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Deep round window insertion versus standard approach in cochlear implant surgery

  • Otology
  • Published:
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Abstract

The aim of this study was to compare the outcomes of vestibular tests and the residual hearing of patients who have undergone full insertion cochlear implant surgery using the round window approach with a hearing preservation protocol (RW-HP) or the standard cochleostomy approach (SCA) without hearing preservation. A prospective study of 34 adults who underwent unilateral cochlear implantation was carried out. One group was operated using the RW-HP (n = 17) approach with Med-El +FlexSOFT electrode array with full insertion, while the control group underwent a more conventional SCA surgery (n = 17) with shorter perimodiolar electrodes. Assessments of residual hearing, cervical vestibular-evoked myogenic potentials (cVEMP), videonystagmography, subjective visual vertical/horizontal (SVH/SVV) were performed before and after surgery. There was a significantly (p < 0.05) greater number of subjects who exhibited complete or partial hearing preservation in the deep insertion RW-HP group (9/17) compared to the SCA group (2/15). A higher degree of vestibular loss but a lower degree of vertigo symptoms could be seen in the RW-HP group, but the differences were not statistically significant. It is possible to preserve residual hearing to a certain extent also with deep insertion. Full insertion with hearing preservation was less harmful to residual hearing particularly at 125 Hz (p < 0.05), than was the standard cochleostomy approach.

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References

  1. Hodges AV, Schloffman J, Balkany T (1997) Conservation of residual hearing with cochlear implantation. Am J Otol 18(2):179–183

    PubMed  CAS  Google Scholar 

  2. von Ilberg CA, Baumann U, Kiefer J, Tillein J, Adunka OF (2011) Electric-acoustic stimulation of the auditory system: a review of the first decade. Audiol Neurootol 16(Suppl 2):1–30

    Article  Google Scholar 

  3. Gstoettner W, Helbig S, Settevendemie C, Baumann U, Wagenblast J, Arnoldner C (2009) A new electrode for residual hearing preservation in cochlear implantation: first clinical results. Acta Otolaryngol 129(4):372–379

    Article  PubMed  Google Scholar 

  4. Gfeller K, Turner C, Mehr M, Woodworth G, Fearn R, Knutson JF, Witt S, Stordahl J (2002) Recognition of familiar melodies by adult cochlear implant recipients and normal-hearing adults. Cochlear Implant Int 3(1):29–53

    Article  Google Scholar 

  5. Gfeller KE, Olszewski C, Turner C, Gantz B, Oleson J (2006) Music perception with cochlear implants and residual hearing. Audiol Neurootol 11(Suppl 1):12–15

    Article  PubMed  Google Scholar 

  6. Enticott JC, Tari S, Koh SM, Dowell RC, O’Leary SJ (2006) Cochlear implant and vestibular function. Otol Neurotol 27(6):824–830

    Article  PubMed  Google Scholar 

  7. Krause E, Wechtenbruch J, Rader T, Gurkov R (2009) Influence of cochlear implantation on sacculus function. Otolaryngol Head Neck Surg 140(1):108–113

    Article  PubMed  Google Scholar 

  8. Fina M, Skinner M, Goebel JA, Piccirillo JF, Neely JG, Black O (2003) Vestibular dysfunction after cochlear implantation. Otol Neurotol 24(2):234–242

    Article  PubMed  Google Scholar 

  9. Basta D, Todt I, Goepel F, Ernst A (2008) Loss of saccular function after cochlear implantation: the diagnostic impact of intracochlear electrically elicited vestibular evoked myogenic potentials. Audiol Neurootol 13(3):187–192

    Article  PubMed  CAS  Google Scholar 

  10. Lehnhardt E (1993) Intracochlear placement of cochlear implant electrodes in soft surgery technique. Hno 41(7):356–359

    PubMed  CAS  Google Scholar 

  11. Balkany TJ, Connell SS, Hodges AV, Payne SL, Telischi FF, Eshraghi AA, Angeli SI, Germani R, Messiah S, Arheart KL (2006) Conservation of residual acoustic hearing after cochlear implantation. Otol Neurotol 27(8):1083–1088

    Article  PubMed  Google Scholar 

  12. Baumgartner WD, Jappel A, Morera C, Gstottner W, Muller J, Kiefer J, Van De Heyning P, Anderson I, Nielsen SB (2007) Outcomes in adults implanted with the FLEXsoft electrode. Acta Otolaryngol 127(6):579–586

    Article  PubMed  Google Scholar 

  13. Garcia-Ibanez L, Macias AR, Morera C, Rodriguez MM, Szyfter W, Skarszynski H, Emamdjomeh H, Baumgartner WD (2009) An evaluation of the preservation of residual hearing with the Nucleus Contour Advance electrode. Acta Otolaryngol 129(6):651–664

    Article  PubMed  Google Scholar 

  14. Skarzynski H, Lorens A, Zgoda M, Piotrowska A, Skarzynski PH, Szkielkowska A (2011) Atraumatic round window deep insertion of cochlear electrodes. Acta Otolaryngol 131(7):740–749

    Article  PubMed  Google Scholar 

  15. Erixon E, Kobler S, Rask-Andersen H (2012) Cochlear implantation and hearing preservation: results in 21 consecutively operated patients using the round window approach. Acta Otolaryngol 132(9):923–931

    Article  PubMed  Google Scholar 

  16. Rajan GP, Kuthubutheen J, Hedne N, Krishnaswamy J (2012) The role of preoperative, intratympanic glucocorticoids for hearing preservation in cochlear implantation: a prospective clinical study. Laryngoscope 122(1):190–195

    Article  PubMed  CAS  Google Scholar 

  17. Chang A, Eastwood H, Sly D, James D, Richardson R, O’Leary S (2009) Factors influencing the efficacy of round window dexamethasone protection of residual hearing post-cochlear implant surgery. Hear Res 255(1–2):67–72

    Article  PubMed  CAS  Google Scholar 

  18. Hochmair I, Arnold W, Nopp P, Jolly C, Muller J, Roland P (2003) Deep electrode insertion in cochlear implants: apical morphology, electrodes and speech perception results. Acta Otolaryngol 123(5):612–617

    Article  PubMed  Google Scholar 

  19. Adunka O, Kiefer J (2006) Impact of electrode insertion depth on intracochlear trauma. Otolaryngol Head Neck Surg 135(3):374–382

    Article  PubMed  Google Scholar 

  20. Helbig S, Baumann U, Hey C, Helbig M (2011) Hearing preservation after complete cochlear coverage in cochlear implantation with the free-fitting FLEXSOFT electrode carrier. Otol Neurotol 32(6):973–979

    Article  PubMed  Google Scholar 

  21. James C, Albegger K, Battmer R, Burdo S, Deggouj N, Deguine O, Dillier N, Gersdorff M, Laszig R, Lenarz T, Rodriguez MM, Mondain M, Offeciers E, Macias AR, Ramsden R, Sterkers O, Von Wallenberg E, Weber B, Fraysse B (2005) Preservation of residual hearing with cochlear implantation: how and why. Acta Otolaryngol 125(5):481–491

    Article  PubMed  Google Scholar 

  22. Jongkees LB (1968) Electronystagmography: its use and usefulness. Ann Otol Rhinol Laryngol 77(4):733–739

    Article  PubMed  CAS  Google Scholar 

  23. Curthoys IS, Dai MJ, Halmagyi GM (1991) Human ocular torsional position before and after unilateral vestibular neurectomy. Exp Brain Res 85(1):218–225

    Article  PubMed  CAS  Google Scholar 

  24. Hafstrom A, Fransson PA, Karlberg M, Magnusson M (2006) Subjective visual tilt and lateral instability after vestibular deafferentation. Acta Otolaryngol 126(11):1176–1181

    Article  PubMed  Google Scholar 

  25. Mick P, Amoodi H, Shipp D, Friesen L, Symons S, Lin V, Nedzelski J, Chen J (2014) Hearing preservation with full insertion of the FLEXsoft electrode. Otol Neurotol 35(1):e40–e44. doi:10.1097/MAO.0b013e318291c66d

    Article  PubMed  Google Scholar 

  26. Todt I, Basta D, Ernst A (2008) Does the surgical approach in cochlear implantation influence the occurrence of postoperative vertigo? Otolaryngol Head Neck Surg 138(1):8–12

    Article  PubMed  Google Scholar 

  27. Todd NP, Rosengren SM, Aw ST, Colebatch JG (2007) Ocular vestibular evoked myogenic potentials (OVEMPs) produced by air- and bone-conducted sound. Clin Neurophysiol 118(2):381–390

    Article  PubMed  Google Scholar 

  28. Enticott JC, Eastwood HT, Briggs RJ, Dowell RC, O’Leary SJ (2011) Methylprednisolone applied directly to the round window reduces dizziness after cochlear implantation: a randomized clinical trial. Audiol Neurootol 16(5):289–303. doi:10.1159/000322137

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

None of the authors have any conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Oslo University Hospital-Rikshospitalet, Oslo, Norway

    Karl Fredrik Nordfalk, Kjell Rasmussen, Marie Bunne & Greg Eigner Jablonski

  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    Karl Fredrik Nordfalk & Greg Eigner Jablonski

  3. ØNH-Avdelingen, Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway

    Karl Fredrik Nordfalk

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  1. Karl Fredrik Nordfalk
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Correspondence to Karl Fredrik Nordfalk.

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Nordfalk, K.F., Rasmussen, K., Bunne, M. et al. Deep round window insertion versus standard approach in cochlear implant surgery. Eur Arch Otorhinolaryngol 273, 43–50 (2016). https://doi.org/10.1007/s00405-014-3451-2

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  • DOI: https://doi.org/10.1007/s00405-014-3451-2

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