Round window insertion of precurved perimodiolar electrode arrays: how successful is it?

HYPOTHESIS: The goal of this human temporal bone study was to assess the safety and efficacy of round window insertion of the Cochlear Contour Advance electrode and identify any anatomic obstacles that may affect its insertion. BACKGROUND: Minimizing intracochlear trauma during electrode insertion reduces the risk of losing residual hearing. The Contour Advance electrode is designed for insertion via an anteroinferior cochleostomy, in which drilling causes a degree of inner ear trauma. If consistently successful round window insertions are possible with this electrode, it would allow for better perimodiolar positioning in the basal turn and greater likelihood of hearing preservation. METHODS: A total of 16 human temporal bone round window insertions with the Contour Advance electrode were performed at the University of Melbourne and Southwestern Medical Center, Dallas. Surgeons' observations, fluoroscopy, histology and anatomic dissections were analyzed. RESULTS: Successful full insertions of the electrode with minimal resistance and good perimodiolar placement were achieved in less that 50% of cases in the Melbourne series and in two-thirds of cases in the Dallas series. A common finding by both centers was obstruction of electrode entry at the anteroinferior margin of the round window, which prevented optimal scala tympani positioning and often resulted in intracochlear trauma. CONCLUSION: The anteroinferior region of the round window bony margin influences the trajectory of insertion of the relatively large Contour Advance electrode as well as physically obstructing and distorting the array. A pure round window insertion is not predictable and reliable enough to be a recommended approach for this electrode.

Giant cell reparative granuloma of the temporal bone treated with calcitonin.

OBJECTIVE: A case report of a giant cell reparative granuloma involving the temporal bone successfully treated with calcitonin. STUDY DESIGN: Case report. SETTING: Teaching hospital, tertiary referral center. PATIENT, INTERVENTION, AND RESULTS: A 62-year-old man was referred to the otolaryngology department with an extensive temporal bone lesion confirmed by biopsy to be a giant cell reparative granuloma. As an alternative to surgery, calcitonin therapy was commenced. After 12 months of treatment, clinical and audiological parameters had returned to normal, and radiological appearances had shown significant bony remodeling. These parameters remain stable 24 months after cessation of treatment. CONCLUSION: Calcitonin is a safe and economical medical treatment, which should be considered for destructive giant cell granulomas of the temporal bone.

Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure.

Nasal continuous positive airway pressure (CPAP) is the mainstay of treatment for patients with moderate to severe obstructive sleep apnoea (OSA). However, tolerance and compliance are poor. An audit using the Christchurch Hospital ORL surgery database identified patients who underwent upper airway surgery for OSA. Tracheostomy and bimaxillary advancement patients were excluded. Adults with moderate to severe OSA (Desaturation Index (DI) >10 n.h(-1)), who had failed a trial of nasal CPAP, and had pre-operative and post-operative sleep study data were identified. Objective (DI) and Subjective (Epworth Sleepiness Score (ESS)) outcome measures were recorded. The database identified 69 patients who underwent surgery for snoring or OSA; of these, 25 patients formed the study group. Sixteen out of 25 improved (64 per cent) after surgery, seven out of 25 showed no change (28 per cent), two patients (eight per cent) showed deterioration in their DI. Forty-eight per cent of patients had >50 per cent post-operative improvement in DI. Fourteen out of 25 (56 per cent) had a post-operative DI <20 n.h(-1). Seven out of 25 (28 per cent) had a post-operative DI <10 n.h(-1). Upper airway surgery has a role in the management of selected patients with OSA who cannot tolerate nasal CPAP.