Comparison of the Telemetry of Neural Reply Saw Chocleostomy or Saw Round Window in Choclear Implantation

Hamerschmidt, Rogério; Schuch, Luiz Henrique; Rezende, Rodrigo Kopp; Oliveira, Adriana de Almeida Santos Furlan de Cristina; Wiemes, Gislaine Richter Minhoto; Mocellin, Marcos

doi:10.7162/s1809-9777201200s1o-023

Cited by 4 publications

(9 citation statements)

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“…Lower electrical impedance correlates with higher integrity of the implant. Our analysis did not reveal any superiority of either the RW or C approach in reducing electrical impedance with two-thirds of the studies we reviewed regarding electrical impedance revealing no difference between the approaches [ 20 , 21 ]. The remaining study found that the RW approach was preferable [ 19 ].…”

Section: Reviewmentioning

confidence: 64%

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Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Avasarala¹,

Jinka²,

Jeyakumar³

2022

Cureus

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We conducted a systematic review and meta-analysis to compare round window (RW) and cochleostomy (C) surgical approaches for the placement of cochlear implants (CIs). After obtaining the Institutional Review Board (IRB) approval, 213 peer-reviewed articles published between January 1, 2000, and August 1, 2021, comparing RW and C approaches were identified via a search on Google Scholar, Cochrane, and PubMed. The inclusion criteria were articles having an English version and involving only human subjects (cadaveric or alive). Statistical analysis of compiled electrode-to-modiolus distances was performed with two-sample independent t-tests. Live patients were categorized as having complete hearing preservation (<10 dB threshold shift), partial hearing preservation (10-20 dB shift), or minimal hearing preservation (>20 dB shift). Chi-squared testing was used to compare the distribution of hearing preservation categories between surgical approaches. Due to the heterogeneous nature of the data, only summative information was provided on the effects of approaches on trauma, electrical impedance, speech perception, vestibular dysfunction, ease of scala tympani insertion, and scalar shift. A total of 3,797 CI patients were evaluated. The RW approach resulted in a smaller (0.15 mm smaller on average, p<0.05) electrode-to-modiolus distance when compared to the C approach. The RW approach (93.0%) led to statistically better hearing preservation than the C approach (84.3%) (p<0.05). The RW approach was also associated with better outcomes in terms of speech perception, ease of scala tympani insertion, and reduced scalar shift. No difference between approaches was found with regard to trauma, electrical impedance, and vestibular dysfunction. Based on our findings, the RW approach appears to have several benefits compared to the C approach.

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Section: Reviewmentioning

confidence: 64%

“…Three of the included studies evaluated electrical impedance [ 19 - 21 ]. One study [ 19 ] showed that the RW approach yielded lower electrical impedance when compared to the C approach while two studies [ 20 , 21 ] indicated that there was no difference (Table 3 , Figure 4 ).…”

Section: Reviewmentioning

confidence: 99%

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Avasarala¹,

Jinka²,

Jeyakumar³

2022

Cureus

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“…34 On the contrary, a study suggested no differences in the auditory nerve action potentials and insisted equal cochlear nerve stimulation in both the techniques but then inadequate sample size, poorly defined inclusion and exclusion criteria and weak study design with no randomization and blinding decreases the internal validity of this study. 18,35 Another factor contributing to lower electrical stimulation levels is the comparatively lower intracochlear basal trauma and more favorable peri-modiolar position in round window insertion. 23,36 Additionally, in RW, electrode enters scala tympani in more basal position leading to stimulation of basal neural fibers more effectively when compared.…”

Section: Discussionmentioning

confidence: 99%

“…We used nucleus cochlear implant which is a multichannel implant with 22 electrodes, and divided all the electrodes into three categories, 1 st one being the basal (1-7) electrodes, 2 nd group consisted of intermediate electrodes from 8 to 15, and the last group comprised of rest of the apical electrodes (16)(17)(18)(19)(20)(21)(22). This categorization was adopted as it divides the electrodes into high, mid and low frequency categories as measuring the value of each electrode individually was not feasible statistically.…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

“…This categorization was adopted as it divides the electrodes into high, mid and low frequency categories as measuring the value of each electrode individually was not feasible statistically. 18 Primary objective outcomes calculated were intraoperative neural response telemetry levels, hearing threshold and maximum comfortable levels. Neural response telemetry levels were measured by using cochlear custom sound 4.0, an automated system for all the electrodes.…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

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Round window versus conventional bony cochleostomy technique in pediatric cochlear implantation; A Randomized controlled double blinded trial.

Shishodia

Saurav²

2021

Int J Otorhinolaryngol Head Neck Surg

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Background: Objective of the study was to investigate the outcomes of cochlear implantation when done via two different techniques namely, the round window or the bony cochleostomy.Methods: A single-center, double-blinded randomized controlled trial including forty prelingual, bilateral severe to profoundly deaf children less than six years from the year 2014 to 2016 in a tertiary referral center in India were randomly allocated to round window and bony cochleostomy group. Our primary outcome measures were intraoperative neural response telemetry levels, behavioral threshold (t) and comfortable (c) loudness levels. The secondary subjective outcomes were measured via the category of auditory performance (CAP) and the meaningful auditory integration scale (MAIS) score. The cases were followed up for 9 months.Results: Intra-operative, electrically evoked compound action potentials (ECAP) showed comparable mean thresholds for both the techniques except intermediate electrodes (p~0.04) showed lower values for the round window. Similarly, a lower threshold (p~0.03) and comfortable mean current levels (p~0.03) were noticed for the round window group at 6 months post-implantation. Secondary speech perception outcome scores measured via category of auditory performance (CAP) and MAIS score were comparable. Conclusions: The round window insertion technique has physiological benefit as compared to the bony cochleostomy as evidenced by better stimulation levels in the intermediate electrodes and lower mean threshold and comfortable levels in the round window with more beneficial peri-modiolar position of electrode arrays. However, comparable speech perception outcomes revealed no clinical benefit in the cochlear implant performance depending on the technique of electrode insertion.

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The effect of cochlear implant insertion technique on post-operative neural response telemetry and impedance in paediatric patients

et al. 2022

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Objective This study aimed to compare neural response telemetry and impedance between the round window and cochleostomy approaches for cochlear implantation. Methods In this case–control study, 64 patients aged less than 3.5 years underwent cochlear implantation via the round window or cochleostomy approach. Post-operative neural response telemetry and impedance were measured. Results The impedance measurements at electrodes 1, 11 and 22 showed no significant differences between the two groups three months after implantation (p = 0.90, p = 0.08 and p = 0.37, respectively). Similar results were observed six months after implantation (p = 0.71, p = 0.65 and p = 0.70, respectively). There was no significant difference in neural response telemetry between the two groups after three months. The neural response telemetry of electrode 1 in the cochleostomy group (171.26 ± 19.81 μV) was significantly higher in comparison with that of electrode 1 in the round window group (161.97 ± 12.71 μV) after six months (p = 0.03). The neural response telemetry values for electrodes 11 and 22 did not show any significant difference after six months (p = 0.14 and p = 0.48, respectively). Conclusion Both approaches provide equal stimulation of the cochlear nerve and impedance.

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Comparison of the Telemetry of Neural Reply Saw Chocleostomy or Saw Round Window in Choclear Implantation

Cited by 4 publications

References 0 publications

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Round window versus conventional bony cochleostomy technique in pediatric cochlear implantation; A Randomized controlled double blinded trial.

The effect of cochlear implant insertion technique on post-operative neural response telemetry and impedance in paediatric patients

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