The use of the CO2 laser seems associated with the best functional results, although on a statistical basis, they do not differ significantly from that obtained with the standard MD platinotomy. The PZS stapedotomy is effective from a surgical point of view for most patients. However, it is associated with a slight but significant deterioration of BC at high frequency and at higher vertigo rate. More basic validation of the stimulation parameters is necessary for safe use of this new technology.
To combine the benefits of perimodiolar stimulation with minimal insertion trauma, a thin, pre-curved electrode (CI532) was recently developed by Cochlear Ltd. (Sidney). This array is held straight prior to insertion by an external polymer reloadable sheath that is removed after full electrode insertion. Sixty-seven patients suffering from severe-to-profound sensorineural hearing loss (mean age 42.2 years; mean duration of the hearing loss 19.6 years; mean PTA thresholds at 250-2000 Hz 92.4 dB HL) were implanted with the CI532. Mean duration of surgery was 58.7 min. In 61 patients, a round window (RW) approach was used. In the remaining six cases, a cochleostomy was done because of RW ossification. Impedances and NRT for each electrode are reported. NRT ratio average value was 0.86 ± 0.12 predicting correct scala tympani electrode placement. Post-operative PTA threshold in the implanted ear was 102.9 dB HL. Finally, speech recognition level in quiet at 65 dB HL was 44.6%, after a short follow-up (mean 5.2 months). Our preliminary experience with the new CI532 shows good surgical, electrophysiological, and audiological outcomes. In particular, our results are promising regarding the possibility to achieve minimal insertion trauma and good residual hearing preservation with the use of a deep inserted close modiolar electrode.
The PZS device proved to be effective for RW osteoplasty; floating mass transducer was successfully implanted in all patients. Audiologic results are comparable to those obtained from traditionally operated patients. Relative to conventional drilling, the PZS allows a safer osteoplasty because it does not produce any rotation or torque that reduces the risk of RW membrane injury. Although hearing was preserved in our sample, the potential inner ear risks need to be further evaluated in both experimental and clinical fields.
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