Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
J Neurol Sci. 2023 Jul 15;450:120672. doi: 10.1016/j.jns.2023.120672. Epub 2023 May 12.
Cochlear implantation surgery (CI) is considered a safe procedure and is the standard treatment for the auditory rehabilitation in patients with severe-to-profound sensorineural hearing loss. Although the development of minimally traumatic surgical concepts (MTSC) have enabled the preservation of residual hearing after the implantation, there is scarce literature regarding the vestibular affection following MTCS. The aim of the study is to analyze histopathologic changes in the vestibule after CI in an animal model (Macaca fascicularis). Cochlear implantation was performed successfully in 14 ears following MTCS. They were classified in two groups upon type of electrode array used. Group A (n = 6) with a FLEX 28 electrode array and Group B (n = 8) with HL14 array. A 6-month follow-up was carried out with periodic objective auditory testing. After their sacrifice, histological processing and subsequent analysis was carried out. Intracochlear findings, vestibular presence of fibrosis, obliteration or collapse is analyzed. Saccule and utricle dimensions and neuroepithelium width is measured. Cochlear implantation was performed successfully in all 14 ears through a round window approach. Mean angle of insertion was >270° for group A and 180-270° for group B. In group A auditory deterioration was observed in Mf 1A, Mf2A and Mf5A with histopathological signs of scala tympani ossification, saccule collapse (Mf1A and Mf2A) and cochlear aqueduct obliteration (Mf5A). Besides, signs of endolymphatic sinus dilatation was seen for Mf2B and Mf5A. Regarding group B, no auditory deterioration was observed. Histopathological signs of endolymphatic sinus dilatation were seen in Mf 2B and Mf 8B. In conclusion, the risk of histological damage of the vestibular organs following minimally traumatic surgical concepts and the soft surgery principles is very low. CI surgery is a safe procedure and it can be done preserving the vestibular structures.
人工耳蜗植入术 (CI) 被认为是一种安全的手术，是重度至极重度感音神经性听力损失患者听觉康复的标准治疗方法。尽管微创外科概念 (MTSC) 的发展使得植入后残余听力得以保留，但关于 MTSC 后前庭影响的文献却很少。本研究旨在分析动物模型 (食蟹猴) 中 CI 后前庭的组织病理学变化。14 只耳朵通过 MTSC 成功进行了人工耳蜗植入。根据使用的电极阵列类型将其分为两组。A 组（n=6）使用 FLEX 28 电极阵列，B 组（n=8）使用 HL14 阵列。通过定期客观听觉测试进行了 6 个月的随访。在牺牲后，进行了组织学处理和随后的分析。分析了内耳蜗的发现、前庭纤维化、闭塞或塌陷的存在。测量了椭圆囊和球囊的尺寸和神经上皮的宽度。通过圆窗入路成功地在所有 14 只耳朵中进行了人工耳蜗植入。A 组的平均插入角度>270°，B 组为 180-270°。在 A 组中，观察到 Mf1A、Mf2A 和 Mf5A 的听觉恶化，并有耳蜗鼓阶骨化、椭圆囊塌陷（Mf1A 和 Mf2A）和耳蜗导水管闭塞（Mf5A）的组织病理学迹象。此外，还观察到 Mf2B 和 Mf5A 的内淋巴窦扩张迹象。对于 B 组，没有观察到听觉恶化。在 Mf 2B 和 Mf 8B 中观察到内淋巴窦扩张的组织病理学迹象。总之，微创外科概念和软手术原则下前庭器官发生组织学损伤的风险非常低。CI 手术是一种安全的手术，可以在保留前庭结构的情况下进行。
