Cochlear implantation and hearing preservation: Results in 21 consecutively operated patients using the round window approach

Erixon, Elsa; Köbler, Susanne; Rask‐Andersen, Helge

doi:10.3109/00016489.2012.680198

Cited by 52 publications

(38 citation statements)

References 21 publications

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“…The round window is used as an insertion site for cochlear implant electrodes and has also recently been used as an implantation site for hearing aid transducers (41)(42)(43). Clear visualization of the round window using a SWIR otoscope could provide an alternative to radiographic imaging for evaluation of such surgical implants.…”

Section: Discussionmentioning

confidence: 99%

Using the shortwave infrared to image middle ear pathologies

Carr

Valdez

Bruns

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Visualizing structures deep inside opaque biological tissues is one of the central challenges in biomedical imaging. Optical imaging with visible light provides high resolution and sensitivity; however, scattering and absorption of light by tissue limits the imaging depth to superficial features. Imaging with shortwave infrared light (SWIR, 1–2 μm) shares many advantages of visible imaging, but light scattering in tissue is reduced, providing sufficient optical penetration depth to noninvasively interrogate subsurface tissue features. However, the clinical potential of this approach has been largely unexplored because suitable detectors, until recently, have been either unavailable or cost prohibitive. Here, taking advantage of newly available detector technology, we demonstrate the potential of SWIR light to improve diagnostics through the development of a medical otoscope for determining middle ear pathologies. We show that SWIR otoscopy has the potential to provide valuable diagnostic information complementary to that provided by visible pneumotoscopy. We show that in healthy adult human ears, deeper tissue penetration of SWIR light allows better visualization of middle ear structures through the tympanic membrane, including the ossicular chain, promontory, round window niche, and chorda tympani. In addition, we investigate the potential for detection of middle ear fluid, which has significant implications for diagnosing otitis media, the overdiagnosis of which is a primary factor in increased antibiotic resistance. Middle ear fluid shows strong light absorption between 1,400 and 1,550 nm, enabling straightforward fluid detection in a model using the SWIR otoscope. Moreover, our device is easily translatable to the clinic, as the ergonomics, visual output, and operation are similar to a conventional otoscope.

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Section: Discussionmentioning

confidence: 99%

Using the shortwave infrared to image middle ear pathologies

Carr

Valdez

Bruns

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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“…The distance between the RW and OW may foresee the 'hook' size. In our view, a transmembrane RW approach to introduce the CI electrode array may be safer to avoid damage to these structures, particularly in patients with partial deafness or substantial residual hearing [Erixon et al, 2012].…”

Section: Discussionmentioning

confidence: 99%

“…Patient selection for CI surgery has changed in recent years since residual hearing can now be preserved in a high number of cases Bruce et al, Erixon et al, 2012]. Patients with partial deafness having normal or near-normal low-frequency hearing can nowadays be operated and use combined electric acoustic stimulation.…”

Section: Discussionmentioning

confidence: 99%

On the Anatomy of the ‘Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation

2014

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Background: The optimal insertion route for an electrode array in hearing preservation cochlear implantation (CI) surgery is stilltentative. Both cochleostomy (CO) and round window (RW) techniques are used today. In the present study we analyzed size variations and topographic anatomy of the ‘hook' region of the human cochlea to better comprehend the Testo effects of various electric array insertion modes. Material and Methods: Size variations of the cochlear ‘hook' region were assessed in 23 human, microdissected temporal bones by measuring the distances between the oval and round windows, also outlining the spiral ligament/spiral lamina. Influence of size variations on spiral ligament position and fundamentals for different surgical approaches were evaluated in a subset of ‘small' and ‘large' cochleae performing different types of CO. In addition, the relationship between the microdissected accessory canal housing the inferior cochlear vein and the RW was analyzed. Results: The lateral vestibular wall and the cochlear ‘hook' displayed large anatomic variations that greatly influenced the size of the potential surgical area. Results showed that only very inferiorly located CO entered the scala tympani without causing trauma to the spiral ligament and spiral lamina. An inferior approach may challenge the inferior cochlear vein. Conclusion: Preoperative assessment of the distance between the round and oval windows may direct the surgeon before CI hearing-preservation surgery. CO techniques, especially in ‘small' ears, may lead to frequent damage to the inner ear structures. In those cases with substantial residual hearing, CI surgery may be better performed through a RW approach. i 2014 S. Karger AG, Basel

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“…Woodson et al [2010] used the Hybrid-S electrode in 81 patients and achieved a mean increase in low-frequency threshold of 14.6 dB after 1 month. In another study by Erixon et al [2012], the MedEl Flex implant (24 mm) was used in 21 patients with a median hearing loss of 14.4 dB reported after 1 month, and in 11 patients with a median hearing loss of 15.6 dB after 1 year.…”

Section: Postoperative Hearing Preservationmentioning

confidence: 99%

Hearing Preservation Outcomes with Different Cochlear Implant Electrodes: Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422

et al. 2014

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Objectives: In recent years, it has been possible to preserve hearing after cochlear implantation in patients with significant amounts of low-frequency residual hearing. Due to the dimensions and characteristics of the cochlear implants (CIs) Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422, both can be used to preserve residual hearing. The aim was to investigate the degree and progression of hearing preservation over a longitudinal postoperative period in a large consecutive cohort of implanted patients with preoperative residual hearing who received either the Nucleus Hybrid-L24 or the Nucleus Freedom CI422 implant. The intention was to examine potential characteristics and triggers of resulting postoperative hearing loss which may support a differentiation of CI candidacy criteria for a certain implant type. Methods: A retrospective data analysis of patient files on consecutively implanted subjects presenting with a severe-to-profound sensorineural hearing loss at frequencies >1,500 Hz and substantial residual hearing at frequencies ≤1,500 Hz, implanted with a Nucleus Hybrid-L24 (n = 97) or a CI422 implant (n = 100), was undertaken. A single-subject repeated-measure design comparing the mean threshold shift for pure-tone thresholds under headphones up to 24 months after implantation was used. Results: Hearing preservation is observed in the majority of subjects with either implant (250-1,500 Hz frequency range). Hybrid-L24 patients exhibited a median hearing loss of 10 dB at initial fitting (n = 97) and of 15 dB after 24 months (n = 51). A 14.4-dB decrease in median hearing loss at initial fitting (n = 100) and a 30-dB decrease after 24 months (n = 28) was observed with the CI422 electrode. At initial fitting, 54.6% of the Hybrid-L24 (n = 97) and 49.0% of the CI422 (n = 100) subjects showed a mean threshold shift <15 dB. After 24 months, 58.8% (Hybrid-L24, n = 51) and 28.6% (CI422, n = 28) of the patients showed a mean threshold shift <15 dB. Conclusions: The results indicate that residual hearing was preserved for the majority of implanted patients with the Hybrid-L24 and the CI422 implant. Patients implanted with the Hybrid-L24 implant demonstrate greater stability and less median hearing loss over time than those with the CI422 implant. Assessments of onset and stability of hearing loss prior to implantation are important factors to consider during candidacy evaluation for electrode selection to potentially maximize the performance outcome for each patient.

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Cochlear implantation and hearing preservation: Results in 21 consecutively operated patients using the round window approach

Cited by 52 publications

References 21 publications

Using the shortwave infrared to image middle ear pathologies

Using the shortwave infrared to image middle ear pathologies

On the Anatomy of the ‘Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation

Hearing Preservation Outcomes with Different Cochlear Implant Electrodes: Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422

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Cochlear implantation and hearing preservation: Results in 21 consecutively operated patients using the round window approach

Cited by 52 publications

References 21 publications

Using the shortwave infrared to image middle ear pathologies

Using the shortwave infrared to image middle ear pathologies

On the Anatomy of the &#8216;Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation

Hearing Preservation Outcomes with Different Cochlear Implant Electrodes: Nucleus® Hybrid™-L24 and Nucleus Freedom™ CI422

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On the Anatomy of the ‘Hook' Region of the Human Cochlea and How It Relates to Cochlear Implantation