Variability in surgical techniques for cochlear implantation: an international survey study

Kant, Ellen; Markodimitraki, Laura M.; Stegeman, Inge; Thomeer, Hans G. X. M.

doi:10.1080/14670100.2022.2051242

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…However, recent evidence suggests no difference in cochlear trauma risk between these techniques, and improved speech perception using the RW approach 148 . A recent international survey suggests that most surgeons now use the RW insertion approach, and this technique is predominantly used in our center 149 . The role of the extended RW technique has been limited and has played a more minor role in our experience.…”

Section: Discussionmentioning

confidence: 98%

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The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta‐Analysis

Gowrishankar

Fleet

Tomasoni

et al. 2023

Otolaryngol.--head neck surg.

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Objective. This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. Data Sources. MEDLINE, Embase, and Cochrane Library.Review Methods. This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models.Results. A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Metaanalysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I 2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. Conclusion.Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.

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Section: Discussionmentioning

confidence: 98%

“…148 A recent international survey suggests that most surgeons now use the RW insertion approach, and this technique is predominantly used in our center. 149 The role of the extended RW technique has been limited and has played a more minor role in our experience.…”

Section: Rw Versus Cochleostomymentioning

confidence: 95%

The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta‐Analysis

Gowrishankar

Fleet

Tomasoni

et al. 2023

Otolaryngol.--head neck surg.

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“…We should note that of the steps investigated, nowadays, cochleostomy is the less common approach for cochlear implantation ( Kant et al, 2022b ). However, cochleostomy and extended round window (which is a related approach as it also requires drilling) are expected still to be used in the future as these approaches are preferred in certain anatomical conditions and for perimodiolar electrode arrays ( Garaycochea et al, 2020 ; Jwair et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Acute effects of cochleostomy and electrode-array insertion on compound action potentials in normal-hearing guinea pigs

Jwair

Ramekers²,

Thomeer³

et al. 2023

Front. Neurosci.

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IntroductionElectrocochleography (ECochG) is increasingly used in cochlear implant (CI) surgery, in order to monitor the effect of insertion of the electrode array aiming to preserve residual hearing. However, obtained results are often difficult to interpret. Here we aim to relate changes in ECochG responses to acute trauma induced by different stages of cochlear implantation by performing ECochG at multiple time points during the procedure in normal-hearing guinea pigs.Materials and methodsEleven normal-hearing guinea pigs received a gold-ball electrode that was fixed in the round-window niche. ECochG recordings were performed during the four steps of cochlear implantation using the gold-ball electrode: (1) Bullostomy to expose the round window, (2) hand-drilling of 0.5–0.6 mm cochleostomy in the basal turn near the round window, (3) insertion of a short flexible electrode array, and (4) withdrawal of electrode array. Acoustical stimuli were tones varying in frequency (0.25–16 kHz) and sound level. The ECochG signal was primarily analyzed in terms of threshold, amplitude, and latency of the compound action potential (CAP). Midmodiolar sections of the implanted cochleas were analyzed in terms of trauma to hair cells, modiolar wall, osseous spiral lamina (OSL) and lateral wall.ResultsAnimals were assigned to cochlear trauma categories: minimal (n = 3), moderate (n = 5), or severe (n = 3). After cochleostomy and array insertion, CAP threshold shifts increased with trauma severity. At each stage a threshold shift at high frequencies (4–16 kHz) was accompanied with a threshold shift at low frequencies (0.25–2 kHz) that was 10–20 dB smaller. Withdrawal of the array led to a further worsening of responses, which probably indicates that insertion and removal trauma affected the responses rather than the mere presence of the array. In two instances, CAP threshold shifts were considerably larger than threshold shifts of cochlear microphonics, which could be explained by neural damage due to OSL fracture. A change in amplitudes at high sound levels was strongly correlated with threshold shifts, which is relevant for clinical ECochG performed at one sound level.ConclusionBasal trauma caused by cochleostomy and/or array insertion should be minimized in order to preserve the low-frequency residual hearing of CI recipients.

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“…Studies suggest that the functional preservation of residual hair cells may depend on the surgical procedure and its variability. 6,7 Apart from electrode design, other considerations that have been suggested to help maintain the residual hearing include the insertion angle, insertion speed, intracochlear size, intracochlear pressure, and the use of surfactants. It has been demonstrated that manual insertion leads to large disparity in the magnitude of pressure based on the insertion technique used by the surgeon.…”

Section: Introductionmentioning

confidence: 99%

“…The advancements in atraumatic electrodes have reduced the anatomical damage dramatically. Studies suggest that the functional preservation of residual hair cells may depend on the surgical procedure and its variability 6,7 …”

Section: Introductionmentioning

confidence: 99%

Development of Automated Tool for Electrode Array Insertion and its Study on Intracochlear Pressure

Zagabathuni,

Padi,

Kameswaran

et al. 2023

The Laryngoscope

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Cochlear implantation is the most successful approach for people with profound sensorineural hearing loss. Manual insertion of the electrode array may result in damaging the soft tissue structures and basilar membrane. An automated electrode array insertion device is reported to be less traumatic in cochlear implant surgery.ObjectivesThe present work develops a simple, reliable, and compact device for automatically inserting the electrode array during cochlear implantation and test the device to observe intracochlear pressure during simulated electrode insertion.MethodsThe device actuates the electrode array by a roller mechanism. For testing the automated device, a straight cochlea having the dimension of the scala tympani and a model electrode is developed using a 3D printer. A pressure sensor is utilized to observe the pressure change at different insertional conditions.ResultsThe electrode is inserted into a prototype cochlea at different speeds without any pause, and it is noticed that the pressure is increased with the depth of insertion of the electrode irrespective of the speed of electrode insertion. The rate of pressure change is observed to be increased exponentially with the speed of insertion.ConclusionAt an insertion speed of 0.15 mm/s, the peak pressure is observed to be 133 Pa, which can be further evaluated in anatomical models for clinical scenarios.Level of EvidenceN/A Laryngoscope, 2023

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Variability in surgical techniques for cochlear implantation: an international survey study

Cited by 5 publications

References 22 publications

The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta‐Analysis

The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta‐Analysis

Acute effects of cochleostomy and electrode-array insertion on compound action potentials in normal-hearing guinea pigs

Development of Automated Tool for Electrode Array Insertion and its Study on Intracochlear Pressure

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