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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [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: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Pimentel de Morais C, Branco P, Pereira A, Castelhano L, Donato M, Correia F, O'Neill A, Santos R, Escada P. The Role of Steroids in the Preservation of Hearing and Vestibular Function in Cochlear Implantation. Laryngoscope 2024. [PMID: 38381055 DOI: 10.1002/lary.31360] [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: 09/18/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Cochlear implant surgery is guided by principles of atraumatic insertion as to protect the inner ear. Previous studies suggest the potential benefit of steroids in patients undergoing cochlear implantation (CI), although the optimal route of administration has yet to be determined. We aim to systematically review the human studies of hearing and vestibular function preservation in patients undergoing CI receiving perioperative steroids and to discuss their role. DATA SOURCES Search performed in PubMed, EMBASE, and CENTRAL databases in December 2023. REVIEW METHODS Studies comparing several methods of steroid delivery and conventional management for patients undergoing CI were identified. Primary outcomes included hearing and vestibular function preservation. Secondary outcomes included reported adverse events, routes of steroid administration, and the presence of a control group without steroid administration. RESULTS A total of 15 studies (N = 659) met inclusion criteria. Methodology, doses, route of steroid administration, and follow-up duration differed between most studies. Audiometric, vestibular, and hearing preservation (HP) results were inconsistent. In 12 studies, perioperative steroids were associated with either increased HP or vestibular function preservation. Only two studies reported adverse events related to oral corticosteroid therapy. CONCLUSIONS There is a tendency for perioperative steroids to have a positive impact, at least in the short term, on hearing and vestibular function preservation in CI. Topical corticosteroid therapy appears to have a superior risk-benefit profile. There is a need for future carefully designed randomized controlled trials to determine the ideal route of steroid administration and its real impact in the long term. Laryngoscope, 2024.
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Affiliation(s)
| | - Pedro Branco
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - André Pereira
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Luís Castelhano
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Mariana Donato
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Filipe Correia
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Assunção O'Neill
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Ricardo Santos
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Pedro Escada
- Otolaryngology and Head and Neck Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
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Le Prell CG, Clavier OH, Bao J. Noise-induced hearing disorders: Clinical and investigational tools. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:711. [PMID: 36732240 PMCID: PMC9889121 DOI: 10.1121/10.0017002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas 75080, USA
| | | | - Jianxin Bao
- Gateway Biotechnology Inc., St. Louis, Missouri 63132, USA
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Gay RD, Enke YL, Kirk JR, Goldman DR. Therapeutics for hearing preservation and improvement of patient outcomes in cochlear implantation—Progress and possibilities. Hear Res 2022; 426:108637. [DOI: 10.1016/j.heares.2022.108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/04/2022]
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Bhavana K, Timmaraju S, Kumar V, Kumar C, Bharti B, Prakash R, Sinha U. OTOPLAN-Based Study of Intracochlear Electrode Position Through Cochleostomy and Round Window in Transcanal Veria Technique. Indian J Otolaryngol Head Neck Surg 2022; 74:575-581. [PMID: 36514425 PMCID: PMC9741677 DOI: 10.1007/s12070-022-03228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
To study the postoperative visualisation of the electrode array insertion angle through transcanal Veria approach in both round window and cochleostomy techniques. Retrospective study. Tertiary care centre. 26 subjects aged 2-15 years implanted with a MED-EL STANDARD electrode array (31.5 mm) through Veria technique were selected. 16 had the electrode insertion through the round window, 10 through anteroinferior cochleostomy. DICOM files of postoperative computer tomography (CT) scans were collected and analysed using the OTOPLAN 3.0 software. Examined parameters were cochlear duct length, average angle of insertion depth. Pearson's Correlation Test was utilized for statistical analysis. Average cochlear duct length was 38.12 mm, ranging from 34.2 to 43 mm. Average angle of insertion depth was 666 degrees through round window insertion and 670 degrees through cochleostomy insertion. Pearson's correlation showed no significant difference in average angle of insertion depth between subjects with cochleostomy and round window insertion. Detailed study on the OTOPLAN software has established that there remains no difference between round window insertion or cochleostomy insertion when it comes to electrode array position and placement in the scala tympani. It is feasible to perform round window insertion and cochleostomy insertion through transcanal Veria approach as this technique provides good visualisation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03228-5.
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Affiliation(s)
- Kranti Bhavana
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | | | - Vijay Kumar
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | | | - Bhartendu Bharti
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | - Rudra Prakash
- Department of Otorhinolaryngology, AIIMS Patna, Phulwarisharif, Patna, 801507 India
| | - Upasana Sinha
- Department of Radiodiagnosis, AIIMS Patna, Patna, India
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Tarabichi O, Jensen M, Hansen MR. Advances in hearing preservation in cochlear implant surgery. Curr Opin Otolaryngol Head Neck Surg 2021; 29:385-390. [PMID: 34354014 PMCID: PMC9002354 DOI: 10.1097/moo.0000000000000742] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Advancements in cochlear implant surgical approaches and electrode designs have enabled preservation of residual acoustic hearing. Preservation of low-frequency hearing allows cochlear implant users to benefit from electroacoustic stimulation, which improves performance in complex listening situations, such as music appreciation and speech understanding in noise. Despite the relative high rates of success of hearing preservation, postoperative acoustic hearing outcomes remain unpredictable. RECENT FINDINGS Thin, flexible, lateral wall arrays are preferred for hearing preservation. Both shortened and thin, lateral wall arrays have shown success with hearing preservation and the optimal implant choice is an issue of ongoing investigation. Electrocochleography can monitor cochlear function during and after insertion of the electrode array. The pathophysiology of hearing loss acutely after cochlear implant may differ from that involved in delayed hearing loss following cochlear implant. Emerging innovations may reduce cochlear trauma and improve hearing preservation. SUMMARY Hearing preservation is possible using soft surgical techniques and electrode arrays designed to minimize cochlear trauma; however, a subset of patients suffer from partial to total loss of acoustic hearing months to years following surgery despite evidence of residual apical hair cell function. Early investigations in robotic-assisted insertion and dexamethasone-eluting implants show promise.
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Affiliation(s)
- Osama Tarabichi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Megan Jensen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
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Abstract
Cochlear implant surgery is a successful procedure for auditory rehabilitation of patients with severe to profound hearing loss. However, cochlear implantation may lead to damage to the inner ear, which decreases residual hearing and alters vestibular function. It is now of increasing interest to preserve residual hearing during this surgery because this is related to better speech, music perception, and hearing in complex listening environments. Thus, different efforts have been tried to reduce cochlear implantation-related injury, including periprocedural glucocorticoids because of their anti-inflammatory properties. Different routes of administration have been tried to deliver glucocorticoids. However, several drawbacks still remain, including their systemic side effects, unknown pharmacokinetic profiles, and complex delivery methods. In the present review, we discuss the role of periprocedural glucocorticoid therapy to decrease cochlear implantation-related injury, thus preserving inner ear function after surgery. Moreover, we highlight the pharmacokinetic evidence and clinical outcomes which would sustain further interventions.
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Kather M, Koitzsch S, Breit B, Plontke S, Kammerer B, Liebau A. Metabolic reprogramming of inner ear cell line HEI-OC1 after dexamethasone application. Metabolomics 2021; 17:52. [PMID: 34028607 PMCID: PMC8144088 DOI: 10.1007/s11306-021-01799-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION One approach to dampen the inflammatory reactions resulting from implantation surgery of cochlear implant hearing aids is to embed dexamethasone into the matrix of the electrode carrier. Possible side effects for sensory cells in the inner ear on the metabolomics have not yet been evaluated. OBJECTIVE We examined changes in the metabolome of the HEI-OC1 cell line after dexamethasone incubation as a cell model of sensory cells of the inner ear. RESULTS AND CONCLUSION Untargeted GC-MS-profiling of metabolic alterations after dexamethasone treatment showed that dexamethasone had antithetical effects on the metabolic signature of the cells depending on growth conditions. The differentiated state of HEI-OC1 cells is better suited for elucidating metabolic changes induced by external factors. Dexamethasone treatment of differentiated cells led to an increase in intracellular amino acids and enhanced glucose uptake and β-oxidation in the cells. Increased availability of precursors for glycolysis and ATP production by β-oxidation stabilizes the energy supply in the cells, which could be assumed to be beneficial in coping with cellular stress. We found no negative effects of dexamethasone on the metabolic level, and changes may even prepare sensory cells to better overcome cellular stress following implantation surgery.
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Affiliation(s)
- Michel Kather
- Centre for Integrative Biological Signalling Studies CISA, University of Freiburg, Habsburger Straße 49, 79104, Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Hebelstr. 27, 79104, Freiburg, Germany
- Institute of Organic Chemistry, University of Freiburg, Albertstraße 21, 79104, Freiburg, Germany
| | - Sabine Koitzsch
- Department of Otorhinolaryngology-Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Bernhard Breit
- Institute of Organic Chemistry, University of Freiburg, Albertstraße 21, 79104, Freiburg, Germany
| | - Stefan Plontke
- Department of Otorhinolaryngology-Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Bernd Kammerer
- Centre for Integrative Biological Signalling Studies CISA, University of Freiburg, Habsburger Straße 49, 79104, Freiburg, Germany.
- Institute of Organic Chemistry, University of Freiburg, Albertstraße 21, 79104, Freiburg, Germany.
- Centre for Biological Signalling Studies BIOSS, University of Freiburg, Schänzlestraße 18, 79104, Freiburg, Germany.
- Center for Biosystems Analysis, ZBSA, University of Freiburg, Habsburgerstr. 49, 79104, Freiburg, Germany.
| | - Arne Liebau
- Department of Otorhinolaryngology-Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
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Killeen DE, Kutz JW, Hunter JB, Isaacson B. Do Perioperative Systemic Corticosteroids Improve Cochlear Implant Hearing Preservation Outcomes? Laryngoscope 2021; 132:255-256. [PMID: 33780014 DOI: 10.1002/lary.29540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Daniel E Killeen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Joe W Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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O'Leary SJ, Choi J, Brady K, Matthews S, Ozdowska KB, Payne M, McLean T, Rousset A, Lo J, Creber N, Tari S, Dowell R, Briggs R. Systemic methylprednisolone for hearing preservation during cochlear implant surgery: A double blinded placebo-controlled trial. Hear Res 2021; 404:108224. [PMID: 33774594 DOI: 10.1016/j.heares.2021.108224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023]
Abstract
AIM To assess whether a single, peri-operative, high dose of methylprednisolone can improve the preservation of residual acoustic hearing following cochlear implantation (CI). METHODS This was a double blinded placebo-controlled trial, performed in a tertiary academic centre. The hypothesis was that methylprednisolone would improve the preservation of hearing, and lower electrode impedances. Adult patients (18-85 years) with hearing at 85 dB or better at 500 Hz in the ear to be implanted were randomly allocated to either treatment (methylprednisolone, 1g administered intravenously upon induction of anaesthesia) or control (normal saline infusion). As per standard clinical practice, all patients received a routine dose of dexamethasone (8 mg intravenously) on induction of anaesthesia. Implantation was undertaken with a slim and flexible lateral wall electrode via the round window. Surgical technique was routine, with adherence to soft surgical principles. The primary outcome was hearing preservation within 20 dB at 500 Hz, 12 months following cochlear implantation. Secondary outcomes included hearing preservation at 6 weeks and 3 months, monopolar electrode impedance, and Consonant-Vowel-Consonant (CVC) Phoneme scores at 3 and 12 months after surgery. RESULTS Forty-five patients were enrolled into the control group and 48 patients received the steroid. The number of patients achieving hearing preservation at 12 months did not differ significantly between those receiving methylprednisolone treatment and the controls. There were no differences in hearing preservation at any frequency at either 6 weeks or 3 months after implantation. Neither CVC phoneme scores nor electrode impedances differed between the groups. CONCLUSIONS This paper demonstrates that high-dose local steroid injection at surgery was not effective in preventing a loss of residual hearing, improving speech perception, or lowering electrode impedances. The findings were contrary to the experimental literature, and emerging clinical evidence that steroid elution from implant electrodes influences cochlear biology in humans. We found no evidence to support the widely-held practice of administering intravenous steroids in the perioperative period, in an attempt to preserve residual hearing.
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Affiliation(s)
- Stephen J O'Leary
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia; Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, Melbourne East 3002, Australia.
| | - June Choi
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia; Department of Otorhinolaryngology - Head & Neck Surgery, Ansan Hospital, College of Medicine, Korea University, 123, Jeokgeum-ro (Street), Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of Korea
| | - Karina Brady
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Sheila Matthews
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Katie Boncza Ozdowska
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Matthew Payne
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Tim McLean
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Alex Rousset
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Jonathon Lo
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Nathan Creber
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Sylvia Tari
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia
| | - Richard Dowell
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia; Department of Audiology and Speech Sciences, University of Melbourne, 550 Swanston St, Carlton 3053, Australia
| | - Robert Briggs
- Department of Surgery - Otolaryngology, The University of Melbourne, Royal Victorian Eye and Ear Hospital, 32 Gisborne St RVEEH, Melbourne East 3002,Victoria, Australia; Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, Melbourne East 3002, Australia
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Prenzler NK, Salcher R, Lenarz T, Gaertner L, Warnecke A. Dose-Dependent Transient Decrease of Impedances by Deep Intracochlear Injection of Triamcinolone With a Cochlear Catheter Prior to Cochlear Implantation-1 Year Data. Front Neurol 2020; 11:258. [PMID: 32390924 PMCID: PMC7194199 DOI: 10.3389/fneur.2020.00258] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/20/2020] [Indexed: 02/02/2023] Open
Abstract
Administration of low-dose steroids via a catheter inserted into the cochlea to apply pharmaceuticals to more apical regions was previously shown not to be sufficient for long-term reduction of electrode impedances. The aim of the present study was to investigate the effect of intra-cochlear high-dose triamcinolone application on impedances in cochlear implant recipients. Patients received low-dose (4 mg/ml; n = 5) or high-dose (20 mg/ml; n = 5) triamcinolone via a cochlear catheter just prior to the insertion of a Med-El Flex28 electrode. Impedances were measured at defined time points from intra-operatively up to 12 months after first fitting and retrospectively compared with a control group (no steroid application). Patients who received a high-dose application of crystalloid triamcinolone showed significantly reduced impedances in the first fitting measurements compared to the control group. This effect was no longer detectable in patients of the low-dose group at that time. Looking at the different regions of the electrode, the impedance values were lowered significantly only at the basal and medial contacts. At later time points, there were no significant differences between any of the groups. This is the first study to demonstrate a dose-dependent reduction of impedances by deep intra-cochlear injection of triamcinolone in cochlear implant patients. With a high-dose, single application of triamcinolone using a cochlear catheter prior to insertion of a Flex28 electrode, the impedances can be significantly reduced up to and including the first fitting. Although the effect was longer lasting than when compared to low-dose triamcinolone, it was also not permanent.
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Affiliation(s)
- Nils K Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hanover Medical School, Hanover, Germany.,Cluster of Excellence "Hearing4all2.0" of the German Research Foundation, Hanover, Germany
| | - Rolf Salcher
- Department of Otorhinolaryngology, Head and Neck Surgery, Hanover Medical School, Hanover, Germany.,Cluster of Excellence "Hearing4all2.0" of the German Research Foundation, Hanover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Hanover Medical School, Hanover, Germany.,Cluster of Excellence "Hearing4all2.0" of the German Research Foundation, Hanover, Germany
| | - Lutz Gaertner
- Department of Otorhinolaryngology, Head and Neck Surgery, Hanover Medical School, Hanover, Germany.,Cluster of Excellence "Hearing4all2.0" of the German Research Foundation, Hanover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hanover Medical School, Hanover, Germany.,Cluster of Excellence "Hearing4all2.0" of the German Research Foundation, Hanover, Germany
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Evaluating the Efficacy of L-N-acetylcysteine and Dexamethasone in Combination to Provide Otoprotection for Electrode Insertion Trauma. J Clin Med 2020; 9:jcm9030716. [PMID: 32155788 PMCID: PMC7141216 DOI: 10.3390/jcm9030716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Electrode insertion trauma (EIT) during cochlear implantation (CI) can cause loss of residual hearing. L-N-acetylcysteine (L-NAC) and dexamethasone (Dex) have been individually shown to provide otoprotection albeit at higher concentrations that may be associated with adverse effects. Objective/Aims: The aim of this study is to determine whether L-NAC and Dex could be combined to decrease their effective dosage. MATERIALS AND METHODS The organ of Corti (OC) explants were divided into various groups: 1) control; 2) EIT; 3) EIT treated with different concentrations of Dex; 4) EIT treated with different concentrations of L-NAC; 5) EIT treated with L-NAC and Dex in combination. Hair cell (HC) density, levels of oxidative stress, proinflammatory cytokines and nitric oxide (NO) was determined. RESULTS There was a significant loss of HCs in explants subjected to EIT compared to the control group. L-NAC and Dex in combination was able to provide significant otoprotection at lower concentrations compared to individual drugs. CONCLUSIONS AND SIGNIFICANCE A combination containing L-NAC and Dex is effective in protecting sensory cells at lower protective doses than each compound separately. These compounds can be combined allowing a decrease of potential side effects of each compound and providing significant otoprotection for EIT.
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Liebau A, Schilp S, Mugridge K, Schön I, Kather M, Kammerer B, Tillein J, Braun S, Plontke SK. Long-Term in vivo Release Profile of Dexamethasone-Loaded Silicone Rods Implanted Into the Cochlea of Guinea Pigs. Front Neurol 2020; 10:1377. [PMID: 32038458 PMCID: PMC6987378 DOI: 10.3389/fneur.2019.01377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022] Open
Abstract
Glucocorticoids are used intra-operatively in cochlear implant surgeries to reduce the inflammatory reaction caused by insertion trauma and the foreign body response against the electrode carrier after cochlear implantation. To prevent higher systemic concentrations of glucocorticoids that might cause undesirable systemic side effects, the drug should be applied locally. Since rapid clearance of glucocorticoids occurs in the inner ear fluid spaces, sustained application is supposedly more effective in suppressing foreign body and tissue reactions and in preserving neuronal structures. Embedding of the glucocorticoid dexamethasone into the cochlear implant electrode carrier and its continuous release may solve this problem. The aim of the present study was to examine how dexamethasone concentrations in the electrode carrier influence drug levels in the perilymph at different time points. Silicone rods were implanted through a cochleostomy into the basal turn of the scala tympani of guinea pigs. The silicone rods were loaded homogeneously with 0.1, 1, and 10% concentrations of dexamethasone. After implantation, dexamethasone concentrations in perilymph and cochlear tissue were measured at several time points over a period of up to 7 weeks. The kinetic was concentration-dependent and showed an initial burst release in the 10%- and the 1%-dexamethasone-loaded electrode carrier dummies. The 10%-loaded electrode carrier resulted in a more elevated and longer lasting burst release than the 1%-loaded carrier. Following this initial burst release phase, sustained dexamethasone levels of about 60 and 100 ng/ml were observed in the perilymph for the 1 and 10% loaded rods, respectively, during the remainder of the observation time. The 0.1% loaded carrier dummy achieved very low perilymph drug levels of about 0.5 ng/ml. The cochlear tissue drug concentration shows a similar dynamic to the perilymph drug concentration, but only reaches about 0.005–0.05% of the perilymph drug concentration. Dexamethasone can be released from silicone electrode carrier dummies in a controlled and sustained way over a period of several weeks, leading to constant drug concentrations in the scala tympani perilymph. No accumulation of dexamethasone was observed in the cochlear tissue. In consideration of experimental studies using similar drug depots and investigating physiological effects, an effective dose range between 50 and 100 ng/ml after burst release is suggested for the CI insertion trauma model.
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Affiliation(s)
- Arne Liebau
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | | | - Ilona Schön
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Michel Kather
- Center for Biological Systems Analysis ZBSA, Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Bernd Kammerer
- Center for Biological Systems Analysis ZBSA, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | | | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
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14
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Warnecke A, Prenzler NK, Schmitt H, Daemen K, Keil J, Dursin M, Lenarz T, Falk CS. Defining the Inflammatory Microenvironment in the Human Cochlea by Perilymph Analysis: Toward Liquid Biopsy of the Cochlea. Front Neurol 2019; 10:665. [PMID: 31293504 PMCID: PMC6603180 DOI: 10.3389/fneur.2019.00665] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/06/2019] [Indexed: 12/20/2022] Open
Abstract
The molecular pathomechanisms in the majority of patients suffering from acute or progressive sensorineural hearing loss cannot be determined yet. The size and the complex architecture of the cochlea make biopsy and in-depth histological analyses impossible without severe damage of the organ. Thus, histopathology correlated to inner disease is only possible after death. The establishment of a technique for perilymph sampling during cochlear implantation may enable a liquid biopsy and characterization of the cochlear microenvironment. Inflammatory processes may not only participate in disease onset and progression in the inner ear, but may also control performance of the implant. However, little is known about cytokines and chemokines in the human inner ear as predictive markers for cochlear implant performance. First attempts to use multiplex protein arrays for inflammatory markers were successful for the identification of cytokines, chemokines, and endothelial markers present in the human perilymph. Moreover, unsupervised cluster and principal component analyses were used to group patients by lead cytokines and to correlate certain proteins to clinical data. Endothelial and epithelial factors were detected at higher concentrations than typical pro-inflammatory cytokines such as TNF-a or IL-6. Significant differences in VEGF family members have been observed comparing patients with deafness to patients with residual hearing with significantly reduced VEGF-D levels in patients with deafness. In addition, there is a trend toward higher IGFBP-1 levels in these patients. Hence, endothelial and epithelial factors in combination with cytokines may present robust biomarker candidates and will be investigated in future studies in more detail. Thus, multiplex protein arrays are feasible in very small perilymph samples allowing a qualitative and quantitative analysis of inflammatory markers. More results are required to advance this method for elucidating the development and course of specific inner ear diseases or for perioperative characterization of cochlear implant patients.
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Affiliation(s)
- Athanasia Warnecke
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence of the German Research Foundation (DFG; "Deutsche Forschungsgemeinschaft") "Hearing4all", Oldenburg, Germany
| | - Nils K Prenzler
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Heike Schmitt
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence of the German Research Foundation (DFG; "Deutsche Forschungsgemeinschaft") "Hearing4all", Oldenburg, Germany
| | - Kerstin Daemen
- Hannover Medical School, Institute of Transplant Immunology, Hanover, Germany
| | - Jana Keil
- Hannover Medical School, Institute of Transplant Immunology, Hanover, Germany
| | - Martin Dursin
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence of the German Research Foundation (DFG; "Deutsche Forschungsgemeinschaft") "Hearing4all", Oldenburg, Germany
| | - Christine S Falk
- Hannover Medical School, Institute of Transplant Immunology, Hanover, Germany
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15
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Abstract
The advances in technology leading to rapid developments in implantable auditory devices are constantly evolving. Devices are becoming smaller, less visible, and more efficient. The ability to preserve hearing outcomes with cochlear implantation will continue to evolve as surgical techniques improve with the use of continuous feedback during the procedure as well as with intraoperative delivery of drugs and robot assistance. As engineering methods improve, there may one day be a totally implantable aid that is self-sustaining in hearing-impaired patients making them indistinguishable from patients without hearing loss.
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Affiliation(s)
- Robert M Rhodes
- The Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Suite 1400, Oklahoma City, OK 73104, USA
| | - Betty S Tsai Do
- The Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Suite 1400, Oklahoma City, OK 73104, USA.
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