electric acoustic stimulation procedure with long electrodes for better hearing preservation

<meta charset="utf8"></head><body>Elektrik-Akustik Stimülasyonda Uzun Elektrotlarla İşitmenin Korunması

Conventional cochlear implantation (CI) is a standard treatment for improving hearing ability in patients with severe-to-profound hearing loss (HL). Subsequently, electric-acoustic stimulation (EAS) is used to treat patients with severe high-frequency hearing loss and residual low-frequency hearing1. In such patients, preserving the residual acoustic hearing is important to achieve better speech perception in noise, sound localization, and improved sound quality when listening to music2. To address this,&#160;the use of&#160;shorter electrodes in EAS patients has been preferred to avoid interfering with the residual function in the acoustic region of the cochlea. However, our earlier studies3,4,5,6&#160;documented that even in EAS cases, less invasive CI surgery combined with thin, straight, and flexible &#34;longer&#34; electrodes enabled the preservation of residual hearing. Additionally, we reported that hearing preservation was unrelated to the length of the inserted cochlear implant electrode7, consistent with the systematic review8.
In patients who underwent conventional CI, longer electrodes led to better speech perception9,10,11&#160;as longer electrodes provide broader cochlear coverage and better place-pitch matching. Similarly, a&#160;correlation between a deeper angle of insertion (AID) and better hearing was reported12,13. In most EAS patients, the residual hearing gradually deteriorates over time14. Identifying the responsible gene for HL allows&#160;one to predict future hearing. When it is anticipated that their hearing would be lost across all frequencies in the future, EAS with longer electrodes, not shorter electrodes, is&#160;ideal in providing&#160;a higher percentage of cochlear coverage15. The optimal AID was thought to range from 630&#176; to 720&#176;16,17,18, corresponding to the distribution of spiral ganglion neurons in the human cochlea. However, as each cochlear duct length (CDL) has a wide range of variation19, measuring the CDL in each case was required to achieve the appropriate AID, even in EAS patients. Recently, commercially available software (see Table of Materials) allowed the measurment&#160;of each CDL easily based on computed tomography (CT) data, which was clinically feasible.
This protocol describes the following: (1) a preoperative evaluation that included genetic analysis to identify the etiology of HL and cochlear duct length measurement to determine the optimal electrode length, (2) a less invasive surgical procedure via exoscopy and endoscopy, and (3) the postoperative hearing outcome and mapping strategy in patients with high-frequency HL who underwent EAS with a longer electrode.

<meta charset="utf8"></head><body>Yazar İncelemesi: Gelişmiş Koklear Kapsama Alanı ve İşitmenin Korunması için Uzun Elektrotlarla EAS'ı Optimize Etme

Daha Uzun Elektrotlu Elektrikli Akustik Stimülasyon ile Yüksek Frekanslı İşitme Kaybında Gelişmiş Koklear Kapsama Alanı ve İşitmenin Korunması

Electric acoustic stimulation with longer electrodes can offer a broader cochlear coverage and various type of map in case of high-frequency hearing loss. We are working on a safer approach to EAS surgery using less invasive techniques, flexible electrodes and steroid administration. This allows deeper insertion with minimal surgical trauma, preserving hearing well.Our earlier studies showed even in EAS cases, this invasive CI surgery combined with thin, straight, and flexible longer electrode enabled the preservation of acoustic hearing. Additionally, we reported that the hearing preservation scores were independent of the length of the inserted electrode are consistent with the systematic review. As most patient gradually lose residual hearing due to the natural cause of hearing loss, in these cases, providing broader cochlear coverage using longer electrode was beneficial for better place-pitch matching.Advanced surgical techniques and steroid administration are important to minimize surgical trauma. Additionally, we think EAS with longer electrodes was useful not only to prepare for future hearing deterioration, but also to offer a couple of types of maps, map strategies. Identification of the etiology of hearing loss using genetic analysis is essential for predicting the future audiogram.

Daha İyi İşitme Koruması için Uzun Elektrotlu Elektrikli Akustik Stimülasyon Prosedürü

electric-acoustic-stimulation-procedure-with-long-electrodes-for

Research

JoVE Journal

Medicine

Electric Acoustic Stimulation Procedure with Long Electrodes for Better Hearing Preservation

233 Görüntüleme. Başlamak için, işitme kaybını veya HL ilerlemesini izlemek için hastaların saf tonlu odyogramlarını analiz edin. HL ile ilişkili genleri tanımlamak, hastalardan ve aile üyelerinden kan örnekleri almak ve genetik test ve yeni nesil dizileme yapmak. BT ve MRI görüntülerini kullanarak, etiyolojiyi belirleyin ve gelecekteki rezidüel akustik işitmeyi tahmin edin.OTOPLAN yazılımını başlatın ve ameliyat öncesi bilgisayarlı tomografi ...

Video: Daha İyi İşitme Koruması için Uzun Elektrotlu Elektrikli Akustik Stimülasyon Prosedürü

Enhanced Cochlear Coverage and Hearing Preservation in High-Frequency Hearing Loss via Electric Acoustic Stimulation with Longer Electrode

Electric-acoustic stimulation (EAS) is a promising treatment to improve hearing ability in patients with high-frequency hearing loss (HL). In EAS surgeries, shorter electrodes have been preferred to avoid the presence of an electrode covering the residual hearing region. However, our earlier studies showed that EAS with longer electrodes (28 mm) could preserve acoustic hearing. Additionally, we reported that the hearing preservation (HP) scores were independent of the length of the inserted electrodes, consistent with the systematic review. As most EAS patients gradually lose residual hearing over time due to the natural course of HL, in these cases, providing broader cochlear coverage using longer electrodes was beneficial toward better place-pitch matching. In addition to preparing for the deterioration in&#160;hearing in&#160;the future, EAS with longer electrodes could offer various types of map strategies. Herein, we show the pre-, intra-, and post-procedures for EAS surgery. Appropriate preoperative evaluation, less invasive surgery, flexible lateral-wall electrodes, and steroid administration resulted in good HP following EAS with longer electrodes.

Electric acoustic stimulation (EAS) with longer electrodes can offer broader cochlear coverage and various types of maps in cases of high-frequency hearing loss. Combining less invasive surgery, flexible lateral-wall electrodes, and steroid administration permits deeper insertion with little or no surgical trauma, resulting in good preservation of hearing.

Electric-acoustic stimulation (EAS) is a promising treatment to improve hearing ability in patients with high-frequency hearing loss (HL). In EAS ...

Tıp

To begin, analyze pure tone audiograms of patients to track hearing loss, or HL progression. To identify HL-associated genes, obtain blood samples from patients as well as their family members, and perform genetic testing and next generation sequencing. Utilizing CT and MRI images, determine the etiology and predict future residual acoustic hearing.Launch the OTOPLAN software and import DICOM data from preoperative computed tomography images into it. After the software measures the cochlear duct length, choose the cochlear implant array length to match areas of expected future hearing loss. For the surgical procedure, create a five to six centimeter postauricular incision in a lazy S shape.And using six to four millimeter cutting bars, perform mastoidectomy to expose the lateral semicircular canal and the short process of the incus. Utilizing 1.5 to two millimeter diamond bars, perform a posterior tympanotomy between the expected facial nerve and chorda tympani. After visualizing the round window niche, with a low speed drill, remove the bony overhang of the round window to expose the membrane.Employing a pick, open the round window membrane sufficiently and carefully insert the electrode for over three minutes. The six-month postoperative audiograms suggested that residual low frequency hearing was well preserved in all the cases after the procedure compared to the preoperative audiograms.