Implantation of the Completely Ossified Cochlea

Abstract

Objectives To report a novel modification of the cochlear drill-out procedure that utilizes customized microstereotactic frames as drill guides. Patient(s) A 34-year-old man with an 18-year history of profound bilateral hearing loss and completely ossified cochleae that underwent a prior unsuccessful conventional cochlear drill-out procedure in the contralateral ear. Interventions Image-guided cochlear implantation using customized microstereotactic frames to drill linear basal and apical cochlear tunnels. Main outcome measures Transfacial recess cochlear drill-out procedure with full electrode insertion. Results Two linear paths were drilled using customized microstereotactic frames targeting the proximal and distal basal turn followed by a full split array insertion. Postoperative imaging confirmed two cochlear tunnels straddling the modiolus with adequate clearance of the facial nerve and internal carotid artery. The patient received auditory benefit with device use and did not experience any surgical complication. Conclusions Successful cochlear implantation in the setting of total scalar obliteration poses a significant challenge. Image guidance technology may assist in navigating the ossified cochlea facilitating safe and precise cochlear tunnel drilling.

Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal—A Technical Report

“…The extent of the surgical resection, i.e., extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy, was based on tumor location and extension. Similar “circum-modiolar drill-out” procedures have been applied in cases of labyrinthitis ossificans ( 20 – 23 ). In patients with intralabyrinthine schwannomas, however, there is no ossification of the fluid spaces of the cochlea, and the tumor could be resected from the bony labyrinth after removal of parts of the cochlear capsule.…”

Cochlear patency following translabyrinthine vestibular schwannoma resection: implications for hearing rehabilitation

“…Previous studies have shown that despite progressive ossification, spiral ganglion cells can survive and result in auditory improvement following electrical stimulation. 12 Furthermore, drill-out techniques now allow cochlear implantation to be performed on progressively ossified cochleae. 8,12,13 Clinically, however, the outcomes can be negatively impacted by ossified cochleae.…”

“…12 Furthermore, drill-out techniques now allow cochlear implantation to be performed on progressively ossified cochleae. 8,12,13 Clinically, however, the outcomes can be negatively impacted by ossified cochleae. 8,13 We show, to our knowledge for the first time, that the cochlea can stay radiologically patent for at least six months post-operatively (75 per cent of cochleae were completely patent and 25 per cent were partially patent).…”

Creating a stem cell niche in the inner ear using self-assembling peptide amphiphiles

“…Subsequent histologic examinations of the modiolus demonstrated comparable SGN densities between injected and control groups [ 25 ]. Although our study used somewhat larger injection volumes, they did not significantly exceed the known volume of the human IAC [ 74 ]. IKVAV-PA gels have been proven safe in animal models, with no reported toxicity after injection into the nervous system or other organs [ 17 , 19 ].…”