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.

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 Radiological and surgical aspects of round window visibility during cochlear implantation: a retrospective analysis

2021 ◽  
Author(s):  
Saad Jwair ◽  
Job J. M. van Eijden ◽  
Esther E. Blijleven ◽  
Jan Willem Dankbaar ◽  
Hans G. X. M. Thomeer
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Ct Scans ◽  
Round Window Membrane ◽  
Chorda Tympani ◽  
Chorda Tympani Nerve ◽  
Cochlear Implant Surgery ◽  
Window Approach ◽  
Almost All ◽  
Surgical Aspects

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.

Cochlear Implant Surgery Through Round Window Approach Is Always Possible

2019 ◽  
Vol 128 (6_suppl) ◽  
pp. 38S-44S ◽  
Author(s):  
Seong-Cheon Bae ◽  
You-Ree Shin ◽  
Young-Myoung Chun
Keyword(s):  
Cochlear Implant ◽  
Standard Procedure ◽  
Round Window ◽  
Lateral Wall ◽  
Anatomical Variations ◽  
Implant Surgery ◽  
Cochlear Implant Surgery ◽  
Alternative Procedures ◽  
Electrode Insertion ◽  
Window Approach

Objectives: The benefit of round window (RW) approach for cochlear implant (CI) has been well studied. Because the RW represents a natural door to scala tympani, it facilitates precise electrode insertion. Atraumatic electrode insertion can also be performed without drilling the cochlear lateral wall. However, the RW approach has several limitations. The purpose of this study is to describe successful CI surgeries utilizing the RW approach except for severe cases of temporal bone anomaly. The authors’ successful surgical solution for cases involving difficult RW access is also described. Materials and Methods: We retrospectively analyzed 377 consecutive surgeries of cochlear implantation performed between June 2010 and December 2018 by a single experienced surgeon. Standard and alternative procedures were used according to anatomical variations. Standard procedures included modified techniques of mastoidectomy in the RW approach, opening of facial recess, exposure of RW membrane, and electrode insertion. Difficult cases involving severe rotated cochlea or hypoplastic mastoid were successfully treated with RW insertion using alternative procedures such as external auditory canal (EAC) wall mobilization and endomeatal approach. Results: We performed CI surgery through a reproducible RW technique in two cases involving endomeatal approach and three cases of EAC mobilization. Other cases were treated using the standard procedure. Conclusion: Cochlear implant surgery through RW is reliable, safe, and effective. The RW technique is reproducible via several surgical procedures in most CI cases. Identification and safe exposure of RW membrane is a prerequisite for successful electrode insertion in cochlear implant surgery.

scholarly journals The impact of cochlear implant microphone settings on the binaural hearing of experienced cochlear implant users with single-sided deafness

2020 ◽  
Author(s):  
Anja Kurz ◽  
Maren Zanzinger ◽  
Rudolf Hagen ◽  
Kristen Rak
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Binaural Hearing ◽  
Sound Quality ◽  
Noise Sources ◽  
Shadow Effect ◽  
Spatial Release ◽  
Release From Masking ◽  
Single Sided Deafness ◽  
The Impact

Abstract Objective Cochlear implantation has become a well-accepted treatment option for people with single-sided deafness (SSD) and has become a clinical standard in many countries. A cochlear implant (CI) is the only device which restores binaural hearing. The effect of microphone directionality (MD) settings has been investigated in other CI indication groups, but its impact on speech perception in noise has not been established in CI users with SSD. The focus of this investigation was, therefore, to assess binaural hearing effects using different MD settings in CI users with SSD. Methods Twenty-nine experienced CI users with SSD were recruited to determine speech reception thresholds with varying target and noise sources to define binaural effects (head shadow, squelch, summation, and spatial release from masking), sound localization, and sound quality using the SSQ12 and HISQUI19 questionnaires. Outcome measures included the MD settings “natural”, “adaptive”, and “omnidirectional”. Results The 29 participants involved in the study were divided into two groups: 11 SONNET users and 18 OPUS 2/RONDO users. In both groups, a significant head shadow effect of 7.4–9.2 dB was achieved with the CI. The MD setting “adaptive” provided a significant head shadow effect of 9.2 dB, a squelch effect of 0.9 dB, and spatial release from masking of 7.6 dB in the SONNET group. No significant summation effect could be determined in either group with CI. Outcomes with the omnidirectional setting were not significantly different between groups. For both groups, localization improved significantly when the CI was activated and was best when the omnidirectional setting was used. The groups’ sound quality scores did not significantly differ. Conclusions Adaptive directional microphone settings improve speech perception and binaural hearing abilities in CI users with SSD. Binaural effect measures are valuable to quantify the benefit of CI use, especially in this indication group.

scholarly journals Correction to: The impact of cochlear implant microphone settings on the binaural hearing of experienced cochlear implant users with single-sided deafness

2021 ◽  
Author(s):  
Anja Kurz ◽  
Maren Zanzinger ◽  
Rudolf Hagen ◽  
Kristen Rak
Keyword(s):  
Cochlear Implant ◽  
Binaural Hearing ◽  
Original Publication ◽  
Single Sided Deafness ◽  
The Impact

In the original publication of the article, under the section Binaural effects, the following sentence.

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 Reducing interaural tonotopic mismatch preserves binaural unmasking in cochlear implant simulations of single-sided deafness

2020 ◽  
Author(s):  
Elad Sagi ◽  
Mahan Azadpour ◽  
Jonathan Neukam ◽  
Nicole Hope Capach ◽  
Mario A. Svirsky
Keyword(s):  
Cochlear Implant ◽  
Low Frequency ◽  
Spatial Separation ◽  
Binaural Hearing ◽  
Normal Hearing ◽  
Input Frequency ◽  
Frequency Range ◽  
Speech Processor ◽  
Frequency Information ◽  
Single Sided Deafness

Binaural unmasking, a key feature of normal binaural hearing, refers to the improved intelligibility of masked speech by adding masking noise that facilities perceived spatial separation of target and masker. A question particularly relevant for cochlear implant users with single-sided deafness (SSD-CI) is whether binaural unmasking can still be achieved if the additional masking is distorted. Adding the CI restores some aspects of binaural hearing to these listeners, although binaural unmasking remains limited. Notably, these listeners may experience a mismatch between the frequency information perceived through the CI and that perceived by their normal hearing ear. Employing acoustic simulations of SSD-CI with normal hearing listeners, the present study confirms a previous simulation study that binaural unmasking is severely limited when interaural frequency mismatch between the input frequency range and simulated place of stimulation exceeds 1-2 mm. The present study also shows that binaural unmasking is largely retained when the input frequency range is adjusted to match simulated place of stimulation, even at the expense of removing low-frequency information. This result bears implication for the mechanisms driving the type of binaural unmasking of the present study, as well as for mapping the frequency range of the CI speech processor in SSD-CI users.

scholarly journals The Effects of Round Window Membrane Injury and the Use of a Model Electrode Application on Hearing in Rats

2021 ◽  
pp. 014556132199018
Author(s):  
Murat Koc ◽  
Abdullah Dalgic ◽  
Mehmet Ziya Ozuer
Keyword(s):  
Hearing Loss ◽  
Cochlear Implant ◽  
Round Window ◽  
Mechanical Trauma ◽  
Round Window Membrane ◽  
Albino Rats ◽  
Topical Steroids ◽  
Distortion Product ◽  
Significant Difference ◽  
Group 3

Objective: To investigate the effects of the mechanical trauma to the round window, a model electrode inserted into the scala tympani on the cochlear reserve, and the efficacy of topical steroids in preventing hearing loss. Materials and Methods: 21 male Wistar Albino rats were equally categorized into three groups. In all groups an initial mechanical injury to round window was created. Only subsequent dexamethasone injection was administrated into the cochlea in the subjects of group 2 while a multichannel cochlear implant guide inserted into the cochlea prior to dexamethasone administration for group 3. Distortion product otoacoustic emissions (DPOAEs) were obtained prior to and immediately after the surgical injury, eventually on postoperative seventh day (d 7). Mean signal/noise ratios (S/Ns) obtained at 2000, 3000, and 4000 Hz were calculated. Data sets were compared with non-parametric statistical tests. Results: The early intraoperative mean S/Ns were significantly less than preoperative measurements for group 1 and 2; however, preoperative and postoperative d 7 average S/Ns did not differ. There was statistically significant difference between preoperative, intraoperative and postoperative d 7 average S/Ns for group 3. Conclusion: We observed that hearing was restored approximately to the preoperative levels following early postoperative repair. However, an electrode insertion into the cochlea via round window subsequent to mechanical trauma seems to cause a progressive hearing loss. Therefore, a special care must be taken to avoid the injury to the round window membrane in the course of the placement of a cochlear implant electrode and surgery for the chronic otitis media.

Surgical considerations during cochlear implantation: the utility of temporal bone computed tomography

2021 ◽  
pp. 1-8
Author(s):  
Beomcho Jun ◽  
Sunwha Song
Keyword(s):  
Computed Tomography ◽  
Temporal Bone ◽  
Cochlear Implantation ◽  
Round Window ◽  
Three Dimensional ◽  
Electrode Placement ◽  
Posterior Tympanotomy ◽  
Electrode Insertion ◽  
Window Approach ◽  
Bone Structures

Abstract Objective This paper describes the construction of portals for electrode placement during cochlear implantation and emphasises the utility of pre-operative temporal bone three-dimensional computed tomography. Methods Temporal bone three-dimensional computed tomography was used to plan portal creation for electrode insertion. Results Pre-operative temporal bone three-dimensional computed tomography can be used to determine the orientation of temporal bone structures, which is important for mastoidectomy, posterior tympanotomy and cochleostomy, and when using the round window approach. Conclusion It is essential to create appropriate portals (from the mastoid cortex to the cochlea) in a step-by-step manner, to ensure the safe insertion of electrodes into the scala tympani. Pre-operative three-dimensional temporal bone computed tomography is invaluable in this respect.

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