Hearing loss patterns after cochlear implantation via the round window in an animal model

Objective: To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. Methods: Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. Results: Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. Conclusion: Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.

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Relationship between Metabolomics Profile of Perilymph in Cochlear-Implanted Patients and Duration of Hearing Loss

Metabolites ◽

10.3390/metabo9110262 ◽

2019 ◽

Vol 9 (11) ◽

pp. 262

Author(s):

Trinh ◽

Blasco ◽

Emond ◽

Andres ◽

Lefevre ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Cochlear Implantation ◽

Round Window ◽

Univariate Analysis ◽

Sensorineural Hearing ◽

Easy Access ◽

Metabolomic Analysis ◽

Innovative Strategy ◽

The Relationship

Perilymph metabolomic analysis is an emerging innovative strategy to improve our knowledge of physiopathology in sensorineural hearing loss. This study aims to develop a metabolomic profile of human perilymph with which to evaluate the relationship between metabolome and the duration of hearing loss. Inclusion criteria were eligibility for cochlear implantation and easy access to the round window during surgery; patients with residual acoustic hearing in the ear to be implanted were excluded. Human perilymph was sampled from 19 subjects during cochlear implantation surgery. The perilymph analysis was performed by Liquid Chromatography−High-Resolution Mass and data were analyzed by supervised multivariate analysis based on Partial Least-Squares Discriminant Analysis and univariate analysis. Samples were grouped according to their median duration of hearing loss. We included the age of patients as a covariate in our models. Statistical analysis and pathways evaluation were performed using Metaboanalyst. Nineteen samples of human perilymph were analyzed, and a total of 106 different metabolites were identified. Metabolomic profiles were significantly different for subjects with ≤ 12 or > 12 years of hearing loss, highlighting the following discriminant compounds: N-acetylneuraminate, glutaric acid, cystine, 2-methylpropanoate, butanoate and xanthine. As expected, the age of patients was also one of the main discriminant parameters. Metabolic signatures were observed for duration of hearing loss. These findings are promising steps towards illuminating the pathophysiological pathways associated with etiologies of sensorineural hearing loss, and hold open the possibilities of further explorations into the mechanisms of sensorineural hearing loss using metabolomic analysis.

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Cochlear implantation via round window or cochleostomy: Effect on hearing in an animal model

The Laryngoscope ◽

10.1002/lary.26033 ◽

2016 ◽

Vol 126 (11) ◽

pp. E375-E378 ◽

Cited By ~ 2

Author(s):

Roy Hod ◽

Joseph Attias ◽

Eyal Raveh ◽

Ben I. Nageris

Keyword(s):

Animal Model ◽

Cochlear Implantation ◽

Round Window

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Preoperative Evaluation and Surgical Outcome of Cochlear Implantation in NIENT

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v26i2.50640 ◽

2020 ◽

Vol 26 (2) ◽

pp. 128-135

Author(s):

Md Zakaria Sarker ◽

Muhammad Rafiqul Islam ◽

Utpal Kumar Dutta ◽

Debabrota Roy ◽

AHM Ferdows Nur ◽

...

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Psychosocial Development ◽

Cochlear Implantation ◽

Preoperative Evaluation ◽

Round Window ◽

Round Window Membrane ◽

Safe Procedure ◽

Female Ratio ◽

Facial Recess

Background: Sensory neural hearing loss (SNHL) is the most common congenital sensory deficit, with an incidence of one to three per 1000 live births. Acoustic deprivation during the first 3 years of life can hinder speech and language acquisition with significant negative consequences on a child’s educational and psychosocial development. The gold standard intervention for permanent severe to profound hearing loss is cochlear implantation. Cochlear implant (CI); is a semi implantable electronic device that bypass the cochlea. Objectives: An observational study was carried out on 40 cases of pre-lingual deaf to find out the causes of pre-lingual deaf, to evaluate the preoperative procedures to set ideal criteria for pre -lingual cochlear implantation and to evaluate surgical procedure and outcome of cochlear implantations. Methods: Evaluation of the candidates included patient medical history, general health checkup, ENT examination, audiometric evaluation, CT and MRI scans, psychological profile of the candidate. A limited cortical mastoidectomy was performed. The facial recess was opened using the fossa of incudis as an initial landmark. The round window niche was visualized through the facial recess about 2 mm inferior to the stapes. A cochleostomy created by drilling over the basal turn of the cochlea anterior and inferior to the annulus of the round window membrane. The electrode array was then carefully inserted through the fenestra into the scala tympani of the cochlea. Electrophysiological testing (Neural Response Telemetry: NRT) was performed to verify the correct placement of active electrodes. Resulst: Among them 22 (55%) were male and 18 (45%) were female. Male female ratio was 1.2:1. Age distribution at implantation was 3.3±1.054(SD). Average hearing loss was 96.4±5.3(SD) dB and in aided audiogram was 63.7±4.6(SD) dB. Overall complications occurred in 10 (25%) cases. Transient facial nerve paresis in 2 (5%), injury of tympanic membrane in 1(2.5%), seroma 4(10%) and delayed otitis media in 1(2.5%) were observed. Major postoperative complications occurred in 2 cases including facial nerve palsy in 1(2.5%) case and spontaneous device failure in 1(2.5%) case. Conclusion: The result of this survey was find out the risk factor of congenital hearing loss. With a thorough preoperative evaluation, we can select proper candidates for CI which is a reliable and safe procedure with a low percentage of severe complication. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 128-135

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Neuroprotective Effect of Near-Infrared Light in an Animal Model of CI Surgery

Audiology and Neurotology ◽

10.1159/000508619 ◽

2020 ◽

pp. 1-7

Author(s):

Ira Strübing ◽

Moritz Gröschel ◽

Susanne Schwitzer ◽

Arne Ernst ◽

Felix Fröhlich ◽

...

Keyword(s):

Animal Model ◽

Hearing Loss ◽

Hair Cells ◽

Cochlear Implantation ◽

Near Infrared ◽

Outer Hair Cells ◽

Auditory Brainstem Responses ◽

Infrared Light ◽

Residual Hearing ◽

Significant Difference

Introduction: The preservation of residual hearing has become an important consideration in cochlear implant (CI) recipients in recent years. It was the aim of the present animal experimental study to investigate the influence of a pretreatment with near-infrared (NIR) light on preservation of sensory hair cells and residual hearing after cochlear implantation. Methods: NIR was applied unilaterally (15 min, 808 nm, 120 mW) to 8 guinea pigs, immediately before a bilateral scala tympani CI electrode insertion was performed. The nonirradiated (contralateral) side served as control. Twenty-eight days postoperatively, auditory brainstem responses (ABRs) were registered from both ears to screen for hearing loss. Thereafter, the animals were sacrificed and inner hair cells (IHCs) and outer hair cells (OHCs) were counted and compared between NIR-pretreated and control (contralateral) cochleae. Results: There was no IHC loss upon cochlear implantation. OHC loss was most prominent on both sides at the apical part of the cochlea. NIR pretreatment led to a statistically significant reduction in OHC loss (by 39.8%). ABR recordings (across the frequencies 4–32 kHz) showed a statistically significant difference between the 2 groups and corresponds well with the apical structural damage. Hearing loss was reduced by about 20 dB on average for the NIR-pretreated group (p ≤ 0.05). Discussion/Conclusion: A single NIR pretreatment in this animal model of CI surgery appears to be neuroprotective for residual hearing. This is in line with other studies where several NIR posttreatments have protected cochlear and other neural tissues. NIR pretreatment is an inexpensive, effective, and noninvasive approach that can complement other ways of preserving residual hearing and, hence, should deserve further clinical evaluation in CI patients.

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A gyógyszeres kezelésre nem javuló hirtelen halláscsökkenés lépcsőzetes sebészi terápiája

Orvosi Hetilap ◽

10.1556/650.2021.32307 ◽

2021 ◽

Vol 162 (51) ◽

pp. 2055-2060

Keyword(s):

Hearing Loss ◽

Inner Ear ◽

Hearing Aids ◽

Cochlear Implantation ◽

Early Stage ◽

Round Window ◽

Complete Recovery ◽

Round Window Membrane ◽

Systemic Steroid ◽

Profound Hearing Loss

Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsődleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezőként felmerül a perilymphafistula lehetősége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép műtéti kezelése a dobüreg feltárását követően a belső fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelő hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmű okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követően exploratív tympanotomiát végeztünk, melynek során a belső fül ablakait obliteráltuk. Hallásjavulást ezt követően sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az előzetes kerekablak-obliteráció nem zárja ki a későbbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055–2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055–2060.

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A maradványhallás megőrzésének lehetőségei cochlearis implantáció során Nucleus CI532 Slim Modiolar elektródasorral

Orvosi Hetilap ◽

10.1556/650.2018.31113 ◽

2018 ◽

Vol 159 (41) ◽

pp. 1680-1688 ◽

Cited By ~ 1

Author(s):

Roland Nagy ◽

János András Jarabin ◽

Balázs Dimák ◽

Ádám Perényi ◽

Ferenc Tóth ◽

...

Keyword(s):

Hearing Loss ◽

Minimally Invasive ◽

Cochlear Implantation ◽

Basilar Membrane ◽

Round Window ◽

Spiral Ganglion ◽

Hearing Threshold ◽

Electrode Array ◽

Hearing Preservation ◽

Residual Hearing

Abstract: During the rehabilitation of hearing-impaired patients, the preservation of residual acoustic hearing following cochlear implantation by minimizing the implantation trauma allows for improved hearing performance. To achieve this, minimally invasive, soft surgery methods and thinner, atraumatic electrodes were required. In our present study, we reported a case where Cochlear® Nucleus CI532 Slim Modiolar electrode was implanted in a patient with residual hearing. Our aim was to study the possible preservation of postoperative acoustic residual hearing by audiological monitoring. Since childhood, due to her congenital hearing loss, she has been wearing a conventional, airborne hearing correction device on both ears. Six months before cochlear implantation, we measured the progression on both sides of the hearing loss, so we decided to perform cochlear implantation. The patient had residual hearing on both ears prior to surgery thus the Cochlear® Nucleus CI532 Slim Modiolar Implant was used. The minimally invasive surgery was performed on the patient’s right ear through the round window approach. Compared to the preoperative hearing threshold (average 85 dBHL) in the 4th postoperative week, an initial hearing threshold progression of 20–25 dBHL was observed between 0.25 and 1.0 kHz, while of 5–10 dBHL between 2.0–4.0 kHz. Hearing threshold measured in the 6th month showed a slight progression in the range above 1 kHz, but improved by the 12th month, to the results achieved at the 4th week. The effects of cochlear implantation on residual hearing have been studied in numerous studies, in which several key surgical and technical factors have been identified. Nucleus CI532 is a Slim Modiolar electrode profile that is close to the modiolus, so it is expected to have a lower endocochlear hydrodynamic load since it lies in the covering of the osseus spiral lamina, thus less influencing the dynamics of the basilar membrane. However, the perimodiolar location of the electrode array allows the adjacent nerve elements of the spiral ganglion to be stimulated with a lower electrical intensity and a reduced surface that may be neuroprotective. Preservation of acoustic residual hearing following cochlear implantation improves the patient’s speech perception and the sound localization skills, particularly in difficult circumstances. Long-term residual hearing preservation may also be of great importance in the subsequent feasibility for regenerative procedures and drug treatments. Orv Hetil. 2018; 159(41): 1680–1688.

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Delayed low frequency hearing loss caused by cochlear implantation interventions via the round window but not cochleostomy

Hearing Research ◽

10.1016/j.heares.2015.12.012 ◽

2016 ◽

Vol 333 ◽

pp. 49-57 ◽

Cited By ~ 11

Author(s):

David Rowe ◽

Scott Chambers ◽

Amy Hampson ◽

Hayden Eastwood ◽

Luke Campbell ◽

...

Keyword(s):

Hearing Loss ◽

Cochlear Implantation ◽

Round Window ◽

Low Frequency

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Conductive Component After Cochlear Implantation in Patients With Residual Hearing Conservation

American Journal of Audiology ◽

10.1044/2014_aja-14-0018 ◽

2014 ◽

Vol 23 (4) ◽

pp. 359-364 ◽

Cited By ~ 16

Author(s):

Richard A. Chole ◽

Timothy E. Hullar ◽

Lisa G. Potts

Keyword(s):

Hearing Loss ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Round Window ◽

Bone Conduction ◽

Surgical Techniques ◽

Residual Hearing ◽

Conductive Component ◽

Conductive Hearing ◽

New Onset

Purpose Changes in auditory thresholds following cochlear implantation are generally assumed to be due to damage to neural elements. Theoretical studies have suggested that placement of a cochlear implant can cause a conductive hearing loss. Identification of a conductive component following cochlear implantation could guide improvements in surgical techniques or device designs. The purpose of this study is to characterize new-onset conductive hearing losses after cochlear implantation. Method In a prospective study, air- and bone-conduction audiometric testing were completed on cochlear implant recipients. An air–bone gap equal to or greater than 15 dB HL at 2 frequencies determined the presence of a conductive component. Results Of the 32 patients with preoperative bone-conduction hearing, 4 patients had a new-onset conductive component resulting in a mixed hearing loss, with air-conduction thresholds ranging from moderate to profound and an average air–bone gap of 30 dB HL. One had been implanted through the round window, 2 had an extended round window, and 1 had a separate cochleostomy. Conclusions Loss of residual hearing following cochlear implantation may be due in part to a conductive component. Identifying the mechanism for this conductive component may help minimize hearing loss. Postoperative hearing evaluation should measure both air- and bone-conduction thresholds.

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