Alyono Jennifer C, Corrales C Eduardo, Huth Markus E, Blevins Nikolas H, Ricci Anthony J
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine Stanford, California, USA.
Department of Otology and Laryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2015 Jun;152(6):1113-8. doi: 10.1177/0194599815573703. Epub 2015 Mar 16.
Creation of an atraumatic, hearing-preservation cochleostomy is integral to the future of minimally invasive inner ear surgery. The goal of this study was to develop and characterize a novel chemical approach to cochleostomy.
Prospective animal study.
Laboratory.
Experimental animal study in which phosphoric acid gel (PAG) was used to decalcify the otic capsule in 25 Hartley guinea pigs. Five animals in each of 5 surgical groups were studied: (1) mechanically opening the auditory bulla alone, (2) PAG thinning of the basal turn otic capsule, leaving endosteum covered by a layer of bone, (3) micro-pick manual cochleostomy, (4) PAG chemical cochleostomy, exposing the endosteum, and (5) combined PAG/micro-pick cochleostomy, with initial chemical thinning and subsequent manual removal of the last osseous layer. Preoperative and postoperative auditory brainstem responses and otoacoustic emissions were obtained at 2, 6, 10, and 16 kHz. Hematoxylin and eosin-stained paraffin sections were compared.
Surgical and histologic findings confirmed that application of PAG provided reproducible local bone removal, and cochlear access was enabled. Statistically significant auditory threshold shifts were observed at 10 kHz (P = .048) and 16 kHz (P = .0013) following cochleostomy using PAG alone (group 4) and at 16 kHz using manual cochleostomy (group 3) (P = .028). No statistically significant, postoperative auditory threshold shifts were observed in the other groups, including PAG thinning with manual completion cochleostomy (group 5).
Hearing preservation cochleostomy can be performed in an animal model using a novel technique of thinning cochlear bone with PAG and manually completing cochleostomy.
创建一种无创、保留听力的耳蜗造口术是微创内耳手术未来发展的关键。本研究的目的是开发并描述一种新型的耳蜗造口化学方法。
前瞻性动物研究。
实验室。
在25只哈特利豚鼠中进行实验动物研究，使用磷酸凝胶（PAG）对听囊进行脱钙。将动物分为5个手术组，每组5只：（1）仅机械打开听泡；（2）用PAG使蜗底转听囊变薄，保留骨内膜覆盖一层骨；（3）用微型器械手动进行耳蜗造口；（4）用PAG进行化学耳蜗造口，暴露骨内膜；（5）联合PAG/微型器械耳蜗造口，先用化学方法变薄，随后手动去除最后一层骨质。在2、6、10和16kHz频率下记录术前和术后的听性脑干反应及耳声发射。比较苏木精-伊红染色的石蜡切片。
手术和组织学结果证实，PAG的应用可实现可重复的局部骨质去除，并能进入耳蜗。单独使用PAG进行耳蜗造口（第4组）后，在10kHz（P = 0.048）和16kHz（P = 0.0013）时观察到有统计学意义的听阈变化；手动进行耳蜗造口（第3组）后，在16kHz时观察到有统计学意义的听阈变化（P = 0.028）。其他组，包括PAG变薄后手动完成耳蜗造口（第5组），术后未观察到有统计学意义的听阈变化。
在动物模型中，可使用一种先用PAG使耳蜗骨质变薄、随后手动完成耳蜗造口的新技术来进行保留听力的耳蜗造口术。
