Noise Exposure of the Inner Ear During Drilling a Cochleostomy for Cochlear Implantation

Pau, Hans Wilhelm; Just, Tino; Bornitz, Matthias; Lasurashvilli, Nikoloz; Zahnert, Thomas

doi:10.1097/mlg.0b013e31802f4169

Cited by 113 publications

(79 citation statements)

References 11 publications

(10 reference statements)

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“…This is also less harmful compared to the standard cochleostomy [19]. The better audiological outcomes with round window insertion are due to absence of drilling into the cochlea leading to prevention of chances of bone dust migration into the cochlea [4]). Additionally, there is availability of increased length of spiral lamina averaging to 2 mm for stimulation with the electrode and utilisation of complete basal turn and increased perimodiolar placement of the electrode leading to increased stimulation of residual dendrites [5,20].…”

Section: Discussionmentioning

confidence: 99%

“…The factors that determine preservation of residual hearing are type and dimension of array [2,3], traditional cochleostomy vs. round window insertion) [4,5], insertion technique [3,6] and drugs used during insertion [7,8]. Soft surgery technique with round window insertion has played a major part among the steps taken for residual hearing preservation in the last decade.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Round Window Accessibility for Electrode Insertion: Validation Study from two Centers

Panda¹

2017

JOENTR

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Purpose: Round window insertion is advocated as a method to reduce insertion trauma and preserve residual hearing. Bony overhang of the round window niche and variations in the cochlear rotation might hamper the accessibility of round window membrane. This paper is an attempt to classify the round window membrane visibility before any drilling of the round window niche through the standard posterior tympanotomy approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Round Window Accessibility for Electrode Insertion: Validation Study from two Centers

Panda¹

2017

JOENTR

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“…On the other hand, drilling directly on the bony part of the cochlea might induce an additional hearing loss (noise-or vibration-induced sensorineural [Pau et al, 2007]) and may also increase the risk of direct trauma to the RW membrane. Leaving the bony lip of the RW niche intact occludes the RW membrane and might increase the risk of RW rupture when fitting the tip into the niche.…”

Section: Clinical Importance Of Present Studymentioning

confidence: 99%

Round Window Membrane Implantation with an Active Middle Ear Implant: A Study of the Effects on the Performance of Round Window Exposure and Transducer Tip Diameter in Human Cadaveric Temporal Bones

Tringali

Koka²,

Devèze

et al. 2010

Audiol Neurotol

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Objectives: To assess the importance of 2 variables, transducer tip diameter and resection of the round window (RW) niche, affecting the optimization of the mechanical stimulation of the RW membrane with an active middle ear implant (AMEI). Materials and Methods: Ten temporal bones were prepared with combined atticotomy and facial recess approach to expose the RW. An AMEI stimulated the RW with 2 ball tip diameters (0.5 and 1.0 mm) before and after the resection of the bony rim of the RW niche. The RW drive performance, assessed by stapes velocities using laser Doppler velocimetry, was analyzed in 3 frequency ranges: low (0.25–1 kHz), medium (1–3 kHz) and high (3–8 kHz). Results: Driving the RW produced mean peak stapes velocities (H_EV) of 0.305 and 0.255 mm/s/V at 3.03 kHz, respectively, for the 1- and 0.5-mm tips, with the RW niche intact. Niche drilling increased the H_EV to 0.73 and 0.832 mm/s/V for the 1- and 0.5-mm tips, respectively. The tip diameter produced no difference in output at low and medium frequencies; however, the 0.5-mm tip was 5 and 6 dB better than the 1-mm tip at high frequencies before and after niche drilling, respectively. Drilling the niche significantly improved the output by 4 dB at high frequencies for the 1-mm tip, and by 6 and 10 dB in the medium- and high-frequency ranges for the 0.5-mm tip. Conclusion: The AMEI was able to successfully drive the RW membrane in cadaveric temporal bones using a classical facial recess approach. Stimulation of the RW membrane with an AMEI without drilling the niche is sufficient for successful hearing outputs. However, the resection of the bony rim of the RW niche significantly improved the RW stimulation at medium and higher frequencies. Drilling the niche enhances the exposure of the RW membrane and facilitates positioning the implant tip.

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“…Ipsilateral sensorineural hearing loss after MVD could be attributed to 1) stretching of cranial nerve VIII during retraction of the cerebellum, 2) manipulation of the labyrinthine artery and/or the anterior inferior cerebellar artery, 3) direct trauma to the nerve by instruments or nearby coagulation, and 4) new compression of the nerve by the prosthesis interposed between the offending vessel and the affected nerve complex at the end of surgery. 23 Although drill-induced noise could aggravate or contribute to sensorineural hearing loss by a mechanism of acoustic trauma and reduced bone-conduction thresholds, 4,12,13,22 it could also contribute to ipsilateral and contralateral HFHL. Our clinical practice includes some patients who complain of hearing disturbance and some who do not, which makes HFHL an incidental finding.…”

Section: Discussionmentioning

confidence: 99%

The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

Meigh

Dasyam²,

Shankar³

et al. 2015

JNS

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S enSorineural hearing loss after microvascular decompression (MVD) has a reported incidence of 1%-23.8% when performed for trigeminal neuralgia (TGN), 1.5%-4.2% for glossopharyngeal neuralgia (GPN), and 22% for geniculate neuralgia (GN). 21,24,25,27 Because of the proximity of the cranial nerve VIII to cranial nerves decompressed during the procedure, the auditory nerve in many patients is often stretched or damaged, resulting in hearing impairment. Although sensorineural hearing loss after MVD is frequently documented and well understood, high-frequency hearing loss (HFHL) is currently not well recognized. HFHL has been recently reported after MVD for hemifacial spasm (HFS). . disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect The primary aim of this study was to evaluate the incidence and discuss the pathogenesis of high-frequency hearing loss (HFHL) after microvascular decompression (MVD) for trigeminal neuralgia (TGN), glossopharyngeal neuralgia (GPN), or geniculate neuralgia (GN). methods The authors analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 93 patients with TGN, 6 patients with GPN, and 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz. results The incidence of HFHL was 30.84% on the side ipsilateral to the surgery and 20.56% on the contralateral side. Of the 47 patients with HFHL, 20 had conductive hearing loss, and 2 experienced nonserviceable hearing loss after the surgery. The incidences of HFHL on the ipsilateral side at 4 and 8 kHz were 17.76% and 25.23%, respectively, and 8.41% and 15.89%, respectively, on the contralateral side. As the audiometric frequency increased, the number of patients with hearing loss increased. No significant postoperative difference was found between patients with and without HFHL in intraoperative BAEP waveforms. Sex, age, and affected side were not associated with an increase in the incidence of hearing loss. coNclusioNs High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL.

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Noise Exposure of the Inner Ear During Drilling a Cochleostomy for Cochlear Implantation

Cited by 113 publications

References 11 publications

Evaluation of Round Window Accessibility for Electrode Insertion: Validation Study from two Centers

Evaluation of Round Window Accessibility for Electrode Insertion: Validation Study from two Centers

Round Window Membrane Implantation with an Active Middle Ear Implant: A Study of the Effects on the Performance of Round Window Exposure and Transducer Tip Diameter in Human Cadaveric Temporal Bones

The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia

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