The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

2018 ◽  
Vol 23 (3) ◽  
pp. 181-186 ◽  
Author(s):  
William Crohan ◽  
Jay Krishnaswamy ◽  
Gunesh Rajan
Keyword(s):  
Cochlear Implantation ◽  
Large Change ◽  
Lateral Wall ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Significant Drop ◽  
Speech Performance ◽  
Intracochlear Pressure ◽  
Pressure Changes

Aim: To investigate and compare residual hearing preservation between patients based on the presence of intraoperative gusher. Methodology: We retrospectively compared 2 cohorts of cochlear implant recipients significantly distinguished by whether or not they experienced gusher intraoperatively. Patients underwent cochlear implantation using 24-mm lateral wall electrode arrays as well pharmacologic steroid protection. All patients were assessed by a hearing implant MDT. Hearing preservation rates and speech perception outcomes were assessed at 1, 6, 12, 24, 36, 48, and 60 months. Results: The patients with no gusher demonstrated complete hearing preservation. The patients with gusher demonstrated significant postoperative reduction of hearing thresholds, which declined at a significantly higher pace during follow-up. All patients demonstrated significantly better speech performance after cochlear implantation. Conclusion: The present study suggests that intraoperative gusher is associated with a significant drop in residual hearing, both immediately and over time, which may be related to the large change in intracochlear pressure intraoperatively.

Preservation of residual hearing following cochlear implantation: comparison between three surgical techniques

2007 ◽  
Vol 122 (3) ◽  
pp. 246-252 ◽  
Author(s):  
S Berrettini ◽  
F Forli ◽  
S Passetti
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Lateral Wall ◽  
Hearing Preservation ◽  
Acoustic Stimulation ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Electrode Insertion

AbstractThe preservation of residual hearing is becoming a high priority in cochlear implant surgery. It allows better speech understanding and ensures long-lasting and stable performance; it also allows the possibility, in selected cases, of combining electro-acoustic stimulation in the same ear.We present the results of a retrospective study of the conservation of residual hearing in three different groups of patients who had undergone cochlear implantation using three different cochlear implant electrode arrays, combined with three different surgical techniques for the cochleostomy. The study aimed to evaluate which approach allowed greater preservation of residual hearing.The best residual hearing preservation results (i.e. preservation in 81.8 per cent of patients) were achieved with the Contour Advance electrode array, using the Advance Off-Stylet technique and performing a modified anterior inferior cochleostomy; this combination enabled reduced trauma to the lateral wall of the cochlea during electrode insertion.

Electrode design and insertional depth-dependent intra-cochlear pressure changes: a model experiment

2017 ◽  
Vol 132 (3) ◽  
pp. 224-229 ◽  
Author(s):  
P Mittmann ◽  
A Ernst ◽  
I Todt
Keyword(s):  
Cochlear Implant ◽  
Fluid Pressure ◽  
Electrode Array ◽  
Lateral Wall ◽  
Peak Frequency ◽  
Peak Amplitude ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Pressure Peak ◽  
Pressure Changes

AbstractBackground:Preservation of residual hearing is one of the major goals in modern cochlear implant surgery. Intra-cochlear fluid pressure changes influence residual hearing, and should be kept low before, during and after cochlear implant insertion.Methods:Experiments were performed in an artificial cochlear model. A pressure sensor was inserted in the apical part. Five insertions were performed on two electrode arrays. Each insertion was divided into three parts, and statistically evaluated in terms of pressure peak frequency and pressure peak amplitude.Results:The peak frequency over each third part of the electrode increased in both electrode arrays. A slight increase was seen in peak amplitude in the lateral wall electrode array, but not in the midscalar electrode array. Significant differences were found in the first third of both electrode arrays.Conclusion:The midscalar and lateral wall electrode arrays have different intra-cochlear fluid pressure changes associated with intra-cochlear placement, electrode characteristics and insertion.

Minimizing Intracochlear Pressure: Influence of the Insertion Sheath

2021 ◽  
pp. 1-6
Author(s):  
Ceyhun Ucta ◽  
Philipp Mittmann ◽  
Arneborg Ernst ◽  
Rainer Seidl ◽  
Gina Lauer
Keyword(s):  
Optical Sensor ◽  
Cochlear Implantation ◽  
Apical Part ◽  
Electrode Arrays ◽  
Insertion Technique ◽  
Cochlear Model ◽  
Electrode Insertion ◽  
Intracochlear Pressure ◽  
Pressure Changes

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.

Intraoperative Intracochlear Electrocochleography and Residual Hearing Preservation Outcomes When Using Two Types of Slim Electrode Arrays in Cochlear Implantation

2019 ◽  
Vol 40 ◽  
pp. S29-S37 ◽  
Author(s):  
Angel Ramos-Macias ◽  
Stephen O’Leary ◽  
Angel Ramos-deMiguel ◽  
Christo Bester ◽  
Juan C. Falcon-González
Keyword(s):  
Cochlear Implantation ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Electrode Arrays

scholarly journals Hearing preservation potential after Cochlear-Implantation: comparison of 6 lateral-wall electrode arrays

2019 ◽  
Author(s):  
MC Suhling ◽  
A Lesinski-Schiedat ◽  
T Lenarz ◽  
R Salcher ◽  
M Schüssler ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Lateral Wall ◽  
Hearing Preservation ◽  
Electrode Arrays ◽  
Preservation Potential

scholarly journals Current criteria for selecting cochlear implant in deaf patients: a review

2021 ◽  
Vol 9 (1) ◽  
pp. 50
Author(s):  
Santosh Kumar Swain
Keyword(s):  
Hearing Loss ◽  
Cochlear Implant ◽  
Neural Plasticity ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
Low Frequency ◽  
Hearing Preservation ◽  
Electrode Arrays ◽  
Profound Hearing Loss ◽  
Unilateral Deafness

Cochlear implantation is indicated in patients with severe to profound hearing loss that cannot be adequately treated by other auditory rehabilitation measures. The definitive indication of cochlear implantation is made on the basis of an extensive interdisciplinary clinical, audiological, radiological, and psychological diagnostic work-up. There are numerous changes are happening in cochlear implant candidacy. These have been associated with concomitant changes in surgical techniques, which enhanced the utility and safety of cochlear implantation. Currently, cochlear implants are approved for individuals with severe to profound unilateral hearing loss rather than previously needed for bilateral profound hearing loss. Studies have begun using the short electrode arrays for shallow insertion in patients with low-frequency residual hearing loss. The advancement in designs of the cochlear implant along with improvements in surgical techniques reduce the complications and result in the safety and efficacy of the cochlear implant which further encourages the use of these devices. This review article aims to discuss the new concepts in the candidacy of the cochlear implant, cochlear implant in younger children and hearing preservation, a cochlear implant for unilateral deafness, bilateral cochlear implant, and cochlear implant with neural plasticity and selection of patients for the cochlear implant.

scholarly journals Effects of Round Window Opening Size and Moisturized Electrodes on Intracochlear Pressure Related to the Insertion of a Cochlear Implant Electrode

2016 ◽  
Vol 6 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Ingo Todt ◽  
Arneborg Ernst ◽  
Philipp Mittmann
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Pressure Change ◽  
Hearing Preservation ◽  
Round Window Membrane ◽  
Cochlear Model ◽  
Window Opening ◽  
Hydrophilic Character ◽  
Intracochlear Pressure ◽  
Pressure Changes

Intracochlear pressure changes during the cochlear implant insertion are assumed to be an important contributor to hearing preservation. The aim was to observe intracochlear pressure changes by different round window opening sizes and different hydrophilic electrode conditions. The experiments were performed in a cochlear model with a micropressure sensor in the helicotrema area. Different artificial round window membrane and different moisturized electrode conditions were compared. A punctured round window causes a significantly higher and an indirect moisturized electrode condition a significantly lower intracochlear pressure change. The degree of round window opening and the hydrophilic character of an electrode during insertion affect the intracochlear pressure significantly in a model.

Slim Perimodiolar Arrays Are as Effective as Slim Lateral Wall Arrays for Functional Hearing Preservation After Cochlear Implantation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Erika Woodson ◽  
Molly Smeal ◽  
Rebecca C. Nelson ◽  
Thomas Haberkamp ◽  
Sarah Sydlowski
Keyword(s):  
Cochlear Implantation ◽  
Lateral Wall ◽  
Hearing Preservation

scholarly journals Methods of Hearing Preservation during Cochlear Implantation

2016 ◽  
Vol 21 (03) ◽  
pp. 297-301 ◽  
Author(s):  
Ahmed Khater ◽  
Mohammad El-Anwar
Keyword(s):  
Cochlear Implantation ◽  
Fibrous Tissue ◽  
Surgical Techniques ◽  
Mechanical Damage ◽  
Hearing Preservation ◽  
Cochrane Library ◽  
Topical Steroids ◽  
Electrode Design ◽  
Residual Hearing ◽  
Contributing Factors

Introduction Recent advances in surgical techniques and electrode design have made residual hearing preservation during cochlear implantation (CI) possible, achievable, and desirable. Objectives The objective of this study was to review the literature regarding methods used for hearing preservation during CI surgery. Data Synthesis We performed a search in the LILACS, MEDLINE, SciELO, PubMed databases, and Cochrane Library, using the keywords CI, hearing preservation, CI electrode design, and CI soft surgery. We fully read about 15 studies that met the criteria described in “study selection”. The studies showed that several factors could contribute to possible cochlear damage during or after CI surgery and must be kept in mind; mechanical damage during electrode insertion, shock waves in the perilymph fluid due to implantation, acoustic trauma due to drilling, loss of perilymph and disruption of inner ear fluid homeostasis, potential bacterial infection, and secondary intracochlear fibrous tissue formation. The desire to preserve residual hearing has led to the development of the soft-surgery protocols with its various components; avoiding entry of blood into the cochlea and the use of hyaluronate seem to be reasonably supported, whereas the use of topical steroids is questionable. The site of entry into the cochlea, electrode design, and the depth of insertion are also important contributing factors. Conclusion Hearing preservation would be useful for CI patients to benefit from the residual low frequency, as well as for the children who could be candidate for future regenerative hair cell therapy.

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