Methylprednisolone Applied Directly to the Round Window Reduces Dizziness after Cochlear Implantation: A Randomized Clinical Trial

Enticott, Joanne; Eastwood, Hayden; Briggs, Robert; Dowell, Richard C.; O’Leary, Stephen

doi:10.1159/000322137

Cited by 53 publications

(50 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is very likely the result of pressure changes of cochlear hydrodynamics occurring through the opening of the inner ear and the insertion of the electrode as described above. Our results suggest that a reduction of insertion speed has a beneficial effect on the vestibular system, this probably in addition to the steroid effects as demonstrated by the trial of Enticott et al [2011]. With a slow insertion, none of the patients experienced vestibular symptoms.…”

Section: Discussionsupporting

confidence: 59%

The Effects of Insertion Speed on Inner Ear Function during Cochlear Implantation: A Comparison Study

2012

View full text Add to dashboard Cite

Objective: To investigate the insertion speed and its impact on electrode insertion characteristics, hearing preservation and clinical vestibular function in a prospective cohort study with a retrospective control group at a tertiary otology/neurotology centre. Interventions: Hearing-preserving cochlear implantation using systemic and topical steroids in conjunction with a round-window approach, a complete cochlear coverage electrode and two different electrode insertion speeds [60 mm/min (n = 18) vs. 15 mm/min (n = 22)] was performed. Results: The insertion speed had a significant impact on various insertion characteristics as well as hearing preservation and vestibular function. In conclusion, a slow electrode insertion speed appears to facilitate full electrode insertion, reduce the occurrence of insertion resistance as well as promote preservation of residual hearing and vestibular function after cochlear implantation.

show abstract

Section: Discussionsupporting

confidence: 59%

The Effects of Insertion Speed on Inner Ear Function during Cochlear Implantation: A Comparison Study

2012

View full text Add to dashboard Cite

show abstract

“…Inner ear protection using steroids was reported in a double-blinded, randomized placebo-controlled trial [Enticott et al, 2011]. In that study, although objective data showed no trend for an otoprotective effect owing to the early termination of the trial, methylprednisolone decreased the incidence of acute postoperative vestibular symptoms and reduced electrode impedance in the midcochlear region.…”

Section: Discussionmentioning

confidence: 97%

“…In addition, the preservation of vestibular function after CI could be an important factor to be considered in the selection of the side to be implanted and in bilateral CI. On the basis of the suggested mechanisms, steroids could also have a protective effect on vestibular preservation after CI [Enticott et al, 2011].…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Is One of the Factors Minimizing the Inner Ear Damage from Electrode Insertion in Cochlear Implantation

et al. 2016

View full text Add to dashboard Cite

The aim of this study was to investigate the efficacy of preoperative and intraoperative steroid administration for inner ear protection in cochlear implantation (CI). Nineteen subjects who underwent CI were included in the study, and 10 subjects were enrolled as controls (steroid-administered group, n = 19; control group, n = 10). Dexamethasone (dexamethasone sodium phosphate, 5 mg/ml) was systemically administered preoperatively (1 ml) and topically applied during CI (0.5 ml). The extent of hearing preservation (HP) after CI and the change in the bithermal caloric response were evaluated. Hearing level was calculated using mean thresholds [(250 Hz + 500 Hz + 1,000 Hz + 2,000 Hz)/4]. Preoperative hearing thresholds were similar in the steroid-administered and control groups (100.92 ± 12.60 vs. 103.29 ± 14.39 dB, p = 0.650). The mean thresholds significantly increased in both groups after surgery (108.46 ± 14.08 dB, p = 0.006, for the steroid-administered group; 117.50 ± 6.34 dB, p = 0.027, for the control group), and the difference between the groups was also significant (p = 0.027). The postoperative shift in the hearing thresholds at frequencies of 500 and 1,000 Hz was significant in the steroid-administered group and that at the frequencies of 500, 1,000 and 2,000 Hz was significant in the control group. However, the extent of the shift in hearing threshold levels at each frequency was not significantly different between the groups. Preservation of hearing thresholds was compared between the groups, and there were significantly more subjects with complete and partial HP in the steroid-administered group than in the control group (p = 0.008). The preoperative caloric response was maintained after CI in the steroid-administered group. This study suggests that the perioperative use of a steroid could minimize the inner ear damage after CI.

show abstract

“…Electroacoustic stimulation has been shown to be associated with improved speech perception, especially in the presence of background noise (Gantz et al 2005;Turner et al 2008), and to improve music appreciation for implant recipients (Gantz et al 2005). The preservation of vestibular function is important for the maintenance of balance, and this is of particular importance for patients with bilateral implants and in the elderly where disequilibrium can lead to falls or a loss of independent living (Enticott et al 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Hearing protection can be achieved in experimental animals undergoing cochlear implantation when glucocorticosteroids are applied to the inner ear Eastwood et al 2010a, b;James et al 2008;Maini et al 2009). Recently, the University of Melbourne and Cochlear implant Clinic in Melbourne presented the first clinical evidence in a randomized placebo-controlled trial (RCT) that the incidence of dizziness following cochlear implantation can be reduced by local steroid application prior to implantation (Enticott et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Direct Entry of Gadolinium into the Vestibule Following Intratympanic Applications in Guinea Pigs and the Influence of Cochlear Implantation

King

Salt

Eastwood

et al. 2011

JARO

View full text Add to dashboard Cite

Although intratympanic (IT) administration of drugs has gained wide clinical acceptance, the distribution of drugs in the inner ear following IT administration is not well established. Gadolinium (Gd) has been previously used as a marker in conjunction with magnetic resonance imaging (MRI) to visualize distribution in inner ear fluids in a qualitative manner. In the present study, we applied gadolinium chelated with diethylenetriamine penta-acetic acid (Gd-DTPA) to the round window niche of 12 guinea pigs using Seprapack TM (carboxlmethylcellulose--hyaluronic acid) pledgets which stabilized the fluid volume in the round window niche. Gd-DTPA distribution was monitored sequentially with time following application. Distribution in normal, unperforated ears was compared with ears that had undergone a cochleostomy in the basal turn of scala tympani and implantation with a silastic electrode. Results were quantified using image analysis software. In all animals, Gd-DTPA was seen in the lower basal scala tympani (ST), scala vestibuli (SV), and throughout the vestibule and semi-circular canals by 1 h after application. Although Gd-DTPA levels in ST were higher than those in the vestibule in a few ears, the majority showed higher Gd-DTPA levels in the vestibule than ST at both early and later time points. Quantitative computer simulations of the experiment, taking into account the larger volume of the vestibule compared to scala tympani, suggest most Gd-DTPA (up to 90%) entered the vestibule directly in the vicinity of the stapes rather than indirectly through the round window membrane and ST. Gd-DTPA levels were minimally affected by the implantation procedure after 1 h. Gd-DTPA levels in the basal turn of scala tympani were lower in implanted animals, but the difference compared to non-implanted ears did not reach statistical significance.

show abstract

Methylprednisolone Applied Directly to the Round Window Reduces Dizziness after Cochlear Implantation: A Randomized Clinical Trial

Cited by 53 publications

References 103 publications

The Effects of Insertion Speed on Inner Ear Function during Cochlear Implantation: A Comparison Study

The Effects of Insertion Speed on Inner Ear Function during Cochlear Implantation: A Comparison Study

Dexamethasone Is One of the Factors Minimizing the Inner Ear Damage from Electrode Insertion in Cochlear Implantation

Direct Entry of Gadolinium into the Vestibule Following Intratympanic Applications in Guinea Pigs and the Influence of Cochlear Implantation

Contact Info

Product

Resources

About