Preservation of Basal Inner Ear Structures in Cochlear Implantation

Adunka, Oliver F.; Gstœttner, Wolfgang; Hambek, Markus; Unkelbach, Marc H.; Radeloff, Andreas; Kiefer, Jan

doi:10.1159/000081887

Cited by 84 publications

(63 citation statements)

References 30 publications

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“…These data support the results of Adunka et al, 14 who showed, in 2004, that cochleostomy has a higher risk of destructive basal trauma (48%) compared with performing round window membrane insertions (15%). In all cases, the electrode array penetrated the basal membrane in the first 45°segment of the cochlea.…”

Section: Discussionsupporting

confidence: 91%

Radiologic and Functional Evaluation of Electrode Dislocation from the Scala Tympani to the Scala Vestibuli in Patients with Cochlear Implants

Fischer¹,

Pinggera²,

Weichbold

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Localization of the electrode after cochlear implantation seems to have an impact on auditory outcome, and conebeam CT has emerged as a reliable method for visualizing the electrode array position within the cochlea. The aim of this retrospective study was to evaluate the frequency and clinical impact of scalar dislocation of various electrodes and surgical approaches and to evaluate its influence on auditory outcome.

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Section: Discussionsupporting

confidence: 91%

Radiologic and Functional Evaluation of Electrode Dislocation from the Scala Tympani to the Scala Vestibuli in Patients with Cochlear Implants

Fischer¹,

Pinggera²,

Weichbold

et al. 2014

AJNR Am J Neuroradiol

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“…Recent studies and discussion in the literature have identified the potential for damage to the spiral ligament, basilar membrane and osseous spiral lamina occurring due to the creation of the cochleostomy [Briggs et al, , 2005Adunka et al, 2004]. If the cochleostomy is sited anterior, rather than inferior, to the RWM, there is the distinct possibility of significant trauma to the adjacent basal turn structures making successful hearing preservation less likely.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Round Window and Cochleostomy Approaches with a Prototype Hearing Preservation Electrode

et al. 2006

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Introduction: Preservation of residual hearing in cochlear implant recipients has been demonstrated to be possible and provides the potential benefit of combined electric and acoustic auditory stimulation. A prototype 16-mm multichannel array has been designed to facilitate placement of 22 electrodes without damage to intracochlear structures. The electrode array is suitable for insertion via the round window membrane (RWM) or a small cochleostomy. Aim: To evaluate the insertion trajectory and the presence of trauma to intracochlear structures with the prototype electrode inserted by either the RWM or a scala tympani cochleostomy. Materials and Methods: Eighteen fresh frozen human temporal bones were prepared for cochlear implantation using a standard transmastoid facial recess technique. Twelve electrodes were implanted at the University of Melbourne and 6 at the Medizinische Hochschule Hannover. In Melbourne fluoroscopy was used to monitor the insertions. Twelve prototype electrodes were inserted via the RWM. A further 6 electrodes were inserted via a small scala tympani cochleostomy. The cochleostomy was sited inferior to the RWM to avoid trauma to the basilar membrane and spiral ligament. Specimens were embedded and fixed with acrylic resin and the cochleae then examined histologically at 200-µm intervals using a grinding and polishing technique. Results: Full insertion of the electrode was achieved without significant resistance in all RWM and cochleostomy specimens. In two RWM specimens fold-over of the electrode tip occurred, and in one specimen the electrode penetrated the spiral ligament to lie in an ‘endosteal ‘position. In one cochleostomy specimen the electrode was rotated within the cochlea to face laterally rather than towards the modiolus. The final electrode position differed for the two groups, with the electrodes inserted via the RWM lying in a more perimodiolar position along the first part of the basal turn. The average depth of insertion was 240° for the RWM electrodes and 255° for the cochleostomy electrodes. Histologic examination showed no damage in any specimen to the modiolus, osseous spiral lamina or basilar membrane. Conclusions: A prototype hearing preservation electrode array was inserted by either a RWM or a scala tympani cochleostomy without evidence of significant intracochlear trauma.

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“…In a large series of human cadaver temporal bone experiments, we were able to demonstrate atraumatic electrode insertions with the MED-EL device [Adunka et al, 2004a]. In those cases, the array was found to be sliding along the inferior part of the lateral wall of the scala tympani.…”

Section: Surgical Proceduresmentioning

confidence: 93%

Ipsilateral Electric Acoustic Stimulation of the Auditory System: Results of Long-Term Hearing Preservation

et al. 2006

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Objective: To evaluate long-term ipsilateral hearing preservation in patients who underwent cochlear implantation for the combined electric acoustic stimulation of the auditory system. Methods: This was a prospective observational study conducted at a tertiary referral center. Twenty-three subjects were implanted with the MED-EL C40+ standard or C40+ medium electrode using an atraumatic surgical protocol via an anterior-inferior cochleostomy approach. The desired insertion depth was 18–24 mm or 360°. All patients showed significant low-frequency hearing prior to surgery and monosyllabic word scores did not exceed 40% in the best aided condition. Pure-tone audiometry was performed prior to implantation and at distinct intervals after surgery. Results: Nine patients (39.1%) showed complete pure-tone audiometric hearing preservation (0–10 dB) over an average of 29 months. Seven subjects (30.4%) showed partial preservation of residual hearing (hearing loss 15–40 dB) until an average of 25 months. Delayed loss of residual hearing was observed in 5 cases (21.7%) and 2 patients (8.6%) completely lost residual hearing during or immediately after surgery. Freiburger Monosyllabic word understanding scores in a group of patients with complete hearing preservation increased from 13.1% preoperatively to 75% in the electric acoustic stimulation condition. Conclusion: This study documents that complete and partial preservation of ipsilateral hearing after cochlear implantation can be achieved in about 70% of cases over an average period of 27.25 months when using 360° electrode insertions.

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Preservation of Basal Inner Ear Structures in Cochlear Implantation

Cited by 84 publications

References 30 publications

Radiologic and Functional Evaluation of Electrode Dislocation from the Scala Tympani to the Scala Vestibuli in Patients with Cochlear Implants

Radiologic and Functional Evaluation of Electrode Dislocation from the Scala Tympani to the Scala Vestibuli in Patients with Cochlear Implants

Comparison of Round Window and Cochleostomy Approaches with a Prototype Hearing Preservation Electrode

Ipsilateral Electric Acoustic Stimulation of the Auditory System: Results of Long-Term Hearing Preservation

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