagnosis of "acoustic neuroma." Exclusion criteria included concomitant ear disease and surgery. Temporal bones were analyzed for EH of the basal, middle, and apical turns and vestibule. Premortem audiometric and clinical data were gathered. RESULTS Of 43 human temporal bones with VS, 6 met inclusion criteria. All temporal bones demonstrated VS that was undisturbed by surgery. Three of six demonstrated EH of at least one cochlear turn as well as vestibular hydrops. Three patients had severe to profound hearing loss. One patient carried a diagnosis of Menière's disease. CONCLUSIONS EH is demonstrated in the setting of VS in human temporal bones. EH may be one mechanism of hearing loss and dizziness in patients with VS. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED The underlying mechanisms of symptoms of VS may be multifactorial. The association of EH in some patients with VS would modify our clinical approach to management. LEARNING OBJECTIVE To discover if EH may be associated with VS. DESIRED RESULT To broaden understanding of pathophysiologic mechanisms in patients with VS. LEVEL OF EVIDENCE Level IVIRB Approved: UCLA IRB No. 10-001449.
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17
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Muacevic A, Adler JR, Alsalhi HS, Hagr A. Cochlear Implant Induced Labyrinthine Ossificans in Mondini Malformation: A Case Series. Cureus 2022; 14:e32648. [PMID: 36654620 PMCID: PMC9842388 DOI: 10.7759/cureus.32648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Cochlear implantation is relatively a safe procedure with a favorable outcome. Labyrinthine ossification is one of the rare complications that has been observed in some occasions post-cochlear implantation. This paper report two cases of Mondini inner ear malformation cochlear implant failure associated with labyrinthine ossification, mandating revision surgery, and a literature review focusing on the reported cases, risk factors, surgical and non-surgical measures to mitigate this complication and to improve overall cochlear implant outcomes.
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18
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Saki N, Shirani M, Kardooni M, Mirmoemeni G, Bayat A. The effects of cochlear implantation on middle ear function: A prospective study. Int J Pediatr Otorhinolaryngol 2022; 163:111368. [PMID: 36327914 DOI: 10.1016/j.ijporl.2022.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although sound conduction mechanisms may influence by cochlear implantation (CI), it is not very clear whether, how, and to what extent these mechanisms may be influenced the pediatric population. Wideband tympanometry (WBT) is a sensitive tool to evaluate alternations in the middle ear mechanics in a wide frequency range. The current study aimed to explore CI's impacts on sound conduction across the middle ear cavity using WBT in pediatrics. METHODS In a prospective design, 35 unilaterally implanted children (<24 months of age) with normal temporal bone anatomy were included in this study. Traditional tympanometry (226-Hz) and WBT measures were compared for each child in the implanted and non-implanted ears preoperatively and three months postoperatively. RESULTS No significant changes in the "static acoustic admittance" and "peak pressure" parameters were observed between the pre-CI and post-CI conditions in the implanted and non-implanted ears in the 226-Hz tympanometry test. Wideband absorbance recordings before CI surgery exhibited a double-peaked pattern over a frequency range of 250 to 8000 Hz. The pre- and postoperative acoustic energy absorbance comparisons indicated a significantly reduced mid-frequency (1260 to 3175 Hz) and high-frequency (5040 to 8000 Hz) absorbance in the implanted ears. However, our results indicated no significant differences in sound absorbance between the pre- and postoperative conditions in non-implanted ears. CONCLUSION Our findings suggested that WBT is a more sensitive method than traditional tympanometry for monitoring the mechanical status of the middle ear after cochlear implantation in pediatrics. Cochlear implantation in young children can significantly reduce mid- and high-frequency acoustic absorbance measured by WBT.
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Affiliation(s)
- Nader Saki
- Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Hearing Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahshid Shirani
- Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Kardooni
- Department of Otolaryngology, Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Golshan Mirmoemeni
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash Bayat
- Hearing Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Audiology, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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19
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The effect of the surgical approach and cochlear implant electrode on the structural integrity of the cochlea in human temporal bones. Sci Rep 2022; 12:17068. [PMID: 36224234 PMCID: PMC9556579 DOI: 10.1038/s41598-022-21399-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
Cochlear implants (CI) restore hearing of severely hearing-impaired patients. Although this auditory prosthesis is widely considered to be very successful, structural cochlear trauma during cochlear implantation is an important problem, reductions of which could help to improve hearing outcomes and to broaden selection criteria. The surgical approach in cochlear implantation, i.e. round window (RW) or cochleostomy (CO), and type of electrode-array, perimodiolar (PM) or lateral wall (LW), are variables that might influence the probability of severe trauma. We investigated the effect of these two variables on scalar translocation (STL), a specific type of severe trauma. Thirty-two fresh frozen human cadaveric ears were evenly distributed over four groups receiving either RW or CO approach, and either LW or PM array. Conventional radiological multiplanar reconstruction (MPR) was compared with a reconstruction method that uncoils the spiral shape of the cochlea (UCR). Histological analysis showed that RW with PM array had STL rate of 87% (7/8), CO approach with LW array 75% (6/8), RW approach with LW array 50% (4/8) and CO approach with PM array 29% (2/7). STL assessment using UCR showed a higher inter-observer and histological agreement (91 and 94% respectively), than that using MPR (69 and 74% respectively). In particular, LW array positions were difficult to assess with MPR. In conclusion, the interaction between surgical approach and type of array should be preoperatively considered in cochlear implant surgery. UCR technique is advised for radiological assessment of CI positions, and in general it might be useful for pathologies involving the inner ear or other complex shaped bony tubular structures.
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20
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Prevalence of Endolymphatic Hydrops in Cochlear Implant Candidates with Idiopathic Profound Sensorineural Hearing Loss. Otol Neurotol 2022; 43:e984-e991. [PMID: 36006776 DOI: 10.1097/mao.0000000000003658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the prevalence of endolymphatic hydrops (EH) in cochlear implant (CI) candidates with idiopathic profound sensorineural hearing loss (SNHL) and its influence on the preservation of audiovestibular function after cochlear implantation. STUDY DESIGN Prospective case series. SETTING Tertiary referral center. PATIENTS CI candidates with idiopathic progressive SNHL, but without classic EH-associated symptoms. INTERVENTIONS Delayed intravenous gadolinium-enhanced inner ear fluid-attenuated inversion recovery magnetic resonance imaging as well as pure-tone audiograms, video head impulse tests, and vestibular evoked myogenic potentials before and 4 weeks after cochlear implantation. MAIN OUTCOME MEASURES Prevalence of EH before cochlear implantation, audiovestibular function before and after surgery in hydropic and nonhydropic ears. RESULTS Thirty-two ears in 16 CI candidates were included. Nine ears (28%) with EH were detected. Although preoperative hearing thresholds, utricular function, and semicircular canal function were not different between the two groups, saccular function was reduced in hydropic ears. Ten subjects received a unilateral CI. Of these, 3 (30%) showed EH on the implanted side. There was no difference regarding postoperative hearing loss between the two groups, but the results point toward a higher vulnerability of hydropic ears with respect to loss of otolith function after cochlear implantation. CONCLUSIONS This is the first study showing that EH can be assumed in about one third of CI candidates with idiopathic profound SNHL, but no classic EH-associated symptoms. Preliminary results suggest that EH has no influence on the preservation of cochlear function but could be a risk factor for loss of otolith function after cochlear implantation.
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Rahman MT, Chari DA, Ishiyama G, Lopez I, Quesnel AM, Ishiyama A, Nadol JB, Hansen MR. Cochlear implants: Causes, effects and mitigation strategies for the foreign body response and inflammation. Hear Res 2022; 422:108536. [PMID: 35709579 PMCID: PMC9684357 DOI: 10.1016/j.heares.2022.108536] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
Cochlear implants provide effective auditory rehabilitation for patients with severe to profound sensorineural hearing loss. Recent advances in cochlear implant technology and surgical approaches have enabled a greater number of patients to benefit from this technology, including those with significant residual low frequency acoustic hearing. Nearly all cochleae implanted with a cochlear implant electrode array develop an inflammatory and fibrotic response. This tissue reaction can have deleterious consequences for implant function, residual acoustic hearing, and the development of the next generation of cochlear prosthetics. This article reviews the current understanding of the inflammatory/foreign body response (FBR) after cochlear implant surgery, its impact on clinical outcome, and therapeutic strategies to mitigate this response. Findings from both in human subjects and animal models across a variety of species are highlighted. Electrode array design, surgical techniques, implant materials, and the degree and type of electrical stimulation are some critical factors that affect the FBR and inflammation. Modification of these factors and various anti-inflammatory pharmacological interventions have been shown to mitigate the inflammatory/FBR response. Ongoing and future approaches that seek to limit surgical trauma and curb the FBR to the implanted biomaterials of the electrode array are discussed. A better understanding of the anatomical, cellular and molecular basis of the inflammatory/FBR response after cochlear implantation has the potential to improve the outcome of current cochlear implants and also facilitate the development of the next generation of neural prostheses.
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Affiliation(s)
- Muhammad T Rahman
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Divya A Chari
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Gail Ishiyama
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Ivan Lopez
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Akira Ishiyama
- Department of Head & Neck Surgery, University of California Los Angeles, LA, USA
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard University, Boston, MA, USA
| | - Marlan R Hansen
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa, Iowa City, IA, USA.
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22
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Van de Heyning PH, Dazert S, Gavilan J, Lassaletta L, Lorens A, Rajan GP, Skarzynski H, Skarzynski PH, Tavora-Vieira D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Polak M. Systematic Literature Review of Hearing Preservation Rates in Cochlear Implantation Associated With Medium- and Longer-Length Flexible Lateral Wall Electrode Arrays. Front Surg 2022; 9:893839. [PMID: 36034377 PMCID: PMC9407249 DOI: 10.3389/fsurg.2022.893839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe last two decades have demonstrated that preoperative functional acoustic hearing (residual hearing) can be preserved during cochlear implant (CI) surgery. However, the relationship between the electrode array length and postoperative hearing preservation (HP) with lateral wall flexible electrode variants is still under debate.Aims/ObjectivesThis is a systematic literature review that aims to analyze the HP rates of patients with residual hearing for medium-length and longer-length lateral wall electrodes.MethodA systematic literature review methodology was applied following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations to evaluate the HP rates of medium-length and longer-length lateral wall electrodes from one CI manufacturer (medium length FLEX 24, longer length FLEX 28 and FLEX SOFT, MED-EL, Innsbruck, Austria). A search using search engine PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) was performed using the search terms “hearing preservation” or “residual hearing” and “cochlear implant” in “All fields.” Articles published only in English between January 01, 2009 and December 31, 2020 were included in the search.ResultsThe HP rate was similar between medium-length (93.4%–93.5%) and longer (92.1%–86.8%) electrodes at 4 months (p = 0.689) and 12 months (p = 0.219). In the medium-length electrode group, patients under the age of 45 years had better HP than patients above the age of 45 years.ConclusionsBoth medium-length and longer electrode arrays showed high hearing preservation rates. Considering the hearing deterioration over time, implanting a longer electrode at primary surgery should be considered, thus preventing the need for future reimplantation.
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Affiliation(s)
- Paul H Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Correspondence: Paul H Van de Heyning
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos, III, (CIBERER-U761), Madrid, Spain
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
| | - Dayse Tavora-Vieira
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
- Audiology Department, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Vedat Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Belgium
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Marek Polak
- Department of Electrophysiology, R&D, MED-EL, Innsbruck, Austria
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Avasarala VS, Jinka SK, Jeyakumar A. Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e25451. [PMID: 35774686 PMCID: PMC9239322 DOI: 10.7759/cureus.25451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/05/2022] Open
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Liu SS, Yang R. Inner Ear Drug Delivery for Sensorineural Hearing Loss: Current Challenges and Opportunities. Front Neurosci 2022; 16:867453. [PMID: 35685768 PMCID: PMC9170894 DOI: 10.3389/fnins.2022.867453] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022] Open
Abstract
Most therapies for treating sensorineural hearing loss are challenged by the delivery across multiple tissue barriers to the hard-to-access anatomical location of the inner ear. In this review, we will provide a recent update on various pharmacotherapy, gene therapy, and cell therapy approaches used in clinical and preclinical studies for the treatment of sensorineural hearing loss and approaches taken to overcome the drug delivery barriers in the ear. Small-molecule drugs for pharmacotherapy can be delivered via systemic or local delivery, where the blood-labyrinth barrier hinders the former and tissue barriers including the tympanic membrane, the round window membrane, and/or the oval window hinder the latter. Meanwhile, gene and cell therapies often require targeted delivery to the cochlea, which is currently achieved via intra-cochlear or intra-labyrinthine injection. To improve the stability of the biomacromolecules during treatment, e.g., RNAs, DNAs, proteins, additional packing vehicles are often required. To address the diverse range of biological barriers involved in inner ear drug delivery, each class of therapy and the intended therapeutic cargoes will be discussed in this review, in the context of delivery routes commonly used, delivery vehicles if required (e.g., viral and non-viral nanocarriers), and other strategies to improve drug permeation and sustained release (e.g., hydrogel, nanocarriers, permeation enhancers, and microfluidic systems). Overall, this review aims to capture the important advancements and key steps in the development of inner ear therapies and delivery strategies over the past two decades for the treatment and prophylaxis of sensorineural hearing loss.
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Affiliation(s)
- Sophie S. Liu
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Rong Yang
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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van der Jagt AMA, Briaire JJ, Boehringer S, Verbist BM, Frijns JHM. Prolonged Insertion Time Reduces Translocation Rate of a Precurved Electrode Array in Cochlear Implantation. Otol Neurotol 2022; 43:e427-e434. [PMID: 35213473 DOI: 10.1097/mao.0000000000003499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Insertion speed during cochlear implantation determines the risk of cochlear trauma. By slowing down insertion speed tactile feedback is improved. This is highly conducive to control the course of the electrode array along the cochlear contour and prevent translocation from the scala tympani to the scala vestibuli. BACKGROUND Limiting insertion trauma is a dedicated goal in cochlear implantation to maintain the most favorable situation for electrical stimulation of the remaining stimulable neural components of the cochlea. Surgical technique is one of the potential influencers on translocation behavior of the electrode array. METHODS The intrascalar position of 226 patients, all implanted with a precurved electrode array, aiming a mid-scalar position, was evaluated. One group (n = 113) represented implantation with an insertion time less than 25 seconds (fast insertion) and the other group (n = 113) was implanted in 25 or more seconds (slow insertion). A logistic regression analysis studied the effect of insertion speed on insertion trauma, controlled for surgical approach, cochlear size, and angular insertion depth. Furthermore, the effect of translocation on speech performance was evaluated using a linear mixed model. RESULTS The translocation rate within the fast and slow insertion groups were respectively 27 and 10%. A logistic regression analysis showed that the odds of dislocation increases by 2.527 times with a fast insertion, controlled for surgical approach, cochlear size, and angular insertion depth (95% CI = 1.135, 5.625). We failed to find a difference in speech recognition between patients with and without translocated electrode arrays. CONCLUSION Slowing down insertion speed till 25 seconds or longer reduces the incidence of translocation.
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Affiliation(s)
| | | | | | - Berit M Verbist
- Department of Radiology
- Department of Radiology, Radboud University Medical Center Nijmegen, Nijmegen
| | - Johan H M Frijns
- Department of Otorhinolaryngology
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands
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Elzayat S, Mandour M, Elfarargy HH, Lotfy R, Soltan I, Lotfy A, Margani V, Covelli E, Monini S, Barbara M. Radiological Analysis of the Facial Recess: Impact on Posterior Tympanotomy Difficulty During Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg 2022; 167:769-776. [PMID: 35133920 DOI: 10.1177/01945998221076998] [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
OBJECTIVES We analyzed several radiological features of the facial recess to correlate them with the intraoperative findings to highlight the most reliable predictors of posterior tympanotomy difficulty. STUDY DESIGN Retrospective observational cohort study. SETTING Multicenter study at tertiary referral institutions. METHODS We included 184 pediatric patients who underwent cochlear implantation through the posterior tympanotomy approach. The correlation was attempted between 8 radiological features in the preoperative high-resolution computed tomography scan and intraoperative surgical difficulty. RESULTS Posterior tympanotomy was straightforward in 136 (73.9%) patients. In contrast, it was challenging in 48 (26.1%) patients. The facial recess was aerated in 74.5% of patients. The mean (SD) posterior tympanotomy depth was 3.98 (0.867) mm. The mean (SD) chorda-facial angle was 27.67° (3.406°). The mean (SD) chorda-facial to stylomastoid length was 3.898 (0.6304) mm. The mean (SD) facial nerve second genu angle was 94.54° (6.631)°. Deep-unaerated facial recess wall was associated with the most difficulty. There was a statistically significant difference in the unchallenging and challenging posterior tympanotomy groups regarding the surgical duration (P < .0001). CONCLUSIONS According to this analytic study, the chorda-facial angle, the facial recess aeration, and the chorda-facial to stylomastoid length were respectively the strongest preoperative radiological predictors of the surgical difficulty of posterior tympanotomy during cochlear implantation. Chorda-facial angle <25.5° was associated with difficult posterior tympanotomy. The oblique parasagittal cut was essential for the radiological analysis of the facial recess.
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Affiliation(s)
- Saad Elzayat
- Otolaryngology Department, Tanta University, Egypt
| | | | | | - Rasha Lotfy
- Radiology Department, Tanta University, Tanta, Egypt
| | - Islam Soltan
- Otolaryngology Department, Tanta University, Egypt
| | - Ashraf Lotfy
- Otolaryngology Department, El-Glaa Military Hospital, Cairo, Egypt
| | - Valerio Margani
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Edoardo Covelli
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Simonetta Monini
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Maurizio Barbara
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
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Intracochlear New Fibro-Ossification and Neuronal Degeneration Following Cochlear Implant Electrode Translocation: Long-Term Histopathological Findings in Humans. Otol Neurotol 2022; 43:e153-e164. [PMID: 35015749 DOI: 10.1097/mao.0000000000003402] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We aim to assess the histopathology of human temporal bones (TBs) with evidence of cochlear implantation (CI) electrode scalar translocation. STUDY DESIGN Otopathology study. SETTING Otopathology laboratory. PATIENTS TBs from patients who had a history of CI and histopathological evidence of interscalar translocation. Specimens with electrode placed entirely within the ST served as controls. INTERVENTION Histopathological assessment of human TBs. MAIN OUTCOME MEASURES TBs from each patient were harvested postmortem and histologically analyzed for intracochlear changes in the context of CI electrode translocation and compared to controls. Intracochlear new fibro-ossification, and spiral ganglion neuron (SGN) counts were assessed. Postoperative word recognition scores (WRS) were also compared. RESULTS Nineteen human TBs with electrode translocation and eight controls were identified. The most common site of translocation was the ascending limb of the basal turn (n = 14 TBs). The average angle of insertion at the point of translocation was 159° ± 79°. Eighteen translocated cases presented moderate fibroosseous changes in the basal region of the cochlea, extending to the translocation point and/or throughout the electrode track in 42%. Lower SGN counts were more pronounced in translocated cases compared to controls, with a significant difference for segment II (p = 0.019). Although final postoperative hearing outcomes were similar between groups, translocated cases had slower rate of improvement in WRS (p = 0.021). CONCLUSIONS Cochlear implant electrode translocation was associated with greater fibroosseous formation and lower SGN population. Our findings suggest that scalar translocations may slow the rate of improvement in WRS overtime as compared to atraumatic electrode insertions.Level of evidence: IV.
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Intracochlear electrode array position and cochlear implant outcomes using the nucleus slim modiolar electrode and the extended round window approach: a follow-up study. Eur Arch Otorhinolaryngol 2022; 279:4735-4743. [PMID: 35041067 PMCID: PMC9474433 DOI: 10.1007/s00405-021-07247-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to evaluate the intracochlear position of the Slim Modiolar Electrode (SME) after insertion via the extended Round Window (eRW) approach, and to correlate this with residual hearing preservation and speech perception outcomes. METHODS Twenty-three adult participants, consecutively implanted with the SME via the eRW approach, were included in this prospective, single-center, observational study. Electrode position was evaluated intra-operatively using X-ray fluoroscopy and TIM measurement, and post-operatively using ultra-high resolution CT. Residual hearing [threshold shift in PTA between pre- and post-operative measurement, relative hearing preservation (RHP%)] and speech perception were evaluated at 2 and 12 months after surgery. RESULTS In each of the 23 participants, complete scala tympani positioning of the electrode array could be achieved. In one participant, an initial tip fold-over was corrected during surgery. Average age at implantation was 63.3 years (SD 13.3, range 28-76) and mean preoperative residual hearing was 81.5 dB. The average post-operative PTA threshold shift was 16.2 dB (SD 10.8) at 2 months post-operatively, corresponding with a RHP% score of 44% (SD 34.9). At 12 months, the average RHP% score decreased to 37%. Postoperative phoneme scores improved from 27.1% preoperatively, to 72.1% and 82.1% at 2 and 12 months after surgery, respectively. CONCLUSION Use of the eRW approach results in an increased likelihood of complete scala tympani insertion when inserting the SME, with subsequent excellent levels of speech perception. However, residual hearing preservation was found to be moderate, possibly as a result of the extended round window approach, emphasizing that it is not an all-purpose approach for inserting this particular electrode array.
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Heutink F, Klabbers TM, Huinck WJ, Lucev F, van der Woude WJ, Mylanus EAM, Verbist BM. Ultra-High-Resolution CT to Detect Intracochlear New Bone Formation after Cochlear Implantation. Radiology 2021; 302:605-612. [PMID: 34874202 DOI: 10.1148/radiol.211400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Histopathologic studies reported that cochlear implantation, a well-established means to treat severe-to-profound sensorineural hearing loss, may induce inflammation, fibrosis, and new bone formation (NBF) with possible impact on loss of residual hearing and hearing outcome. Purpose To assess NBF in vivo after cochlear implantation with ultra-high-spatial-resolution (UHSR) CT and its implication on long-term residual hearing outcome. Materials and Methods In a secondary analysis of a prospective single-center cross-sectional study, conducted between December 2016 and January 2018, patients with at least 1 year of cochlear implantation experience underwent temporal bone UHSR CT and residual hearing assessment. Two observers evaluated the presence and location of NBF independently, and tetrachoric correlations were used to assess interobserver reliability. In addition, the scalar location of each electrode was assessed. After consensus agreement, participants were classified into two groups: those with NBF (n = 83) and those without NBF (n = 40). The association between NBF and clinical parameters, including electrode design, surgical approach, and long-term residual hearing loss, was tested using the χ2 and Student t tests. Results A total of 123 participants (mean age ± standard deviation, 63 years ± 13; 63 women) were enrolled. NBF was found in 83 of the 123 participants (68%) at 466 of 2706 electrode contacts (17%). Most NBFs (428 of 466, 92%) were found around the 10 most basal contacts, with an interobserver agreement of 86% (2297 of 2683 contacts). Associations between electrode types and surgical approaches were significant (58 of 79 participants with NBF and a precurved electrode vs 24 of 43 with NBF and a straight electrode, P = .04; 64 of 88 participants with NBF and a cochleostomy approach vs 18 of 34 with NBF and a round window approach, P = .03). NBF was least often seen in full scala tympani insertions, but there was no significant association between scalar position and NBF (P = .15). Long-term residual hearing loss was significantly larger in the group with NBF compared with the group without NBF (mean, 22.9 dB ± 14 vs 8.6 dB ± 18, respectively; P = .04). Conclusion In vivo detection of new bone formation (NBF) after cochlear implantation is possible by using ultra-high-spatial-resolution CT. Most cochlear implant recipients develop NBF, predominately located at the base of the cochlea. NBF adversely affects long-term residual hearing preservation. © RSNA, 2021.
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Affiliation(s)
- Floris Heutink
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Tim M Klabbers
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Wendy J Huinck
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Federica Lucev
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Willem Jan van der Woude
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Emmanuel A M Mylanus
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
| | - Berit M Verbist
- From the Departments of Otorhinolaryngology (F.H., T.M.K., W.J.H., E.A.M.M.) and Radiology (W.J.v.d.W., B.M.V.), Radboud University Medical Center, Philips van Leydenlaan 16, Route 377, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands (F.H., T.M.K., W.J.H., E.A.M.M.); Department of Radiology, Civil Hospital, Vigevano, Italy (F.L.); and Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (B.M.V.)
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Hodge SE, Ishiyama G, Lopez IA, Ishiyama A. Histopathologic Analysis of Temporal Bones With Otosclerosis Following Cochlear Implantation. Otol Neurotol 2021; 42:1492-1498. [PMID: 34607995 PMCID: PMC8595606 DOI: 10.1097/mao.0000000000003327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Analyze changes in osteoneogenesis and fibrosis following cochlear implant (CI) surgery in patients with otosclerosis and compare differences based on insertion technique. BACKGROUND When advanced otosclerotic disease extends to the otic capsule, severe and profound sensorineural hearing loss necessitates consideration of a cochlear implant. Histopathological analysis of the human temporal bone after implantation in the patient with otosclerosis may reveal important variables that predict CI success. METHODS Histopathological evaluation of archival human temporal bones from subjects with a history of CI for cochlear otosclerosis. A total of 17 human temporal bones (HTB) were analyzed, 13 implanted, and 4 contralateral non-implanted controls. RESULTS Histopathological studies revealed extensive osteoneogenesis and fibrosis which was more prominent at the cochleostomy insertion site in the basal turn of the cochlea often obliterating the scala tympani in the basal turn, and in some cases extending to the scala media and scala vestibuli. Cochlear hydrops was nearly universal in these cases. This contrasted with the round window insertion, which exhibited minimal osteoneogenesis within the cochlear duct. In addition, in the contralateral, unimplanted control ears, there was otosclerosis at the stapes footplate, fissula ante fenestrum but no osteoneogenesis within the cochlear duct. CONCLUSION Cochleostomy approach to CI insertion in otosclerosis patients is associated with significant fibrosis, osteoneogenesis, and cochlear hydrops. A round window insertion technique can be utilized to help minimize these histopathologic findings whenever feasible.
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Affiliation(s)
| | - Gail Ishiyama
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Ivan A Lopez
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Areias B, Parente MPL, Gentil F, Natal Jorge RM. Finite element modelling of the surgical procedure for placement of a straight electrode array: Mechanical and clinical consequences. J Biomech 2021; 129:110812. [PMID: 34688063 DOI: 10.1016/j.jbiomech.2021.110812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/07/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
A cochlear implant is an electronic device implanted into the cochlea to directly stimulate the auditory nerve. Such device is used in patients with severe-to-profound hearing loss. The cochlear implant surgery is safe, but involves some risks, such as infections, device malfunction or damage of the facial nerve and it can result on a poor hearing outcome, due to the destruction of any present residual hearing. Future improvements in cochlear implant surgery will necessarily involve the decrease of the intra-cochlear damage. Several implant related variables, such as materials, geometrical design, processor and surgical techniques can be optimized in order for the patients to partially recover their hearing capacities The straight electrode is a type of cochlear implant that many authors indicate as being the less traumatic. From the finite element analysis conducted in this work, the influence of the insertion speed, the friction coefficient between the cochlear wall and the electrode array, and several configurations of the cochlear implant tip were studied. The numerical simulations of the implantation showed the same pattern of the insertion force against insertion depth, thus indicating the different phases of the insertion. Results demonstrated that lower insertion speeds, friction coefficients and tip stiffness, led to a reduction on the contact pressures and insertion force. It is expected that these improved configurations will allow to preserve the residual hearing while reducing surgical complications.
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Affiliation(s)
- B Areias
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal.
| | - M P L Parente
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal; FEUP, Faculty of Engineering, University of Porto, Porto, Portugal.
| | - F Gentil
- Escola Superior de Saúde - Politécnico do Porto, Porto, Portugal; Clínica ORL - Dr. Eurico de Almeida, Porto, Portugal; WIDEX, Porto, Portugal.
| | - R M Natal Jorge
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal; FEUP, Faculty of Engineering, University of Porto, Porto, Portugal.
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Mandour M, Elzayat S, Elfarargy HH, Lotfy R, ELnaggar A. Radiological classification of the mastoid portion of the facial nerve: impact on the surgical accessibility of the round window in cochlear implantation. Acta Otolaryngol 2021; 141:894-897. [PMID: 34424819 DOI: 10.1080/00016489.2021.1963473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mastoid portion of the facial nerve plays an important role in the round window approach of cochlear implantation. OBJECTIVES This study aimed to predict the anterior displacement of the mastoid portion of the facial nerve in the preoperative HRCT coronal cuts. We also aimed to detect the implication of anterior displacement of MPFN on the R.W. accessibility through the posterior tympanotomy during cochlear implantation. MATERIALS AND METHODS It was a retrospective observational cohort study in tertiary referral hospitals. We included 246 pediatric patients who underwent cochlear implantation due to bilateral severe to profound SNHL through a posterior tympanotomy approach. RESULTS Type I MPFN was present in 84 cases, type II MPFN was present in 149 patients, and type III MPFN was present in 13 cases. R.W. was inaccessible in 3 cases with MPFN type II and in 11 subjects with MPFN type III. There was a statistically significant difference regarding the R.W. accessibility between the three types of MPFN (p-value <.05). There was a strong statistically significant correlation between R.W. accessibility and the radiological type of the MPFN. CONCLUSION Mandour radiological classification of the mastoid portion of the facial nerve in the preoperative HRCT coronal offers an easily applicable method to detect the anterior displacement of the facial nerve by using easy and well-known landmarks. This classification can also predict R.W. accessibility through posterior tympanotomy during cochlear implantation with 97.97% accuracy.
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Affiliation(s)
| | - Saad Elzayat
- Otolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | | | - Rasha Lotfy
- Radiology Department, Tanta University, Tanta, Egypt
| | - Ahmed ELnaggar
- Otolaryngology Department, Tanta University, Tanta, Egypt
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Panara K, Shahal D, Mittal R, Eshraghi AA. Robotics for Cochlear Implantation Surgery: Challenges and Opportunities. Otol Neurotol 2021; 42:e825-e835. [PMID: 33993143 DOI: 10.1097/mao.0000000000003165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI. DATA SOURCES MEDLINE, PubMed, and EMBASE databases. STUDY SELECTION A search was conducted using the keywords "robotics otolaryngology," "robotic cochlear implant," "minimally-invasive cochlear implantation," "minimally-invasive mastoidectomy," and "percutaneous cochlear implant" with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present. RESULTS The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics. CONCLUSIONS The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.
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Affiliation(s)
- Kush Panara
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - David Shahal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Rahul Mittal
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
| | - Adrien A Eshraghi
- Department of Otolaryngology, Cochlear Implant and Hearing Research Laboratory
- Department of Neurological Surgery
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida
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Merchant GR, Schulz KM, Patterson JN, Fitzpatrick D, Janky KL. Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance. Ear Hear 2021; 41:1111-1124. [PMID: 32032225 PMCID: PMC7392788 DOI: 10.1097/aud.0000000000000831] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. DESIGN Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. RESULTS All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. CONCLUSIONS Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.
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Affiliation(s)
| | - Kyli M. Schulz
- Boys Town National Research Hospital, Omaha, NE 68131
- The University of Texas at Austin, TX 78712
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Liu Q, Guo W, Yang S, Ji X, Lin C, Chen W. Electrophysiological and histomorphological changes of cochlea in miniature pigs after abrasion of round window niches. Acta Otolaryngol 2021; 141:557-566. [PMID: 33881381 DOI: 10.1080/00016489.2021.1899281] [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: 10/21/2022]
Abstract
Background: In operations of cochlea implantation (CI), many surgeons choose to drill a window on the bone wall of cochlea basic rotation, when more and more patients receive CI with residual hearing, what damage this step would result in is unclear.Objective: To study the effect to inner ear hair cells which is caused by drilling during CI.Methods: 6 miniature pigs are equally divided into two groups, Round window niche of each pig in the experimental group was milled, while the pigs in control group wasn't. After implanting depth of 6.5, 11.5 and 20 mm, round window electrocochleography was recorded to analyze the change of cochlea microphonic (CM) potentials respectively, histomorphological changes was observed.Results: Thresholds of CM in experimental group were higher than that of control group at different depth, amplitudes were smaller. In further group, cilia of inner hair cells (IHC) at bottom rotation were significantly damaged. After operation, ABR hearing threshold of experimental group was higher, differences at low frequency region were more obvious.Conclusions: Damage caused by mulling round window niche may seriously affect the function of the hair cells. Damage of the IHC is greater than OHC. CI through round window may protect residual hearing.
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Affiliation(s)
- Qian Liu
- Department of Otolaryngology, Affiliated First Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Weiwei Guo
- Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General Hospital, Beijing, P.R. China
| | - Shiming Yang
- Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General Hospital, Beijing, P.R. China
| | - Xiaojun Ji
- Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General Hospital, Beijing, P.R. China
| | - Chang Lin
- Department of Otolaryngology, Affiliated First Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Wei Chen
- Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology of PLA, Chinese PLA General Hospital, Beijing, P.R. China
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Wrobel C, Bevis NF, Meyer AC, Beutner D. Access to the Apical Cochlear Modiolus for Possible Stem Cell-based and Gene Therapy of the Auditory Nerve. Otol Neurotol 2021; 42:e371-e377. [PMID: 33165157 DOI: 10.1097/mao.0000000000002941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Loss of spiral ganglion neurons (SGN) is permanent and responsible for a substantial number of patients suffering from hearing impairment. It can derive from the degeneration of SGNs due to the death of sensory hair cells as well as from auditory neuropathy. Utilizing stem cells to recover lost SGNs increasingly emerges as a possible therapeutic option, but access to human SGNs is difficult due to their protected location within the bony impacted cochlea. Aim of this study was to establish a reliable and practicable approach to access SGNs in the human temporal bone for possible stem cell and gene therapies. METHODS In seven human temporal bone specimen a transcanal approach was used to carefully drill a cochleostomy in the lateral second turn followed by insertion of a tungsten needle into the apical modiolus to indicate the spot for intramodiolar injections. Subsequent cone beam computed tomography (CBCT) served as evaluation for positioning of the marker and cochleostomy size. RESULTS The apical modiolus could be exposed in all cases by a cochleostomy (1.6 mm2, standard deviation ±0.23 mm2) in the lateral second turn. 3D reconstructions and analysis of CBCT revealed reliable positioning of the marker in the apical modiolus, deviating on average 0.9 mm (standard deviation ±0.49 mm) from the targeted center of the second cochlear turn. CONCLUSION We established a reliable, minimally invasive, transcanal surgical approach to the apical cochlear modiolus in the human temporal bone in foresight to stem cell-based and gene therapy of the auditory nerve.
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Affiliation(s)
- Christian Wrobel
- Department of Otorhinolaryngology.,InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
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Ucta C, Mittmann P, Ernst A, Seidl R, Lauer G. Minimizing Intracochlear Pressure: Influence of the Insertion Sheath. Audiol Neurootol 2021; 26:281-286. [PMID: 33647910 DOI: 10.1159/000512466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Atraumatic cochlear implantation (CI) and insertion of the electrode in particular are major goals of recent CI surgery. Perimodiolar electrode arrays need a stylet or exosheath for insertion. The sheath can influence the intracochlear pressure changes during insertion of the electrode. The aim of this study was to modify the insertion sheath to optimize intracochlear pressure changes. METHODS In an artifical cochlear model, 7 different modified insertion sheaths were used. The intracochlear pressure was measured with a micro-optical sensor in the apical part of the model cochlea. RESULTS Significant lower intracochlear pressure changes were observed when the apical part of the insertion sheath was either shortened or tapered. Modification of the stopper does influence the intracochlear pressure significantly. CONCLUSION Modification of the insertion sheath leads to lower intracochlear pressure gain. The differences and impact on intracochlear pressure changes found in this study underline the importance of even subtle modifications of the electrode insertion technique.
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Affiliation(s)
- Ceyhun Ucta
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Arneborg Ernst
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Rainer Seidl
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Gina Lauer
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany,
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Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool. Eur Arch Otorhinolaryngol 2021; 279:127-136. [PMID: 33604749 DOI: 10.1007/s00405-021-06632-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To develop and gather validity evidence for a novel tool for assessment of cochlear implant (CI) surgery, including virtual reality CI surgery training. METHODS Prospective study gathering validity evidence according to Messick's framework. Four experts developed the CI Surgery Assessment Tool (CISAT). A total of 35 true novices (medical students), trained novices (residents) and CI surgeons performed two CI-procedures each in the Visible Ear Simulator, which were rated by three blinded experts. Classical test theory and generalizability theory were used for reliability analysis. RESULTS The CISAT significantly discriminated between the three groups (p < 0.001). The generalizability coefficient was 0.76 and most of the score variance (53.3%) was attributable to the participant and only 6.8% to the raters. When exploring a standard setting for CI surgery, the contrasting groups method suggested a pass/fail score of 36.0 points (out of 55), but since the trained novices performed above this, we propose using the mean CI surgeon performance score (45.3 points). CONCLUSION Validity evidence for simulation-based assessment of CI performance supports the CISAT. Together with the standard setting, the CISAT might be used to monitor progress in competency-based training of CI surgery and to determine when the trainee can advance to further training.
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Radiological and surgical aspects of round window visibility during cochlear implantation: a retrospective analysis. Eur Arch Otorhinolaryngol 2021; 279:67-74. [PMID: 33471167 PMCID: PMC8739281 DOI: 10.1007/s00405-021-06611-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
Purpose The round window approach has become the most preferred option for cochlear implant (CI) insertion, however, sometimes it may not be possible due to the (in)visibility of the round window membrane (RWM). We addressed the prevalence, consequences and indicators of difficult detection of the RWM in cochlear implant surgery. Methods This study retrospectively analysed the operative reports and preoperative high resolution axial-computed tomography (CT) scans of a consecutive cohort of patients who underwent a CI insertion. The main outcomes were surgical outcomes of the RW approach, and assessment of radiological
markers. Results The operative reports showed that RWM insertion was feasible in 151 out of 153 patients. In 18% of the patients the RWM was difficult to visualize. All these patients had at least one intraoperative event. The chorda tympani nerve (CTN) or posterior canal wall was affected in 8% of the 153 patients and the fallopian canal in 6%. These patients had a facial-chorda tympani nerve distance on the CT scan that was considerably smaller than normal patients (1.5 mm vs 2.3 mm). In addition, a prediction line towards the anterolateral side of the RWM was found to be more prevalent in these patients’ CT scans (sensitivity 81%, specificity 63%). Conclusion The RW approach is feasible in almost all patients undergoing CI surgery. Difficult visualisation of the RWM seems to lead to at least one intraoperative event. Radiological measures showed that these patients had a smaller facial recess and a more anteriorly placed facial nerve, which can be used to better plan a safe insertion approach.
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Elafandi H, Khalifa MA, Elguindy AS. Cochlear implantation outcomes with round window electrode insertion versus cochleostomy insertion. Int J Pediatr Otorhinolaryngol 2020; 138:110272. [PMID: 32798831 DOI: 10.1016/j.ijporl.2020.110272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES assessment of two techniques for electrode insertion during cochlear implantation which are the round window and the traditional cochleostomy insertions, the comparison utilized cochlear implantation outcomes. STUDY DEIGN: a prospective cohort study. PATIENTS children (n = 200) between 2 and 8 years old who had bilateral severe to profound SNHL and received a unilateral cochlear implant, 100 children had a round window insertion and were labeled the RW group while the other 100 children had a cochleostomy insertion and were labeled the C group which was taken as a control group. OUTCOME MEASURE(S) all the participants in this study were followed up and tested twice for their cochlear implant outcomes, the first time when the duration of using their implants was no less than 24 months and no more than 30 months. The second time between 31 and 36 months post implantation. For speech perception; The Consonant-Nucleus-Consonant test (CNC) and The Bamford-Kowal-Bench sentence lists (BKB). For language acquisition; The Preschool Language Scale-fourth edition (PLS-4) and The Peabody Picture Vocabulary Test, Fourth edition (PPVT-4) had been utilized. For speech production; the Diagnostic Evaluation of Articulation and Phonology (DEAP). RESULTS for speech perception: The mean CNC scores for the RW group and the C group between 24 and 30 months post-implantation and at 31-36 months post-implantation were better for the round window group. Also, the mean BKB scores for the RW group were higher than the C group between 24 and 30 months post-implantation (p < 0.0013) and at 31-36 months post-implantation (p < 0.0011). for language acquisition; the PLS-4 mean scores for the RW group and the C group between 24 and 30 months post-implantation and at 31-36 months post-implantation were better for the round window group (p < 0.001). The PPVT-4 mean scores for the RW group were also higher than the C group at both durations. for speech production; The mean word intelligibility scores of the DEAP for the RW group were better at 24 to 30 and 31-36 months post-implantation. CONCLUSION Round window insertion is associated with superior cochlear implantation outcomes regarding speech perception, language acquisition and speech production rather than the standard cochleostomy insertion.
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The role of high-resolution Computer Tomography in prediction of the round window membrane visibility and the feasibility of the round window electrode insertion. Eur Arch Otorhinolaryngol 2020; 278:3283-3290. [PMID: 33058011 DOI: 10.1007/s00405-020-06417-6] [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: 06/09/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this work is to assess the role of pre-operative high-resolution computerized tomography (HRCT) in prediction of the round window membrane (RWM) visibility and the feasibility of round window electrode insertion. MATERIALS AND METHODS Retrospective study on a series of 97 cases of cochlear implant (CI) who were implanted in tertiary referral centers. We reviewed HRCT of all cases, and we implicated two radiological measurements on HRCT which are membrano-facial angle (MFA) and length of the bony overhang of the round window niche (RWN). We reviewed the intra-operative surgical video recordings of all cases for detection of the type of RWM visibility, according to The St Thomas' Hospital classification. RESULTS The MFA was 21.9 ± 14.5. The length of the bony overhang of the RWN was 2.4 ± 0.33 mm. About 37% of the studied patients needed cochleostomy. The best cut-off of MFA in the prediction of the RW (type 2B and 3) was ≥ 15.1o with sensitivity 100%, and specificity 82%. CONCLUSION HRCT offers highly reliable and reproducible measurements for the prediction of RWM visibility and, therefore, prediction of the utility of the RW approach for electrode insertion. Membrano-facial angle (MFA) is a new measurement that can be used for this purpose.
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Correlation of cochlear nerve cross-sectional area and auditory performance after cochlear implantation in prelingual children with bilateral profound hearing loss. Int J Pediatr Otorhinolaryngol 2020; 137:110173. [PMID: 32658798 DOI: 10.1016/j.ijporl.2020.110173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess whether cochlear nerve (CN) cross-sectional area as measured with parasagittal magnetic resonance imaging (MRI) in prelingual pediatric deaf patients correlates with auditory performance after cochlear implantation. STUDY DESIGN Prospective Cohort study. METHODS Thirty-two prelingual children with bilateral profound sensorineural hearing loss (SNHL) who received unilateral cochlear implant were included in this study. Diameters of CN at Internal auditory canal (IAC) fundus and mid-point of IAC were retrospectively measured on parasagittal images of FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence MRI by two independent observers. Cross-sectional areas [π (Height/2) (Width/2)] were then correlated with post-operative CAPS (Categories of Auditory Performance) and IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) scores regularly assessed at 3 monthly intervals post device activation. RESULTS The cochlear nerve was identified in all the 32 patients. Mean cross-sectional areas (CSA) of cochlear nerve were 0.71 ± 0.16 mm2 at IAC fundus and 0.73 ± 0.18 mm2 at mid-point of IAC. The correlation value between CSA at mid-point of IAC and CAPS score at 6 months was 0.271 (p-value- 0.140) and correlation value between CSA at mid-point of IAC and IT-MAIS score at 6 months was 0.282 (p-value- 0.124) which were statistically not significant. CONCLUSION There was no significant correlation between the cross-sectional areas of the cochlear nerve on MRI and postoperative auditory scores as measured by CAPS and IT-MAIS scores at six months from the device activation. Hence, we conclude that above an adequate diameter, which can affect the minimum required neurons, the changes in the diameter do not have significant bearing on auditory outcomes after cochlear implantation.
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Widmann G, Dejaco D, Luger A, Schmutzhard J. Pre- and post-operative imaging of cochlear implants: a pictorial review. Insights Imaging 2020; 11:93. [PMID: 32803542 PMCID: PMC7429612 DOI: 10.1186/s13244-020-00902-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Cochlear implants are increasingly used to treat sensorineural hearing disorders in both children and adults. Pre-operative computed tomography and magnetic resonance imaging play a pivotal role in patient selection, to rule out findings that preclude surgery or identify conditions which may have an impact on the surgical procedure. The post-operative position of the electrode array within the cochlea can be reliably identified using cone-beam computed tomography. Recognition of scalar dislocation, cochlear dislocation, electrode fold, and malposition of the electrode array may have important consequences for the patient such as revision surgery or adapted fitting.
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Affiliation(s)
- Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria.
| | - Daniel Dejaco
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Luger
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Nguy PL, Saidha S, Jay A, Jeffrey Kim H, Hoa M. Radiologic anatomy of the round window relevant to cochlear implantation and inner ear drug delivery. World J Otorhinolaryngol Head Neck Surg 2020; 7:9-16. [PMID: 33474538 PMCID: PMC7801246 DOI: 10.1016/j.wjorl.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/03/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To determine anatomic relationships and variation of the round window membrane to bony surgical landmarks on computed tomography. Study design Retrospective imaging review. Methods 100 temporal bone images were evaluated. Direct measurements were obtained for membrane position. Vector distances and angulation from umbo and bony annulus were calculated from image viewer software coordinates. Results The angle of round window membrane at junction with cochlear basal turn was (42.1 ± 8.6)°. The membrane's position relative to plane of the facial nerve through facial recess was (14.7 ± 5.2)° posterior from a reference line drawn through facial recess to carotid canal. Regarding transtympanic drug delivery, the round window membrane was directed 4.1 mm superiorly from the inferior annulus and 5.4 mm anteriorly from the posterior annulus. The round window membrane on average was angled superiorly from the inferior annulus (77.1 ± 27.9)° and slightly anteriorly from the posterior annulus (19.1 ± 11.1°). The mean distance of round window membrane from umbo was 4 mm and posteriorly rotated 30° clockwise from a perpendicular drawn from umbo to inferior annulus towards posterior annulus. Together, these measurements approximate the round window membrane in the tympanic membrane's posteroinferior quadrant. Conclusions These radiologic measurements demonstrate normal variations seen in round window anatomy relative to facial recess approach and bony tympanic annulus, providing a baseline to assess round window insertion for cochlear implantation and outlines anatomic factors affecting transtympanic drug delivery.
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Affiliation(s)
- Peter L Nguy
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington DC, USA
| | - Sheela Saidha
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ann Jay
- Department of Radiology, Georgetown University Medical Center, Washington DC, USA
| | - H Jeffrey Kim
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington DC, USA
| | - Michael Hoa
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington DC, 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: 1] [Impact Index Per Article: 0.3] [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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Stuermer K, Winter T, Nachtsheim L, Klussmann JP, Luers JC. Round window accessibility during cochlear implantation. Eur Arch Otorhinolaryngol 2020; 278:363-370. [PMID: 32506146 DOI: 10.1007/s00405-020-06095-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/26/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess data regarding round window (RW) visibility and surgical approaches in cochlear implant cases, and to describe and analyze surgical steps relevant for the RW approach in cochlear implantation. STUDY DESIGN Prospective clinical study. METHODS A questionnaire was completed by surgeons after each of altogether 110 cochlear implantations. Round window membrane (RWM) visibility was graded according to the St Thomas Hospital (STH) classification. RESULTS Performing different surgical steps during the preparation of the RW niche, the RWM could be fully exposed (STH Type I) in 87%. A RW approach could be used for electrode insertion in 89% of the adult and 78% of the pediatric cases. The distribution of RW types differed significantly between adults and children. Drilling of the superior bony lip was the surgical step most frequently needed in adult as well as pediatric cases to obtain optimal RW exposure. CONCLUSION In children, optimized surgical exposure of the RW niche resulted in only 52% full RWM visibility; whereas in adults, this could be achieved in 87%. The facial nerve (FN) had to be exposed at the level of the posterior tympanotomy in more than 70% of pediatric cases with full RWM visibility; while in adult cases with 100% visibility, such specific exposure was necessary in only 33%. Thus, surgical preparation of the RW niche seems to be more demanding in children than in adults.
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Affiliation(s)
- Konrad Stuermer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937, Cologne, Germany
| | - Tanja Winter
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937, Cologne, Germany
| | - Lisa Nachtsheim
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937, Cologne, Germany.
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937, Cologne, Germany
| | - Jan Christoffer Luers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937, Cologne, Germany
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Pringle MB, Konieczny KM. Anatomy of the Round Window Region With Relation to Selection of Entry Site Into the Scala Tympani. Laryngoscope 2020; 131:E598-E604. [PMID: 32415784 DOI: 10.1002/lary.28738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of cochlear implantation is to safely insert an electrode array into the scala tympani (ST) while avoiding damage to surrounding structures. There is disagreement on the optimal way of entering the ST-the round window (RW) approach versus cochleostomy. Regardless of the chosen approach, it is vital to understand the regional anatomy, which is complex, difficult to conceptualize, and rarely dissected in temporal bone courses. The goal of this study was to examine the anatomy of the RW to gain more in-depth knowledge on the local relationships of the anatomical structures and propose an approach for entering the ST in cochlear implant surgery tailored to the encountered anatomy. STUDY DESIGN Cadaveric prevalence study and expert opinion with literature review. METHODS Cadaveric temporal bone dissection (n = 13) by the first author assessing the RW anatomy. RESULTS The round window membrane (RWM) and the osseous spiral lamina (OSL) are curved structures, each with a horizontal and a vertical part. The two horizontal portions are very closely apposed. The relationship between the OSL and the RWM determines the best site for a cochleostomy, which if required is best placed anteroinferiorly to the RWM. The distance between the oval window inferior margin and the RW membrane is less than 2 to 3 mm. The ST initially extends inferiorly and medially to the RW. CONCLUSIONS The findings of our dissection have implications for cochlear implant surgery in aiming to avoid trauma to the OSL and basilar membrane and aid decision making in choosing the safest surgical approach. LEVEL OF EVIDENCE 5. Laryngoscope, 131:E598-E604, 2021.
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Affiliation(s)
- Michael B Pringle
- ENT Department, Portsmouth Hospitals NHS Foundation Trust, Portsmouth, United Kingdom
| | - Katarzyna M Konieczny
- ENT Department, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
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Comparison of electrophysiological parameters between perimodiolar and lateral wall electrodes in paediatric cochlear implant users. Eur Arch Otorhinolaryngol 2020; 277:2693-2699. [DOI: 10.1007/s00405-020-05927-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
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Otopathology of Unilateral Cochlear Implantation in Patients With Bilateral Temporal Bone Fracture. Otol Neurotol 2020; 40:e14-e19. [PMID: 30531637 DOI: 10.1097/mao.0000000000002057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Audiometric outcomes following cochlear implantation (CI) in patients with temporal bone fracture (TBF) are variable and the pathophysiology is not well understood. Herein, we describe otopathologic findings in two such cases to provide insight into pathophysiology and outcomes. PATIENTS Two patients had a history of head trauma resulting in bilateral TBF and sudden, profound, sensorineural hearing loss. INTERVENTION Both cases underwent unilateral CI following head trauma. MAIN OUTCOME MEASURES Both TBs from each patient were harvested postmortem and histologically analyzed to determine fracture lines, intralabyrinthine fibroosseous changes, and spiral ganglion neuron (SGN) counts. Clinical histories and audiometric outcomes were also reviewed. RESULTS In both cases, the implanted TB showed extensive intracochlear ossification, which was greater when fracture involved the cochlea. In contrast, the nonimplanted cochleae were patent with small osseous deposits at the round window membrane. Interaural SGN counts were lower on the implanted side and hearing results were moderate to poor. CONCLUSIONS Otopathologic analyses of patients with a CI after bilateral TBF are rare. Based on otopathology of two patients with bilateral TBF and subsequent CI, implanted TBs show extensive intracochlear fibroosseous changes greater than the nonimplanted side. Findings have implications for auditory rehabilitation after TBF.
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Bhavana K, Bharti B, Vishwakarma R. Round Window Insertion in Veria Technique of Cochlear Implantation: An Essential Modification. Indian J Otolaryngol Head Neck Surg 2019; 71:1586-1591. [PMID: 31750221 PMCID: PMC6841796 DOI: 10.1007/s12070-019-01677-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022] Open
Abstract
Cochlear implants have been done using various surgical approaches. The classical posterior tympanotomy approach has been practiced by majority of surgeons worldwide. An alternative approach is the transcanal Veria approach. This is non mastoidectomy approach where the electrode is threaded via a transcanal tunnel into the cochleostomy site. Majority of "Veria" surgeons are inserting the cochlear electrodes via a cochleostomy. This article focuses on round window insertion of cochlear electrode which has been proven to be a "softer "technique of electrode insertions and finds its role in preservation of residual hearing. Out of 115 cochlear implants done at AIIMS Patna between May 2014-May 2018, using the Veria approach, 52 patients have now been done using the round window insertion. Veria approach is a non-mastoidectomy technique where a special perforator is used to drill a trans canal tunnel which lodges the cochlear electrodes. All kind of implants were used and round window insertion was possible with different kind of electrodes. Out of 52 implants, 24 were MEDEL Sonata with straight electrode and flex soft electrode, 21 were Advanced Bionics Precurved 1 J electrode, 2 were (CI 24 REST) Cochlear devices standard straight array and 5 were Neurelec standard straight array devices. Insertion was uneventful in all the cases and intra op telemetry results were satisfactory post insertion. Round window insertion has now become routine for cochlear implants especially in cases where we have to preserve residual hearing. Veria approach earlier was considered to be only a "cochleostomy" approach but our successful insertion via the round window using the Veria technique is a landmark modification and alleviates any such limitation which was associated with this technique before.
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Affiliation(s)
- Kranti Bhavana
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Patna, Phulwarisharif, Patna, 801507 India
| | - Bhartendu Bharti
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Patna, Phulwarisharif, Patna, 801507 India
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