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

Rajan, Gunesh; Kontorinis, Georgios; Kuthubutheen, Jafri

doi:10.1159/000342821

Cited by 108 publications

(91 citation statements)

References 52 publications

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“…Insertion speed has been shown to be one factor causing ICP changes and is believed to have an impact on the sensory neuroepithelia of the labyrinth [Rajan et al, 2013].…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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To achieve a functional atraumatic insertion, low intracochlear pressure changes during the procedure are assumed to be important. The aim of this study was to observe intracochlear pressure changes due to different insertion techniques in a cochlear model. Cochlear implant electrode insertions were performed in an artificial cochlear model to record intracochlear pressure changes with a micropressure sensor to evaluate the maximum amplitude and frequency of pressure changes under different insertional conditions. We found statistically significant differences in the occurrence of intracochlear pressure peak changes comparing different techniques. Based on our model results, an insertion should be maximally supported to minimize micromovement-related pressure changes.

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“…Insertion speed has been shown to be one factor causing ICP changes and is believed to have an impact on the sensory neuroepithelia of the labyrinth [Rajan et al, 2013].…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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“…Therefore, atraumatic insertion of the electrode through the round window membrane, which is in direct continuity with the scala tympani, might be appropriate for vestibular function preservation . Rajan et al [2013] suggested that a reduction in the insertion speed of the electrode has a beneficial effect on vestibular function preservation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…EAS CI was performed using a hearing preservation technique developed and published by our unit [Rajan et al, , 2013. The key steps involved are: (1) preoperative transtympanic steroid injection of 0.5 mL methylprednisolone 40 mg/mL, (2) a standard wide posterior tympanotomy approach with repeat application of steroids into the middle ear, (3) a large opening of the round window membrane underwater, (4) slow insertion of the electrode, and (5) repeat application of topical depot steroids (0.5 mL methylprednisolone 40mg/ml) after insertion.…”

Section: Surgical Methodsmentioning

confidence: 99%

The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

2018

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Aim: To investigate and compare residual hearing preservation between patients based on the presence of intraoperative gusher. Methodology: We retrospectively compared 2 cohorts of cochlear implant recipients significantly distinguished by whether or not they experienced gusher intraoperatively. Patients underwent cochlear implantation using 24-mm lateral wall electrode arrays as well pharmacologic steroid protection. All patients were assessed by a hearing implant MDT. Hearing preservation rates and speech perception outcomes were assessed at 1, 6, 12, 24, 36, 48, and 60 months. Results: The patients with no gusher demonstrated complete hearing preservation. The patients with gusher demonstrated significant postoperative reduction of hearing thresholds, which declined at a significantly higher pace during follow-up. All patients demonstrated significantly better speech performance after cochlear implantation. Conclusion: The present study suggests that intraoperative gusher is associated with a significant drop in residual hearing, both immediately and over time, which may be related to the large change in intracochlear pressure intraoperatively.

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

Cited by 108 publications

References 52 publications

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

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

The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

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