Scala vestibuli cochlear implantation in patients with partially ossified cochleas

Partial cochlear obstruction is a relatively common finding in candidates for cochlear implants and frequently involves the inferior segment of the scala tympani in the basal turn of the cochlea. In such patients, the scala vestibuli is often patent and offers an alternative site for implantation. The current report describes two patients with such partial obstruction of the inferior segment of the basal cochlear turn, caused in one case by systemic vasculitis (Takayasu's disease) and in the other by obliterative otosclerosis. A scala vestibuli implantation allowed for complete insertion of the electrode array. No problems were encountered during the surgical procedures and the good post-operative hearing and communicative outcomes achieved were similar to those reported in patients without cochlear ossification. The importance of accurate pre-operative radiological study of the inner ear is underscored, to disclose the presence and define the features of the cochlear ossification and ultimately to properly plan the surgical approach.     

Potassium circulation in the perilymph of guinea pig cochlea

To determine whether any differences exist in potassium circulation between the scala vestibuli and scala tympani, we recorded the change in K⁺ activity in both scalae of the guinea pig cochlea at the basal and third turns, using a double-barrelled, K⁺-sensitive microelectrode after perfusion with artificial perilymph containing 20 mM KCl and 130 mM NaCl. K⁺ activity increased immediately after the start of perfusion and decreased after its completion. The rates of decrease of K⁺ activities were approximately 1.0 mEq/l per min in the scala vestibuli of the basal and third turns, also 1.0 mEq/l per min in the scala tympani of the basal turn, and approximately 0.5 mEq/l per min in the scala tympani of the third turn. The rate of decrease of K⁺ activity in the scala tympani was significantly slower in the third turn than in the basal turn. Blockage of the cochlear aqueduct depressed the rate of decrease of K⁺ activity in the scala tympani more in the basal turn than in the third turn. These results suggest that there is a difference in potassium circulation between the scala vestibuli and scala tympani, and that the cochlear aqueduct plays an important role in potassium circulation in the perilymph of the scala tympani.     

Math1基因导入成年大鼠前庭有效途径的探索

目的探索Math1基因导人大鼠前庭简便有效的方法和途径,为前庭功能障碍基因治疗的相关研究提供参考。方法将20只成年Wistar大鼠分为缺失E1、E3基因片段且构建有Math1基因和增强型绿色荧光蛋白报告基凶的复制缺陷型腺病毒（adnovirus—Math1—enhanced green fluorescence protein,Ad—Math1—EGFP）鼓阶导入组和前庭阶导人组．Ad—Math1—EGFP导入组大鼠在右耳通过耳蜗底转鼓阶或前庭阶打孔的方法导人物理滴度为2．1×1011v．p／ml的上述腺病毒5μl。在导入3天、7天后分别将动物处死,进行GFP表达观察。结果导入Ad—Mathl—EGFP3天后,前庭阶导入组大鼠的前庭终末器官及耳蜗均出现明显的GFP阳性表达;而鼓阶导入组的表达则局限于耳蜗,7天后仍未见前庭终末器官的GFP阳性表达。结论耳蜗底转前庭阶打孔可以作为Math1基因导入大鼠前庭简便有效的途径。     

Scalar localization of the electrode array after cochlear implantation: clinical experience using 64-slice multidetector computed tomography.

OBJECTIVE: To use the improved resolution available with 64-slice multidetector computed tomography (MDCT) in vivo to localize the cochlear implant electrode array within the basal turn. STUDY DESIGN: Sixty-four-slice MDCT examinations of the temporal bones were retrospectively reviewed in 17 patients. Twenty-three implants were evaluated. SETTING: Tertiary referral facility. PATIENTS: All patients with previous cochlear implantation evaluated at our center between January 2004 and March 2006 were offered a computed tomographic examination as part of the study. In addition, preoperative computed tomographic examinations in patients being evaluated for a second bilateral device were included. INTERVENTION: Sixty-four-slice MDCT examination of the temporal bones. MAIN OUTCOME MEASURE: Localization of the electrode array within the basal turn from multiplanar reconstructions of the cochlea. RESULTS: Twenty-three implants were imaged in 17 patients. We were able to localize the electrode array within the scala tympani within the basal turn in 10 implants. In 3 implants, the electrode array was localized to the scala vestibuli. Migration of the electrode array from scala tympani to scala vestibuli was observed in three implants. Of the 7 implants in which localization of the electrode array was indeterminate, all had disease entities that obscured the definition of the normal cochlear anatomy. CONCLUSIONS: Sixty-four-slice MDCT with multiplanar reconstructions of the postoperative cochlea after cochlear implantation allows for accurate localization of the electrode array within the basal turn where normal cochlear anatomy is not obscured by the underlying disease process. Correlating the position of the electrode in the basal turn with surgical technique and implant design could be helpful in improving outcomes.     

Surface microstructure of the perilymphatic space: implications for cochlear implants and cell- or drug-based therapies

OBJECTIVE: To study the surface microstructure of the scala tympani and scala vestibuli in humans and cats using scanning electron microscopy. DESIGN: Cochleas from 8 humans and 4 cats were harvested and the otic capsule and soft tissue removed before the cochleas were prepared for scanning electron microscopy. Micrographs were taken of the bony surface of both the scala tympani and scala vestibuli in each cochlear turn. The diameter and density of the micropores (canaliculi perforantes) and the thickness of the osseous spiral lamina (OSL) adjacent to Rosenthal's canal was measured. RESULTS: The human cochlea exhibits numerous canaliculi on the surface of the scala tympani, particularly associated with the OSL. There was a large range of diameters in the modiolar region of the OSL (0.2-23.0 micro m). The OSL was also very thin, with a mean thickness of 26.8 micro m in the base, tapering to 8.4 micro m in the apical turn. Far fewer canaliculi were evident in the scala vestibuli. Examination of the cat cochleas showed a similar distribution of canaliculi to that seen in the human; however, they were smaller in diameter and the OSL was thicker than in the human cochleas. CONCLUSIONS: The OSL is a thin and highly porous bony lamina that would appear to provide an open and extensive fluid communication channel between the scala tympani and Rosenthal's canal. These findings have important implications for the design and application of perimodiolar cochlear implant electrode arrays and may provide a potential route for drug- and cell-based cochlear therapies delivered via the scala tympani.     

Cochlear implantation trough the middle cranial fossa: a novel approach to access the basal turn of the cochlea

The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation.ObjectiveTo describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa.MethodFifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy.ResultsOnly the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani.ConclusionThe proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.     

Scala vestibuli insertion in cochlear implantation: a valuable alternative for cases with obstructed scala tympani

Insertion of a sufficient number of electrodes is important for a successful use of cochlear implants. We investigated the results of scala vestibuli insertion for cochlear implantation in cases of obstructed scala tympani. In a series of 200 cochlear implantations, scala vestibuli insertion was successfully performed in 4 cases with obstruction of the scala tympani. Etiologies included a temporal bone fracture, severe otosclerosis and malformations of the cochlea. The maximum insertion depth obtained via the scala vestibuli was 30 mm. Postoperative results were comparable to patients in whom conventional scala tympani insertion was performed. No adverse effects related to the site of insertion were observed. Scala vestibuli insertion offers a valuable alternative in cases of obstructed scala tympani that can be employed for a variety of etiologies.     

Cochlear hook anatomy: evaluation of the spatial relationship of the basal cochlear duct to middle ear landmarks

The cochlear hook is an important anatomical area for the otologist performing cochlear implants and other otological procedures, who requires knowledge of the basal cochlea. A total of 15 human temporal bones were dissected and the spatial relationship of the hook segment of the cochlear duct to the stapes, round window, cochleariform process and ductus reuniens were evaluated. Inter-individual variability was noted for widths of scala tympani (average width 1.36 +/- 0.25 mm) and scala vestibuli (average width 1.18 +/- 0.18 mm) in the region of typical cochlear implant placement, with the scala vestibuli occasionally being wider than the scala tympani. The cochlear duct was in closest proximity to the stapes at the midportion of the footplate, with an average distance of 1.23 mm at this narrowest width. A fibrous anchor, not previously described in otology literature, was identified securing the most basal end of the cochlear duct. Knowing the spatial relationship of the cochlear duct to the middle and inner ear structures could prevent damage to the basilar membrane in procedures around or involving the basal cochlear, such as cochlear implantation, stapedotomy, or implantable hearing devices.     

Variance of angular insertion depths in free-fitting and perimodiolar cochlear implant electrodes.

OBJECTIVE: To assess the variance in cochlear implant electrode insertion depth in degrees around the modiolus (angular insertion depth) in free-fitting and perimodiolar electrode arrays. MATERIALS AND METHODS: Twenty-eight fresh human temporal bones were implanted with free-fitting cochlear implant electrodes, and 18 bones were implanted using perimodiolar electrode arrays. Specimens were embedded, and 2-dimensional radiographs were obtained to assess angular insertion depths. Histologic serial sections of undecalcified bones were then evaluated to analyze intracochlear electrode positions. Finally, linear surgical insertion depths (in millimeters) were correlated with angular insertion depth (degrees around the modiolus). RESULTS: A moderate variance of angular insertion depth was documented for both free-fitting and perimodiolar electrode arrays. Full insertions into the scala tympani ranged from 540 to 630 degrees with free-fitting arrays and from 270 to 375 degrees with perimodiolar electrodes. In free-fitting devices, a linear relationship between linear (in millimeters) and angular (degrees) insertion depths was observed. Insertions into scala vestibuli were observed in 9 of 28 and 5 of 18 of the specimens for free-fitting and perimodiolar electrodes, respectively. Additionally, scala vestibuli insertions showed greater angular insertion depths when compared with scala tympani implantations. CONCLUSION: Variances in angular insertion depths seem to be moderate and similar in free-fitting and perimodiolar electrode arrays. Scala vestibuli insertions showed greater angular insertion depths than comparable insertions into the scala tympani. In perimodiolar electrodes, angular insertion depths equal or greater than 390 degrees suggested scala vestibuli placement.     

In vivo observation of dynamic perilymph formation using 4.7 T MRI with gadolinium as a tracer

OBJECTIVE: To investigate the pharmacokinetics of gadolinium in the perilymphatic fluid spaces of the cochlea in vivo using high-resolution MRI to obtain information concerning perilymph formation. MATERIAL AND METHODS: A Bruker Biospec Avance 47/40 experimental MRI system with a magnetic field strength of 4.7 T was used. Anesthetized pigmented guinea pigs were injected with the contrast agent Gd-diethylenetriaminepentaacetic acid-bismethylamide and placed in the magnet. The signal intensity of Gd in the tissues was used as a biomarker for dynamic changes in the perilymphatic fluid. RESULTS: The most rapid uptake of Gd in the perilymphatic fluid spaces occurred in the lower part of the modiolus, followed by the second turn of the scala tympani. Within the scala tympani, the distribution of Gd in the basal turn was significantly lower than that in the other turns. Destruction of the cochlear aqueduct was followed by an increase in Gd uptake in the perilymph instead of a reduction. CONCLUSIONS: These findings offer further evidence that the pervasive perilymphatic fluid derives from the cochlear blood supply via the cochlear glomeruli, which are in close proximity to the scala tympani within the modiolus, and the capillary in the spiral ligament. Cerebrospinal fluid communicates with perilymph via the cochlear aqueduct but is not the main source of perilymph. These findings are of relevance to the treatment of inner ear diseases, as well as to our understanding of the flow and source of perilymphatic fluid.     

Cochlear microphonic responses of the peripheral auditory system to frequency-varying signals

Cochlear partition displacement responses to rising and falling frequency sweeps were inferred from cochlear microphonic potentials recorded from three basal turn locations in the guinea pig cochlea. Relative phase measures of microphonic potentials recorded from the three locations suggested that displacements of the partition toward either scala vestibuli or scala tympani occurred closely together in time for rising sweeps and were dispersed in time for falling sweeps. These differences in peripheral response patterns to sweeps may explain, in part, asymmetric neural discharges elicited from higher neural centers.     

Intracochle?re Elektrodenlage

Introduction

Due to the increasing number of cochlear implantations (CI), postoperative radiological verification of the electrode position, e.g., with respect to quality control, plays a central role. The aim of this study was to evaluate the intracochlear position of deep inserted electrodes by cone beam computed tomography (CBCT).

Materials and methods

CBCT data sets (Accu-I-tomo, Morita, Kyoto, Japan) of 22?patients (28?ears operated between 2008 and 2011) were retrospectively analyzed. All patients underwent a CI (round window approach) with deep insertion of the electrode (Flex soft or standard electrode from MedEl?). CBCT data were analyzed for intracochlear position of the electrode (scala vestibuli, scala tympani, malposition between the scalae) and the certainty of this evaluation.

Results

All ears could be evaluated with the status certain or relatively certain in the basal turn of the cochlea. Thereby, the electrode array was inserted into the scala tympani in 93% (n?=?26). Primary insertion into the scala vestibuli and the scala media was observed in 3.5% of the ears, respectively. In the apical part of the cochlea, only 32% (n?=?9 ears) could be evaluated with relative certainty. The remaining 68% of cases could not be evaluated. Of the 32% interpretable cases in the apical part of the cochlea, 25% (n?=?7) were inserted into the scala tympani, 3.5% (n?=?1) into the scala vestibuli, and 3.5% (n?=?1) were malpositioned between the scalae.

Conclusion

The exact evaluation of the intracochlear position of the electrode by CBCT is only possible in the basal turn of the cochlea. In deep insertion, determination of the position in the medial and apical parts of the cochlea by CBCT is still not possible. Furthermore, the round window approach allows reliable implantation into the scala tympani.     

Computer-aided three-dimensional reconstruction and measurement for multiple-electrode cochlear implant

To assist surgeons in performing multiple-electrode cochlear implant operations, the spatial relations between middle and inner ear structures in six normal temporal bones were studied using the computer-aided 3-D reconstruction method. When viewed through the external auditory canal, the approach used for electrode insertion, and the relation of the malleus to the helicotrema or the scala vestibuli in the second turn of the cochlea were found to vary considerably. In contrast, when viewed from the same transmeatal approach, both the direction and the distance from the stapes footplate to the scala vestibuli of the second turn of the cochlea and helicotrema were found to be quite stable. We concluded that the stapes footplate was a better landmark than the malleus when approaching the helicotrema and scala vestibuli of the second turn of the cochlea during multiple-electrode cochlear implant surgery.     

Cerebrospinal fluid absorption in the rabbit. Inner ear pathways

Fifteen adult rabbits were perfused intrathecally with horseradish peroxidase (HRP) for 20-30 min under conditions that prevented any increase in cerebrospinal fluid (CSF) pressure. Histologic and ultrastructural examination of the cochlea disclosed HRP deposits along the cochlear and vestibular branches of the auditory nerve and beyond their ganglia, in a) epineural and perineural spaces; b) intraneural spaces reaching the membrane of myelinated axons via nodes of Ranvier; and c) extending beyond the epineurium into area lymphatics. HRP was also found in the basilar membrane, along with deposits in the scalae tympani, vestibuli, media and the spiral ligament. The endolymph also received HRP which followed vestibular nerve fibers and penetrated between sustentacular and hair cells of the cristae ampullaris and both maculae. HRP permeated interendothelial spaces lining the modiolus to reach the scala vestibuli lymphatics close to all the above areas were also permeated by HRP, but the inner tunnel was devoid of the marker.     

蜗内直流电对耳蜗基底膜振动的影响

目的：探讨外加直流电流后对耳蜗基底膜振动的影响。方法：在豚鼠耳蜗底回距圆窗龛缘2．4mm处开一直径约0．4mm小孔，作为测量活体基底膜的振动速度测试窗，在测试窗上，下缘的鼓阶，前庭阶各开一小孔，将铂－铱电极置入鼓阶，前庭阶作为跨蜗管的电刺激电极，用激光多普勒干涉测速仪观察直流电流对纯音诱发的基底膜振动速度的影响。结果：当外加电流前庭阶极性为正，鼓阶极性为负时，可以看到基底膜振动速度显著增大，给相反极性电流时，基底膜振动速度减小。结论：生理状态下的正内淋巴电位是耳蜗将声音能量转变为神经冲动的必要条件，适当提高外毛细胞顶端正电位，有助于提高耳蜗放大器的增益，外加负电位则严重影响耳蜗放大器的增益。     

Auditory Prosthesis with a Penetrating Nerve Array

Contemporary auditory prostheses (“cochlear implants”) employ arrays of stimulating electrodes implanted in the scala tympani of the cochlea. Such arrays have been implanted in some 100,000 profoundly or severely deaf people worldwide and arguably are the most successful of present-day neural prostheses. Nevertheless, most implant users show poor understanding of speech in noisy backgrounds, poor pitch recognition, and poor spatial hearing, even when using bilateral implants. Many of these limitations can be attributed to the remote location of stimulating electrodes relative to excitable cochlear neural elements. That is, a scala tympani electrode array lies within a bony compartment filled with electrically conductive fluid. Moreover, scala tympani arrays typically do not extend to the apical turn of the cochlea in which low frequencies are represented. In the present study, we have tested in an animal model an alternative to the conventional cochlear implant: a multielectrode array implanted directly into the auditory nerve. We monitored the specificity of stimulation of the auditory pathway by recording extracellular unit activity at 32 sites along the tonotopic axis of the inferior colliculus. The results demonstrate the activation of specific auditory nerve populations throughout essentially the entire frequency range that is represented by characteristic frequencies in the inferior colliculus. Compared to conventional scala tympani stimulation, thresholds for neural excitation are as much as 50-fold lower and interference between electrodes stimulated simultaneously is markedly reduced. The results suggest that if an intraneural stimulating array were incorporated into an auditory prosthesis system for humans, it could offer substantial improvement in hearing replacement compared to contemporary cochlear implants.     

蜗内直流电对耳蜗基底膜振动的影响

目的探讨外加直流电流后对耳蜗基底膜振动的影响.方法在豚鼠耳蜗底回距圆窗龛缘2.4mm处开一直径约0.4mm小孔,作为测量活体基底膜的振动速度测试窗.在测试窗上、下缘的鼓阶、前庭阶各开一小孔,将铂-铱电极置入鼓阶、前庭阶作为跨蜗管的电刺激电极.用激光多普勒干涉测速仪观察直流电流对纯音诱发的基底膜振动速度的影响.结果当外加电流前庭阶极性为正,鼓阶极性为负时,可以看到基底膜振动速度显著增大,给相反极性电流时,基底膜振动速度减小.结论生理状态下的正内淋巴电位是耳蜗将声音能量转变为神经冲动的必要条件.适当提高外毛细胞顶端正电位,有助于提高耳蜗放大器的增益.外加负电位则严重影响耳蜗放大器的增益.     

Communication between the perilymphatic scalae and spiral ligament visualized by in vivo MRI

We evaluated the transport of Gadolinium-diethylenetriaminepentaacetate-bismethylamide (Gd-DTPA-BMA) through the round window (RW) membrane into the perilymphatic space with 4.7-T MRI in an animal study and 1.5-T MRI in humans. After administration of Gd-DTPA-BMA onto the intact RW membrane of guinea pig, Gd-DTPA-BMA uptake was observed in the basal turn and part of the second turn within 40 min. The scala tympani, scala vestibuli, the fibrous part of the spiral ligament and semicircular canal all showed uptake of Gd-DTPA-BMA. All turns of the cochlea were filled with Gd within 10 min in the perforated RW membrane administration group and within 30 min in the intravenous administration group. In patients who accepted middle ear injection of Gd-DTPA-BMA, uptake was observed within 2 h in the basal turn and semicircular canal. After 12 h the apex did still not show any uptake. Gd-DTPA-BMA is transported from the RW to the semicircular canal, the scala tympani and scala vestibuli without passing the helicotrema.     

Evaluating cochlear implant trauma to the scala vestibuli

Objectives: Placement of cochlear implant electrodes into the scala vestibuli may be intentional, e.g. in case of blocked scala tympani or unintentional as a result of trauma to the basilar membrane or erroneous location of the cochieostomy. The aim of this study was to evaluate the morphological consequences and cochlear trauma after implantation of different cochlear implant electrode arrays in the scala vestibuli. Design: Human temporal bone study with histological and radiological evaluation. Setting: Twelve human cadaver temporal bones were implanted with different cochlear implant electrodes. Implanted bones were processed using a special method to section undecalcified bone. Main outcome measures: Cochlear trauma and intracochlear positions. Results: All implanted electrodes were implanted into the scala vestibuli using a special approach that allows direct scala vestibuli insertions. Fractures of the osseous spiral lamina were evaluated in some bones in the basal cochlear regions. In most electrodes, delicate structures of the organ of Corti were left intact, however, Reissner's membrane was destroyed in all specimens and the electrode lay upon the tectorial membrane. In some bones the organ of Corti was destroyed. Conclusions: Scala vestibuli insertions did not cause severe trauma to osseous or neural structures, thus preserving the basis for electrostimulation of the cochlea. However, destruction of Reissner's membrane and impact on the Organ of Corti can be assumed to destroy residual hearing.     

蜗轴与鼓阶周壁电阻抗的研究

目的:观察鼓阶内壁与蜗轴之间的阻抗是否低于鼓阶外壁与蜗轴之间的阻抗。方法:6例颞骨标本,分别在鼓阶不同位置测量蜗轴和鼓阶内、外侧壁之间的阻抗,刺激频率分别为0.1、1.0、10.0 kHz。结果:鼓阶内侧壁与蜗轴之间的阻抗明显小于相同位置下鼓阶外侧壁与鼓阶外侧壁之间的阻抗(P<0.05)。结论:为了有效刺激蜗轴的残余螺旋神经节神经元,人工耳蜗植入电极应该尽量靠近鼓阶内侧壁。