Atraumatic Scala Tympani Cochleostomy; Resolution of the Dilemma

Badr, Ahmad; Shabana, Yousef Kamel; Mokbel, Khaled; El-Sharabasy, Ayman El-Saeed; Ghonim, Mohamed; Sanna, Mario

doi:10.5152/iao.2018.4974

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…The preferred location for the surgical placement of Cochlear Implant (CI) electrode is the Scala Tympani (ST) (Aschendorff et al., 2007). While the Round Window (RW) approach of electrode insertion has been widely accepted as the standard of CI surgery (O'Connell et al., 2016) still cochleostomy approach is practiced by some group of surgeons (Badr et al., 2018). As per Eshraghi's scale of electrode insertion intra-cochlear trauma (Eshraghi et al., 2003), an electrode insertion into the cochlea would result in any of the following degree of trauma.…”

Section: Introductionmentioning

confidence: 99%

Review on cochlear implant electrode array tip fold-over and scalar deviation

Dhanasingh

Jolly

2019

Journal of Otology

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Objective Determine the occurrence rate of cochlear implant (CI) electrode tip fold-over and electrode scalar deviation as reported in patient cases with different commercial electrode types. Data-sources PubMed search for identifying peer-reviewed articles published till 2018 on CI electrode tip fold-over and scalar deviation. Key-words for searching were “Cochlear electrode tip fold-over”, “Cochlear electrode scalar position” and “Cochlear electrode scalar location”. Articles-selection Only if electrode related issues were investigated in patient cases. 38 articles met the inclusion-criteria. Results 13 articles on electrode tip fold-over issue covering 3177 implanted ears, out of which 50 ears were identified with electrode tip fold-over with an occurrence rate of 1.57%. Out of 50 ears, 43 were implanted with pre-curved electrodes and the remaining 7 with lateral-wall electrodes. One article reported on both tip fold-over and scalar deviation. 26 articles reported on the electrode scalar deviation covering an overall number of 2046 ears out of which, 458 were identified with electrode scalar deviation at a rate of 22.38%. After removing the studies that did not report on the number of electrodes per electrode type, it was 1324 ears implanted with pre-curved electrode and 507 ears with lateral-wall electrode. Out of 1324 pre-curved electrode implanted ears, 424 were reported with scalar deviation making an occurrence rate of 32%. Out of 507 lateral-wall electrode implanted ears, 43 were associated with scalar deviation at an occurrence rate of 6.7%. Conclusion This literature review revealing the fact of higher rate of electrode insertion trauma associated with pre-curved electrode type irrespective of CI brand is one step closer to obsolete it from the clinical practice in the interest of patient's cochlear health.

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Section: Introductionmentioning

confidence: 99%

Review on cochlear implant electrode array tip fold-over and scalar deviation

Dhanasingh

Jolly

2019

Journal of Otology

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“…In this regard and due to the ambiguity of the nomenclature for the topography of the CO, which makes difficult to understand certain anatomical notions, Badr et al published some landmarks for the placement of the CO in a less traumatic manner in order to guarantee the insertion of the portelectrode into the scala tympani and to avoid as much as possible the vestibular damages (Figure 5). The authors sustain that the most secure place to perform the CO seems to be the intersection between B and C area (intermediate CO position -ICP) [27]. The variability of the CO place is understandable and depends on the surgeon training for a specific procedure.…”

Section: Figure 4 -Postoperative Saccular Status (T1) For Bilateral Sequential Versus Bilateral Simultaneous Cochlear Implantation In Chimentioning

confidence: 96%

Saccular function evolution related to cochlear implantation in hearing impaired children

Cozma

Cristina

Cobzeanu³

et al. 2020

Rom J Morphol Embryol

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Vestibular sensorial input is essential for psychomotor development of the very small children. In consequence, possible vestibular impairment induced by cochlear implantation in deaf children could affect the balance and walking learning process. Some of cochlear implanted children can present congenital vestibular deficit. The anatomical and embryological relation between auditory and vestibular system explains why congenital neurosensorial hearing loss may associate vestibular impairment. The cochlear implant surgery presents a vestibular lesion risk. Bilateral vestibulopathy, as it appears in early childhood, has a poor prognosis for the psychomotor and cognitive development. Even probably rare, bilateral vestibulopathy induced by simultaneous bilateral cochlear implantation can delay the acquisition of motor skills. This pathology can be avoided by an appropriate surgical indication related to the vestibular preoperative status. This study reports the vestibular saccular functional modifications after the cochlear implantation in children. The cervical vestibular evoked myogenic potentials (cVEMPs) were performed in children before and after the cochlear implantation. Since previous studies report different vestibular impairment related to the portelectrode insertion approach, another objective of our study was to assess the saccular postoperative status depending of the insertion by cochleostomy (CO) or through the round window (RW). We performed cVEMPs for 80 patients (135 cochlear implanted ears) before and after cochlear implantation. We have detected preoperative saccular areflexia in 33 (24.4%) ears. In the group of 102 (75.6%) ears with preoperative normal saccular function, 72 (70.6%) ears preserved the cVEMP response after the surgery, while in 30 (29.4%) ears the cVEMP response was lost. Reporting our findings to the portelectrode insertion method, we found normal saccular function in 73.3% of the cochlear implanted ears by RW surgical approach and in 68.42% ears by CO approach. These results suggest that the RW portelectrode insertion is the recommended strategy in order to avoid the saccular vestibular impairment.

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“…Additionally, we utilized a delivery approach (injection into the perilymph space) that can be translated into human patients clinically. Based on human cochlear implantation data, in a mature ear, violation of the scala media (which has been used in other delivery experiments) results in loss of residual function, making delivery to the perilymph space essential 61 . Interestingly, we were unable to achieve any significant delivery of RNP LNPs to the inner ear hair cells using a perilymph-based delivery (Figs 4 and 5).…”

Section: Discussionmentioning

confidence: 99%

CRISPR-Cas9 Engineered Extracellular Vesicles for the Treatment of Dominant Progressive Hearing Loss

Pan,

Huang,

Ali

et al. 2023

Preprint

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The treatment of inner ear disorders remains challenging due to the intrinsic anatomical barriers. The majority treatments and delivery approaches for accessing inner hair cells are still engaged with surgical intervention, which is highly invasive and inconsistent in terms of efficacy and safety. In order to address this challenge for crossing anatomical barriers, we report an extracellular vesicle (EVs) -based delivery approach to inner hair cells, which enables carrying CRISPR/Cas9 ribonucleoprotein (RNP)-sgRNA complex in high-throughput and high efficiency. The novel Microfluidic Droplet-based Electroporation System (uDES) is developed to efficiently load cargos into EVs via millisecond pulsed, low-voltage electroporation within flow-through droplets as enormous bioreactors in a continuous-flow and scalable manner. The observed loading efficiency of CRISPR/Cas9 RNA complex into EVs (RNP-EVs) is 10-fold higher than current bulk cuvette electroporation with hundred-fold increase of processing throughput. The low-voltage electroporation minimized the Joule heating influence on nanosized EVs, which retained the native surface membrane properties of cargo-loaded EVs. Both ex vivo and in vivo testing in Shaker-1 mice model demonstrated the high biocompatibility and biodistribution of produced RNP-EVs in the mouse cochlea penetrating inner hair cells. In contrast, the CRISPR/Cas9 RNP lipid-like nanoparticles (RNP-LNPs) control group was unable to penetrate anatomical barriers to access inner hair cells. In the Shaker-1 mouse model, uDES produced RNP-EVs demonstrated much higher editing efficiency at Myo7ash1 mRNA level and showed significant hearing recovery in the Myo7aWT/Sh1 mice via Auditory Brainstem Response (ABR) testing. The report work will present a new solution to advance gene therapy in treating sensorineural hearing loss.

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Atraumatic Scala Tympani Cochleostomy; Resolution of the Dilemma

Cited by 8 publications

References 27 publications

Review on cochlear implant electrode array tip fold-over and scalar deviation

Review on cochlear implant electrode array tip fold-over and scalar deviation

Saccular function evolution related to cochlear implantation in hearing impaired children

CRISPR-Cas9 Engineered Extracellular Vesicles for the Treatment of Dominant Progressive Hearing Loss

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