Cochlear implant placement: round window approach

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Douglas D. Backous
Keyword(s):  
Clinical Trials ◽  
Surgical Technique ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Round Window ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Implant Placement ◽  
Single Sided Deafness ◽  
Window Approach

The indications for cochlear implantation continue to extend to patients with increased levels of residual hearing. Single-sided deafness and tinnitus are currently under various clinical trials as even further expansion of the application of cochlear implant device and programming technology is underway. This video details a round window and hearing preservation approach for cochlear implant placement, and incorporates the most recent advances in surgical technique.The video can be found here: http://youtu.be/bDqkbboXrU4.

scholarly journals The evaluation of a slim perimodiolar electrode: surgical technique in relation to intracochlear position and cochlear implant outcomes

2019 ◽  
Vol 277 (2) ◽  
pp. 343-350 ◽  
Author(s):  
Floris Heutink ◽  
Berit M. Verbist ◽  
Lucas H. M. Mens ◽  
Wendy J. Huinck ◽  
Emmanuel A. M. Mylanus
Keyword(s):  
Speech Perception ◽  
Surgical Technique ◽  
Round Window ◽  
Hearing Preservation ◽  
Electrode Position ◽  
Residual Hearing ◽  
High Resolution Computed Tomography ◽  
Absolute Increase ◽  
Window Approach

Abstract Purpose In cochlear implantation (CI), the two factors that are determined by the surgeon with a potential significant impact on the position of the electrode within the cochlea and the potential outcome, are the surgical technique and electrode type. The objective of this prospective study was to evaluate the position of the slim, perimodiolar electrode (SPE), and to study the influence of the SPE position on CI outcome. Methods Twenty-three consecutively implanted, adult SPE candidates were included in this prospective cohort study conducted between December 2016 and April 2019. Mean age at surgery was 59.5 years. Mean preoperative residual hearing was 92.2 dB. Intra-operative fluoroscopy and high-resolution computed tomography scans were performed to evaluate electrode position after insertion using a cochleostomy (CS) approach. Follow-up was 12 months after implantation; residual hearing (6–8 weeks) and speech perception (6–8 weeks and 12 months) were evaluated in relation to the intracochlear SPE position. Results In most patients in whom the SPE was positioned in the scala tympani residual hearing was preserved [mean absolute increase in PTA of 4.4 dB and 77.2% relative hearing preservation (RHP%)]. Translocation into the scala vestibuli occurred in 36% of the insertions, resulting in a mean absolute increase in PTA of 17.9 dB, and a RHP% of 19.2%. Participants with a translocation had poorer speech perception scores at 12-month follow-up. Conclusion Given the incidence of CS-associated translocations with the SPE and the negative effect on outcome, it is advised to insert the SPE using the (extended) round window approach.

scholarly journals Comparison of residual hearing preservation and auditory based performance after paediatric cochlear implantation by round window insertion versus cochleostomy technique: an ambispective cohort study

2021 ◽  
Vol 7 (9) ◽  
pp. 1455
Author(s):  
Dayana Antony ◽  
Aneena Chacko ◽  
Ravi A.
Keyword(s):  
Cohort Study ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Round Window ◽  
Tertiary Care ◽  
Sensorineural Deafness ◽  
Hearing Preservation ◽  
Care Hospital ◽  
Residual Hearing ◽  
Round Window Insertion

<p class="abstract"><strong>Background:</strong> Cochlear implantation (CI) has revolutionized the treatment of sensorineural deafness. The aim of the study was to compare auditory based performance in cochlear implants who underwent round window insertion and cochleostomy.</p><p class="abstract"><strong>Methods:</strong> Ambispective cohort study was done among the children who underwent perilingual cochlear implant in a tertiary care hospital for period of 1 year. Children who satisfied the inclusion criteria were selected and randomly subdivided into 2 groups: group A- round window insertion and group B-cochleostomy. Pre- and post-operative pure tone average (PTA) and residual hearing preserved were evaluated among the cochleostomy and round window insertion groups separately. Post-operatively, children were evaluated, from three months to 1 year from the activation of cochlear implant, with the use of scores such as Category of Auditory Performance (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility rating (SIR) and Meaningful use of speech scale (MUSS score) to measure speech production skills by auditory verbal therapist.   </p><p class="abstract"><strong>Results:</strong> A total of 80 patients were included in the study. Complete hearing preservation (within 10 dB) was significantly high in round window insertion group compared to   cochleostomy technique (p&lt;0.001). None the subjects had complete loss of residual hearing. On evaluating the post CI performance, MAIS score in the round window insertion group (9.34, 18.21, 27.79) were significantly better compared to cochleostomy group during the 3 months, 6 months and 12 months follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Round window insertion technique is significantly more successful in complete hearing preservation at low frequencies compared to cochleostomy technique. Among the auditory scores, only MAIS in the round window insertion group was found to be significantly better compared to cochleostomy group.</p>

The Effect of Systemic Steroid on Hearing Preservation After Cochlear Implantation via Round Window Approach

2017 ◽  
Vol 38 (7) ◽  
pp. 962-969 ◽  
Author(s):  
Mun Young Chang ◽  
Yoon Chan Rah ◽  
Jun Jae Choi ◽  
Shin Wook Woo ◽  
Yu-Jung Hwang ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Hearing Preservation ◽  
Systemic Steroid ◽  
Window Approach

Effect of Round Window Opening Size on Residual Hearing Preservation in Cochlear Implantation

2020 ◽  
Vol 163 (2) ◽  
pp. 375-381
Author(s):  
Giselle L. Gotamco ◽  
Chuan-Hung Sun ◽  
Yi-Fan Chou ◽  
Chuan-Jen Hsu ◽  
Hung-Pin Wu
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Hearing Preservation ◽  
Round Window Membrane ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Window Technique ◽  
Cochlear Implant Surgery ◽  
Window Opening ◽  
Window Approach

Objectives This study aims to compare the hearing preservation outcomes in cochlear implant surgery following slit versus full opening of the round window membrane. Setting Tertiary referral center. Study Design Comparative study. Subjects and Methods Seventy patients (mean, 26.3 years; range, 2-69 years) who underwent cochlear implantation via the round window approach were included in the study. Thirty-five subjects were prospectively enrolled for cochlear implantation via the open round window technique between August 2018 and January 2019. Thirty-five patients who underwent cochlear implantation from January 2017 to July 2018 via the slit round window opening, frequency matched by sex and age, were retrospectively enrolled. Pre- and postoperative thresholds were obtained. The percentage of hearing preservation was computed with the HEARRING Network formula and classified into complete, partial, and minimal hearing preservation. The results between the groups were compared and analyzed at 6 months postoperatively. Results The rate of complete hearing preservation in the open group was statistically significant ( P = .030) at 71.4% (n = 25) as compared with 45.7% (n = 16) in the slit group. Conclusions The widely opened round window may be an optional technique that surgeons can utilize to improve hearing preservation outcomes.

scholarly journals Cochlear Implant in Patients with Intralabyrinthine Schwannoma without Tumor Removal

2022 ◽  
Vol 12 (1) ◽  
pp. 33-41
Author(s):  
Andrea Laborai ◽  
Sara Ghiselli ◽  
Domenico Cuda
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Hearing Threshold ◽  
Binaural Hearing ◽  
Tumor Removal ◽  
Vestibulocochlear Nerve ◽  
Intralabyrinthine Schwannoma ◽  
Feasible Option ◽  
Single Sided Deafness ◽  
Window Approach

(1) Background: Schwannomas of the vestibulocochlear nerve are benign, slow-growing tumors, arising from the Schwann cells. When they originate from neural elements within the vestibule or cochlea, they are defined as intralabyrinthine schwannomas (ILSs). Cochlear implant (CI) has been reported as a feasible solution for hearing restoration in these patients. (2) Methods: Two patients with single-sided deafness (SSD) due to sudden sensorineural hearing loss and ipsilateral tinnitus were the cases. MRI detected an ILS. CI was positioned using a standard round window approach without tumor removal. (3) Results: The hearing threshold was 35 dB in one case and 30 dB in the other 6 mo after activation. Speech audiometry with bisillables in quiet was 21% and 27% at 65 dB, and the tinnitus was completely resolved or reduced. In the localization test, a 25.9° error azimuth was obtained with CI on, compared to 43.2° without CI. The data log reported a daily use of 11 h and 14 h. In order to not decrease the CI’s performance, we decided not to perform tumor exeresis, but only CI surgery to restore functional binaural hearing. (4) Conclusions: These are the sixth and seventh cases in the literature of CI in patients with ILS without any tumor treatment and the first with SSD. Cochlear implant without tumor removal can be a feasible option for restoring binaural hearing without worsening the CI’s performance.

scholarly journals Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Graziela de Souza Queiroz Martins ◽  
Rubens Vuono Brito Neto ◽  
Robinson Koji Tsuji ◽  
Eloisa Maria Mello Santiago Gebrim ◽  
Ricardo Ferreira Bento
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Electrode Array ◽  
Hearing Preservation ◽  
Round Window Membrane ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Minimal Trauma ◽  
Electrode Insertion ◽  
Temporal Bones

Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane.Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation.Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arraysin situ. The resulting images were analyzed for signs of intracochlear trauma.Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion.Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.

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

2018 ◽  
Vol 159 (41) ◽  
pp. 1680-1688 ◽  
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.

scholarly journals Double Ring in Cochlear Otosclerosis: A Limit to Cochlear Implantation? The Solution Is the Surgical Approach

2019 ◽  
pp. 014556131989560
Author(s):  
Daniela Messineo ◽  
Massimo Ralli ◽  
Antonio Greco ◽  
Arianna Di Stadio
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Surgical Approach ◽  
Cochlear Implantation ◽  
Round Window ◽  
Severe Form ◽  
Double Ring ◽  
Window Approach ◽  
The Right ◽  
Normal Speech

We present a case of a 50-year patient with a severe form of otosclerosis (double ring) that was successfully implanted. We used a bone-anchored hearing implant for restoring the hearing in the right side and a cochlear implant in the left side; both surgeries did not show any complications. For reducing the risk of a secondary bone ossification related to the trauma of cochleostomy for electrode’s insertion, we used a round window approach. The patient recovered a normal auditory threshold and normal speech perception capacity both in silence and noise conditions 1 year after surgery.

scholarly journals Benefits of Binaural Integration in Cochlear Implant Patients with Single-Sided Deafness and Residual Hearing in the Implanted Ear

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 265
Author(s):  
Artur Lorens ◽  
Anita Obrycka ◽  
Piotr Henryk Skarzynski ◽  
Henryk Skarzynski
Keyword(s):  
Cochlear Implant ◽  
Sound Localization ◽  
Low Frequency ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Low Frequencies ◽  
Monosyllabic Words ◽  
Localization Ability ◽  
Single Sided Deafness ◽  
Spatial Locations

The purpose of the study is to gauge the benefits of binaural integration effects (redundancy and squelch) due to preserved low-frequency residual hearing in the implanted ear of cochlear implant users with single-sided deafness. There were 11 cochlear implant users (age 18–61 years old) who had preserved low-frequency hearing in the implanted ear; they had a normal hearing or mild hearing loss in the contralateral ear. Patients were tested with monosyllabic words, under different spatial locations of speech and noise and with the cochlear implant activated and deactivated, in two listening configurations—one in which low frequencies in the implanted ear were masked and another in which they were unmasked. We also investigated how cochlear implant benefit due to binaural integration depended on unaided sound localization ability. Patients benefited from the binaural integration effects of redundancy and squelch only in the unmasked condition. Pearson correlations between binaural integration effects and unaided sound localization error showed significance only for squelch (r = −0.67; p = 0.02). Hearing preservation after cochlear implantation has considerable benefits because the preserved low-frequency hearing in the implanted ear contributes to binaural integration, presumably through the preserved temporal fine structure.

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