Sally Nguyen1, François Cloutier2, Daniel Philippon3, Mathieu Côté3, Richard Bussières3, Douglas D Backous2. 1. Department of Otolaryngology and Head and Neck Surgery, Laval University, Faculté de médecine, 1050, avenue de la Médecine, local 4889, Québec, Québec, Canada G1V 0A6. Electronic address: sally.nguyen.1@ulaval.ca. 2. Swedish Neuroscience Institute, Center for Hearing and Skull Base Surgery, 550 17th Avenue, Suite 540 for Neuro-Otology, Seattle, WA 98122, United States. 3. Department of Otolaryngology and Head and Neck Surgery, Hôtel-Dieu de Québec (CHU de Québec), 11, côte du Palais, Québec, Québec, Canada G1R 2J6.
Abstract
INTRODUCTION: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used. OBJECTIVE: The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation. RESULTS: Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation. CONCLUSION: Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeon's preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities.
INTRODUCTION: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used. OBJECTIVE: The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation. RESULTS: Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation. CONCLUSION:Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeon's preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities.
Authors: Lukas D Landegger; Bifeng Pan; Charles Askew; Sarah J Wassmer; Sarah D Gluck; Alice Galvin; Ruth Taylor; Andrew Forge; Konstantina M Stankovic; Jeffrey R Holt; Luk H Vandenberghe Journal: Nat Biotechnol Date: 2017-02-06 Impact factor: 54.908
Authors: Magdalena Beata Skarżyńska; Piotr Henryk Skarżyński; Bartłomiej Król; Magdalena Kozieł; Kamila Osińska; Elżbieta Gos; Henryk Skarżyński Journal: Med Sci Monit Date: 2018-04-22
Authors: Athanasia Warnecke; Nils Prenzler; Jennifer Harre; Ulrike Köhl; Lutz Gärtner; Thomas Lenarz; Sandra Laner-Plamberger; Georg Wietzorrek; Hinrich Staecker; Teresa Lassacher; Julia Hollerweger; Mario Gimona; Eva Rohde Journal: J Extracell Vesicles Date: 2021-06-04