Effect of KTP Laser Cochleostomy on Morphology in the Guinea Pig Inner Ear

Kamalski, Digna M. A.; Peters, Jeroen P. M.; Boorder, Tjeerd de; Trabalzini, Franco; Klis, Sjaak F.L.; Grolman, Wilko

doi:10.1159/000360997

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…The lateral cochlear wall, with which the straight electrode interacts, is known to have a rich blood supply, and the risk of bleeding during implantation has been reported previously in anatomical studies 20 . Furthermore, bleeding from discrete vessels has been observed on histology performed immediately after experimental cochlear surgery 21 . Therefore, cause of high 4PI during surgery may be acute intracochlear bleeding.…”

Section: Discussionmentioning

confidence: 99%

Four-point impedance as a biomarker for bleeding during cochlear implantation

Bester

Razmovski

Collins

et al. 2020

Sci Rep

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Cochlear implantation has successfully restored the perception of hearing for nearly 200 thousand profoundly deaf adults and children. More recently, implant candidature has expanded to include those with considerable natural hearing which, when preserved, provides an improved hearing experience in noisy environments. But more than half of these patients lose this natural hearing soon after implantation. To reduce this burden, biosensing technologies are emerging that provide feedback on the quality of surgery. Here we report clinical findings on a new intra-operative measurement of electrical impedance (4-point impedance) which, when elevated, is associated with high rates of postoperative hearing loss and vestibular dysfunction. In vivo and in vitro data presented suggest that elevated 4-point impedance is likely due to the presence of blood within the cochlea rather than its geometry. Four-point impedance is a new marker for the detection of cochlear injury causing bleeding, that may be incorporated into intraoperative monitoring protocols during CI surgery. The preservation of cochlear structure and residual functional hearing has become the standard of care for cochlear implantation (CI). Hearing preservation is important to facilitate combined electrical and acoustic stimulation of the cochlea, as this improves speech recognition in noise and music appreciation 1-4. Cochlear structural preservation will ensure that the ear is ready for future, regenerative therapies 5,6. Structural and functional preservation of the cochlea depends not only upon the electrode design, but also the surgery. Electrodes must be introduced into the cochlea without causing injury. Until recently, technologies have not existed to guide the surgeon during the implant procedure; the operation has been conducted "blind" without the provision of feedback. Over recent years, we and others have begun to monitor cochlear function during cochlear implantation 7-10 , using the CI's own electrodes to monitor the electrophysiological response of the ear to acoustic stimulation. This technique, known as electrocochleography, has provided valuable information to guide surgeons during the operation; if the electrophysiological response is preserved during surgery, residual hearing is better after implantation 7-10. This paper is motivated by a desire to increase the scope of intraoperative monitoring during CI surgery. Current methods allow real-time detection of cochlear dysfunction, but these do not assess cochlear injury directly. Here we report on a method that has this potential. We have monitored "four-point" electrical impedance (4PI) from the implant's intracochlear electrodes during CI surgery. This impedance measurement is acquired by passing current between two outer electrodes whilst the voltage (from which the impedance may be inferred) is measured between two inner electrodes (Fig. 1A). The method is believed to assess the bulk impedance between the two inner electrodes, and has been used to differentiate between tissue and fluid ...

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Section: Discussionmentioning

confidence: 99%

Four-point impedance as a biomarker for bleeding during cochlear implantation

Bester

Razmovski

Collins

et al. 2020

Sci Rep

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“…Clinically, the occurrence of mechanical effects as fast pressure differences in the inner ear could be potentially damage hair cell functioning. Animal studies supports this finding [4,6,22,23]. The diode 1,470 nm laser has not tested in animals yet.…”

Section: Discussionmentioning

confidence: 84%

“…Theoretically, the KTP laser could generate heat in rich pigmented areas of the neuro‐epithelium of the vestibule due to light transmission through the perilymph. However, the KTP laser and the 980 nm diode laser parameters which are typically used in for stapedotomy are unlikely to damage inner ear structures directly . These lasers appear to be safe in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

A 1,470 nm diode laser in stapedotomy: Mechanical, thermal, and acoustic effects

et al. 2017

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The diode 1,470 nm laser highly absorbs in perilymph and is capable of forming a clear fenestration in the stapes. An overlapping laser pulse will increase the risk of vapor bubbles, pressure waves, and heating the vestibule. As long as we do not know the possible damage of these effects to the inner ear function, it seems advisable to use the laser with less potential harm. Lasers Surg. Med. 49:619-624, 2017. © 2017 Wiley Periodicals, Inc.

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“…[10][11][12] Lasers of various wavelengths (eg, carbon dioxide, erbium:yttriumaluminum-garnet, and potassium-titanyl-phosphate) and piezoelectric devices have been used as alternatives to diamond burrs. [1][2][3][13][14][15][16][17] In this study we describe a novel approach using PAG to perform chemical cochleostomy.…”

Section: Discussionmentioning

confidence: 99%

“…The use of topical steroids, application of hyaluronic acid, and variation in cochleostomy site have also been investigated 10‐12 . Lasers of various wavelengths (eg, carbon dioxide, erbium:yttrium‐aluminum‐garnet, and potassium‐titanyl‐phosphate) and piezoelectric devices have been used as alternatives to diamond burrs 1‐3,13‐17 . In this study we describe a novel approach using PAG to perform chemical cochleostomy.…”

Section: Discussionmentioning

confidence: 99%