Delayed loss of hearing after hearing preservation cochlear implantation: Human temporal bone pathology and implications for etiology

Quesnel, Alicia M.; Nakajima, Hideko Heidi; Rosowski, John J.; Hansen, Marlan R.; Gantz, Bruce J.; Nadol, Joseph B.

doi:10.1016/j.heares.2015.08.018

Cited by 142 publications

(118 citation statements)

References 37 publications

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“…As reported in previous studies (9,10), some ECoG responses showed an increase after insertion of the cochlear implant electrode. In this series, such a finding was present in five subjects (Subjects 4,5,8,12,and 14). Different reasons could be responsible.…”

Section: Discussionsupporting

confidence: 46%

“…Besides acute cochlear trauma during surgery, postoperative mechanisms seem to influence hearing preservation. Early inflammatory responses (33) or endolymphatic hydrops (34) could lead to hearing loss during the early postoperative phase, whereas tissue responses (8,35) and excitotoxicity because of electrical stimulation (36) could, among other factors, lead to delayed loss of residual hearing within months. Therefore, to further explore the correlation between trauma during surgery and postoperative hearing loss and gain more insight regarding the incidence of postoperative mechanisms, a tool to assess cochlear trauma during surgery is needed.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying reasons are controversial. Besides cochlear trauma during surgery, postoperative mechanisms seem to cause deterioration of cochlear function (8)(9)(10)(11). Therefore, methods to evaluate and monitor cochlear trauma during cochlear implantation could help to better understand the correlation between cochlear trauma and loss of cochlear function.…”

mentioning

confidence: 99%

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Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography

Dalbert

Huber

Veraguth

et al. 2016

Otology &Amp; Neurotology

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography

Dalbert

Huber

Veraguth

et al. 2016

Otology &Amp; Neurotology

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“…Lack of significant correlation between fibrous tissue thickness and word recognition scores may be due to either that fibrous encapsulation of the electrode is not an important determinant factor, or that given the small sample size, there is insufficient data to demonstrate a significant effect. Although fibrous tissue thickness does not correlate with CI performance, fibrosis within the cochlea may play a role in loss of residual acoustic hearing with cochlear implantation (Quesnel et al, 2016, Bas et al, 2016). Therefore, understanding the etiology of fibrous capsule development may influence electrode array design as the indications for cochlear implantation expand to include those with more residual hearing.…”

Section: Discussionmentioning

confidence: 99%

The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays

et al. 2017

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An inflammatory tissue reaction around the electrode array of a cochlear implant (CI) is common, in particular at the electrode insertion region (cochleostomy) where mechanical trauma often occurs. However, the factors determining the amount and causes of fibrous reaction surrounding the stimulating electrode, especially medially near the perimodiolar location, are unclear. Temporal bone (TB) specimens from patients who had undergone cochlear implantation during life with either Advanced Bionics (AB) Clarion TM or HiRes90KTM (Sylmar, CA, USA) or Cochlear TM Nucleus (Sydney, Australia) devices were evaluated. The thickness of the fibrous tissue surrounding the electrode array of both types of CI devices at both the lower (LB) and upper (UB) basal turns of the cochlea was quantified at three locations: the medial, inferior, and superior aspects of the sheath. Fracture of the osseous spiral lamina and/or marked displacement of the basilar membrane were interpreted as evidence of intracochlear trauma. In addition, post-operative word recognition scores, duration of implantation, and post-operative programming data were evaluated. Seven TBs from six patients implanted with AB devices and five TBs from five patients implanted with Nucleus devices were included. A fibrous capsule around the stimulating electrode array was present in all twelve specimens. TBs implanted with AB device had a significantly thicker fibrous capsule at the medial aspect than at the inferior or superior aspects at both locations (LB and UB) of the cochlea (Wilcoxon signed-ranks test, p<0.01). TBs implanted with a Nucleus device had no difference in the thickness of the fibrous capsule surrounding the track of the electrode array (Wilcoxon signed-ranks test, p>0.05). Nine of fourteen (64%) basal turns of the cochlea (LB and UB of seven TBs) implanted with AB devices demonstrated intracochlear trauma compared to two of ten (20%) basal turns of the cochlea (LB and UB of five TBs) with Nucleus devices, (Fisher exact test, p<0.05). There was no significant correlation between the thickness of the fibrous tissue and the duration of implantation or the word recognition scores (Spearman rho, p=0.06, p=0.4 respectively). Our outcomes demonstrated the development of a robust fibrous tissue sheath medially closest to the site of electric stimulation in cases implanted with the AB device electrode, but not in cases implanted with the Nucleus device. The cause of the asymmetric fibrous sheath may be multifactorial including insertional trauma, a foreign body response, and/or asymmetric current flow.

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“…This finding demonstrates that delayed hearing loss in the low frequencies is not caused by the degeneration of spiral ganglia neurons. Recently, a single case of human temporal bone study was published of a patient who had received the Iowa/Nucleus8 hybrid implant electrode (16). This patient experienced progression of loss of residual hearing and at18 weeks following surgery he had profound sensorineural hearing loss in the operated ear.…”

Section: Discussionmentioning

confidence: 99%

Post Hybrid Cochlear Implant Hearing Loss and Endolymphatic Hydrops

Ishiyama

Doherty

Ishiyama

et al. 2016

Otology &Amp; Neurotology

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Objective To evaluate for potential causes of delayed loss of residual hearing that variably occurs with hybrid cochlear implants. Study design Histopathological evaluation of 29 human temporal bone (HTB) with cochlear implant. Setting The Neurotology and House HTB Laboratory of UCLA (House-UCLA). Subjects and methods HTB from cochlear implant patients from the House-UCLA HTB Laboratory (n = 28) and one courtesy of Massachusetts Eye and Ear Infirmary (MEEI). Histopathological analysis to identify the location of cochleostomy, fibrosis and bone formation in the scala vestibuli and tympani, and endolymphatic hydrops. Spiral ganglion neuron counts were obtained. Statistical analysis compared presence of cochleostomy and location with the histopathological findings. Results Seventeen of 29 bones with fibrosis in the scala vestibule (SV) and tympani had evidence of a cochleostomy involving the SV containing the ductus reunions, all of which had hydrops. Ten of eleven bones had no SV fibrosis, and a cochleostomy limited to the scala tympani, of which all had no hydrops. One HTB had moderate SV fibrosis not involving the ductus reuniens, and was without hydrops. One HTB had a SV cochleostomy but the electrode ruptured Reissner’s membrane, and was without hydrops. Cochleostomy was significantly associated with SV fibrosis and hydrops (p<0.01), those without hydrops had no SV atrophy (p<0.01). Round window insertion was associated with no fibrosis and no hydrops. Conclusion We hypothesize that cochleostomies involving scala vestibuli incite fibrosis, compromising the ductus reuniens, causing hydrops which may cause the delayed loss of residual low frequency hearing in cochlear implant.

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Delayed loss of hearing after hearing preservation cochlear implantation: Human temporal bone pathology and implications for etiology

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Cited by 142 publications

References 37 publications

Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography

Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography

The pattern and degree of capsular fibrous sheaths surrounding cochlear electrode arrays

Post Hybrid Cochlear Implant Hearing Loss and Endolymphatic Hydrops

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