Scalar Translocation Comparison Between Lateral Wall and Perimodiolar Cochlear Implant Arrays - A Meta-Analysis.

OBJECTIVES/HYPOTHESIS: Two types of electrode arrays for cochlear implants (CIs) are distinguished: lateral wall and perimodiolar. Scalar translocation of the array can lead to intracochlear trauma by penetrating from the scala tympani into the scala vestibuli or scala media, potentially negatively affecting hearing performance of CI users. This systematic review compares the lateral wall and perimodiolar arrays with respect to scalar translocation. STUDY DESIGN: Systematic review. METHODS: PubMed, Embase, and Cochrane databases were reviewed for studies published within the last 11 years. No other limitations were set. All studies with original data that evaluated the occurrence of scalar translocation or tip fold-over (TF) with postoperative computed tomography (CT) following primary cochlear implantation in bilateral sensorineuronal hearing loss patients were considered to be eligible. Data were extracted independently by two reviewers. RESULTS: We included 33 studies, of which none were randomized controlled trials. Meta-analysis of five cohort studies comparing scalar translocation between lateral wall and perimodiolar arrays showed that lateral wall arrays have significantly lower translocation rates (7% vs. 43%; pooled odds ratio = 0.12). Translocation was negatively associated with speech perception scores (weighted mean 41% vs. 55%). Tip fold-over of the array was more frequent with perimodiolar arrays (X2  = 6.8, P < .01). CONCLUSIONS: Scalar translocation and tip fold-overs occurred more frequently with perimodiolar arrays than with lateral wall arrays. In addition, translocation of the array negatively affects hearing with the cochlear implant. Therefore, if one aims to minimize clinically relevant intracochlear trauma, lateral wall arrays would be the preferred option for cochlear implantation. Laryngoscope, 131:1358-1368, 2021.

Intracochlear pressure measurements during acoustic shock wave exposure.

INTRODUCTION: Injuries to the peripheral auditory system are among the most common results of high intensity impulsive acoustic exposure. Prior studies of high intensity sound transmission by the ossicular chain have relied upon measurements in animal models, measurements at more moderate sound levels (i.e. < 130 dB SPL), and/or measured responses to steady-state noise. Here, we directly measure intracochlear pressure in human cadaveric temporal bones, with fiber optic pressure sensors placed in scala vestibuli (SV) and tympani (ST), during exposure to shock waves with peak positive pressures between ∼7 and 83 kPa. METHODS: Eight full-cephalic human cadaver heads were exposed, face-on, to acoustic shock waves in a 45 cm diameter shock tube. Specimens were exposed to impulses with nominal peak overpressures of 7, 28, 55, & 83 kPa (171, 183, 189, & 192 dB pSPL), measured in the free field adjacent to the forehead. Specimens were prepared bilaterally by mastoidectomy and extended facial recess to expose the ossicular chain. Ear canal (EAC), middle ear, and intracochlear sound pressure levels were measured with fiber-optic pressure sensors. Surface-mounted sensors measured SPL and skull strain near the opening of each EAC and at the forehead. RESULTS: Measurements on the forehead showed incident peak pressures approximately twice that measured by adjacent free-field and EAC entrance sensors, as expected based on the sensor orientation (normal vs tangential to the shock wave propagation). At 7 kPa, EAC pressure showed gain, calculated from the frequency spectra, consistent with the ear canal resonance, and gain in the intracochlear pressures (normalized to the EAC pressure) were consistent with (though somewhat lower than) previously reported middle ear transfer functions. Responses to higher intensity impulses tended to show lower intracochlear gain relative to EAC, suggesting sound transmission efficiency along the ossicular chain is reduced at high intensities. Tympanic membrane (TM) rupture was observed following nearly every exposure 55 kPa or higher. CONCLUSIONS: Intracochlear pressures reveal lower middle-ear transfer function magnitudes (i.e. reduced gain relative to the ear canal) for high sound pressure levels, thus revealing lower than expected cochlear exposure based on extrapolation from cochlear pressures measured at more moderate sound levels. These results are consistent with lowered transmissivity of the ossicular chain at high intensities, and are consistent with our prior report measuring middle ear transfer functions in human cadaveric temporal bones with high intensity tone pips.

Electrophysiological Detection of Scalar-Changing Perimodiolar Cochlear Electrode Arrays: A Six-Month Follow-Up Study.

The position of the cochlear electrode array within the scala tympani is essential for optimal hearing benefit. An intraoperative neural response telemetry ratio (NRT ratio; a threshold ratio of pairs of apical and basal electrodes) has been established, which can provide information about the intracochlear electrode array position. Out of a previous collective of 85 patients, the 6-month follow-up electrophysiological NRT data of 37 patients have been included in this study. Comparing the intraoperatively estimated NRT ratio with the 6-month follow-up NRT ratio, it remained unchanged intraindividually in 92% of cases. Within this group the NRT ratio and the intracochlear position of the electrode array matched in all cases. There were two newly occurring mismatches and one new match was observed. After a period of 6 months the NRT ratio remained unchanged in most cases and showed a good correlation with the intracochlear position of the electrode array.

Scalar position in cochlear implant surgery and outcome in residual hearing and the vestibular system.

OBJECTIVE: To evaluate the effect of the intracochlear electrode position on the residual hearing and VNG- and cVEMP responses. DESIGN: Prospective pilot study. STUDY SAMPLE: Thirteen adult patients who underwent unilateral cochlear implant surgery were examined with high-resolution rotational tomography after cochlear implantation. All subjects were also tested with VNG, and 12 of the subjects were tested with cVEMP and audiometry before and after surgery. RESULTS: We found that although the electrode was originally planned to be positioned inside the scala tympani, only 8 of 13 had full insertion into the scala tympani. Loss of cVEMP response occurred to the same extent in the group with full scala tympani positioning and the group with scala vestibuli involvement. There was a non-significant difference in the loss of caloric response and residual hearing between the two groups. Interscalar dislocation of the electrode inside the cochlea was observed in two patients. A higher loss of residual hearing could be seen in the group with electrode dislocation between the scalae. CONCLUSIONS: Our findings indicate that intracochlear electrode dislocation is a possible cause to loss of residual hearing during cochlear implantation but cannot be the sole cause of postoperative vestibular loss.

On the necessity of full length electrical cochlear stimulation to suppress severe tinnitus in single-sided deafness.

BACKGROUND: Cochlear implantation (CI) has proven in long term prospective trials to reduce significantly incapacitating tinnitus in single sided deafness (SSD). Discussion arises whether electrical stimulation near the round window (RW) is also able to reduce tinnitus. AIM: to assess whether electrical stimulation of the basal first 4 intracochlear electrodes of a CI could sufficiently reduce tinnitus and to compare these results with stimulation with all CI electrodes. MATERIAL AND METHODS: 7 patients who met the criteria of severe tinnitus due to SSD were implanted with a Med-El Sonata Ti100 with a FlexSoftTM or Flex24TM electrode. After 4 weeks only the basal electrode pair (E12) nearest to the RW was activated. Each week the following pair was activated until the 4th pair.Thereafter all electrodes were activated. Tinnitus was assessed before CI surgery and before each electrode pair was activated. When all electrodes were fitted, evaluation was done after 1, 3 and 6 months.Tinnitus was assessed with Visual Analogue Scale (VAS) for loudness, psychoacoustic tinnitus loudness comparison at 1 kHz and Tinnitus Questionnaire (TQ) for the effect on quality of life. To evaluate the natural evolution, a tightly matched control group with severe tinnitus due to SSD was followed prospectively. RESULTS: All the tinnitus outcome measures remained unchanged with 1, 2, 3 or 4 activated electrode pairs. With complete CI activation, the tinnitus decreased significantly comparable with earlier reports.Pre-implantation the tinnitus loudness was 8.2/10 on the VAS and was reduced to 4.1/10 6 months postimplantation.Psychometrically the loudness level went from 21.7 dB SL (SD: 16.02) to 7.5 dB SL (SD: 5.24)and the TQ from 60/84 to 39/84. The non-implanted group had no decrease of the tinnitus, the average VAS remained stable at 8.9/10 throughout the follow-up period of 6 months. CONCLUSION: with the current stimulation parameters electrical stimulation in the first 8e10 mm of the basal part of the scala tympani is insufficient to reduce tinnitus. However, stimulation over the complete CI length yields immediate tinnitus reduction confirming earlier results.

Delayed electrical stimulation and BDNF application following induced deafness in rats.

CONCLUSION: Under the condition of delayed intervention (30 days after deafening) following gentamicin+furosemide deafening in rats, we conclude that chronic intracochlear electrical stimulation (ES) and continuous intracochlear administration of brain-derived neurotrophic factor (BDNF) enhance spiral ganglion cell (SGC) body and peripheral process survival and improve auditory sensitivity. Moreover, the combination of ES and BDNF has a synergistic protective effect rather than an additive effect. Both SGC body and peripheral process influence the auditory sensitivity, and the latter appears to be more important. OBJECTIVE: To determine the influence of delayed application of combined ES and neurotrophins on the survival of SGC body and peripheral processes after induced deafness in the rat. This study also explored the relationship between auditory sensitivity and SGC/peripheral process density. MATERIALS AND METHODS: The left cochlea of profoundly deafened rats was implanted with an electrode and drug-delivery system 30 days after deafening. BDNF or artificial perilymph (AP) was delivered continuously for 28 days. Experimental animals received ES with or without BDNF (BDNF+ES and ES+AP), and control animals received BDNF or AP without ES (BDNF and AP). The right cochleae of the animals served as deafened untreated controls. Electrically evoked auditory brainstem responses (EABRs) were recorded immediately after surgery and every 7 days. RESULTS: In the AP group, EABR thresholds demonstrated a systematic and rapid increase throughout the treatment period after the deafening procedure and electrode implantation. However, in the other three treatment groups, EABR thresholds showed a slow increase at the beginning and then slow decrease. The thresholds of the BDNF and ES+AP groups were significantly less than those of the AP group from day 7 to 28 and those of the BDNF+ES group were significantly less than those of other three groups from day 21 to 28, indicating that BDNF infusion and chronic ES have a synergistic effect rather than an additive effect. In terms of SGC and peripheral process density, the difference between the treated and control ears of BDNF, ES+AP, and BDNF+ES groups was clearly significant. Analysis of the SGC/peripheral process density of the left cochlea across the treatment groups demonstrated that SGC/peripheral process density of the BDNF and ES+AP groups was significantly greater than that of the AP group and the density of the BDNF+ES group was significantly greater than that of the other three groups, indicating that BDNF infusion and chronic ES have a synergistic effect rather than an additive effect. Finally, a functional formula was developed relating the last EABR threshold and SGC density and process density.

3D finite element analyses of insertion of the Nucleus standard straight and the Contour electrode arrays into the human cochlea.

Previous experimental studies of insertion of the Nucleus standard straight and the Contour arrays into the scala tympani have reported that the electrode arrays cause damage to various cochlear structures. However, the level of insertion-induced damage by these electrode arrays to cochlear structures (the spiral ligament, the basilar membrane and the osseous spiral lamina) has not been quantified. Although it has been suggested that rotation can overcome this resistance and prevent the basilar membrane from being pierced by the tip of the Nucleus standard straight array, there has not been any attempt to study the relationship between the rotation and the reduction of damage to the basilar membrane. In this study, 3D finite element analyses of insertions of the Nucleus standard straight array and the Contour array into the scala tympani have been undertaken. The perforation of the basilar membrane by the tip of the Nucleus standard straight array at the region of 11-14 mm from the round window appears to be compounded by the geometry of the spiral passage of the scala tympani. Anti-clockwise rotations between 25 degrees and 90 degrees applied at the basal end of the electrode array (for the right cochlea) were shown to significantly reduce the contact stresses exerted by the tip on the basilar membrane which support the practice of applying small rotation partway through insertion of electrode array to minimize damage to the basilar membrane. Although the Contour array (with its stylet intact) is stiffer than the Nucleus standard straight array, a slight withdrawal of the stylet from the Contour array before insertion was found to significantly reduce damage by the electrode array to the spiral ligament and the basilar membrane.

Ventral approach to rat inner ear preserves cochlear function.

CONCLUSION: This technique enabled us to visualize the cochlea without causing damage. OBJECTIVE: The mammalian inner ear is difficult to approach surgically. This is particularly true in the cases of the rat and mouse, which both have small cochleae. Rat and mouse research is particularly important because their genomes are well characterized, and significantly similar to that of the human. The aim of the present study was to develop a method of accessing the rat cochlea without affecting its function. MATERIALS AND METHODS: In the ventral approach, a small hole was made for access to the scala tympani. Cochlear function was assessed through auditory brainstem response (ABR) threshold measurements. RESULTS: The ventral approach enabled the direct visualization of the tympanic bulla. Thus, the tympanic bulla could be easily opened in a manner that was benign to cochlear function. There was no significant difference in ABR threshold before and after surgery.

Multifrequency immittancemetry in experimentally induced stapes, round window and cochlear lesions.

OBJECTIVES: To establish that admittance (Y) and susceptance (B) conductance (G) tympanograms at 2 kHz can reflect the status of the annular ligament and the cochlear pressure. METHODS: Seven experiments were set up in 22 guinea pigs: ventilation of the bulla, blockage of the stapes and round window membrane (RWM), fistula, fluid removal from the cochlea, injection of saline in the scala tympani and acoustic trauma. Resonance frequency, Y, B and G at 2 kHz and curve shapes were analyzed before and after lesions. RESULTS: A supplementary peak was observed in Y/G tympanograms in all RWM fistulas and in some cases of acoustic trauma; injection of saline into the scala tympani induced constant, immediate and reproducible changes; RWM and stapes blockages induced foreseeable peaking at 2 kHz; fluid removal from the cochlea induced multiple peak curves. CONCLUSION: Experimentally induced modifications at the AL result in noticeable, constant and reproducible changes in tympanogram curves at 2 kHz and seem to reflect inner ear pressure.

Predicting the effect of post-implant cochlear fibrosis on residual hearing.

Intracochlear scarring is a well-described sequela of cochlear implantation. We developed a mathematical model of passive cochlear mechanics to predict the impact that this might have upon residual acoustical hearing after implantation. The cochlea was modeled using lumped impedance terms for scala vestibuli (SV), scala tympani (ST), and the cochlear partition (CP). The damping of ST and CP was increased in the basal one half of the cochlea to simulate the effect of scar tissue. We found that increasing the damping of the ST predominantly reduced basilar membrane vibrations in the apex of the cochlea while increasing the damping of the CP predominantly reduced basilar membrane vibrations in the base of the cochlea. As long as intracochlear scarring continues to occur with cochlear implantation, there will be limitations on hearing preservation. Newer surgical techniques and electrode technologies that do not result in as much scar tissue formation will permit improved hearing preservation.

[Aural fullness and endolymphatic hydrops]. / Druckgefühl im Ohr bei endolymphatischem Hydrops.

BACKGROUND: Low-frequency modulated DPOAEs were registrated to investigate whether the subjective symptom of aural fullness can indicate an endolymphatic hydrops. METHOD: The cochlear partition is periodically moved towards scala vestibuli and scala tympani by a low-frequency suppressor tone. The level of simultaneously registrated DPOAEs is modulated depending on the phase of the suppressor. This modulation may be reduced when the displacement of the organ of Corti is inhibited by mechanical stiffening of the basilar membrane (e. g. in endolymphatic hydrops). SUBJECTS: Low-frequency modulated DPOAEs were registrated in 15 patients with Menière's disease, in 8 patients with aural fullness and tinnitus, but without vertigo, and in 21 normal hearing adults. RESULTS: In both patient groups the modulation depth is high significantly lower than in the control group. The results do not differ significantly in the patients with and without vertigo. CONCLUSION: The reduction of the modulation depth can be interpreted as a sign of an endolymphatic hydrops. In the group of patients with aural fullness a cochlear hydrops can be assumed. The measurement of low-frequency modulated DPOAEs is a new tool to diagnose and monitor the course of endolymphatic hydrops and to evaluate the effectiveness of therapeutic methods.

Effects of electrode configuration and place of stimulation on speech perception with cochlear prostheses.

Recent research and clinical experience with cochlear implants suggest that subjects' speech recognition with monopolar or broad bipolar stimulation might be equal to or better than that obtained with narrow bipolar stimulation or other spatially restricted electrode configurations. Furthermore, subjects often prefer the monopolar configurations. The mechanisms underlying these effects are not clear. Two hypotheses are (a) that broader configurations excite more neurons resulting in a more detailed and robust neural representation of the signal and (b) that broader configurations achieve a better spatial distribution of the excited neurons. In this study we compared the effects of electrode configuration and the effects of longitudinal placement and spacing of the active electrodes on speech recognition in human subjects. We used experimental processor maps consisting of 11 active electrodes in a 22-electrode scala tympani array. Narrow bipolar (BP), wide bipolar (BP + 6), and monopolar (MP2) configurations were tested with various locations of active electrodes. We tested basal, centered, and apical locations (with adjacent active electrodes) and spatially distributed locations (with every other electrode active) with electrode configuration held constant. Ten postlingually deafened adult human subjects with Nucleus prostheses were tested using the SPEAK processing strategy. The effects of electrode configuration and longitudinal place of stimulation on recognition of CNC phonemes and words in quiet and CUNY sentences in noise (+10 dB S/N) were similar. Both independent variables had large effects on speech recognition and there were interactions between these variables. These results suggest that the effects of electrode configuration on speech recognition might be due, in part, to differences among the various configurations in the spatial location of stimulation. Correlations of subjective judgments of sound quality with speech-recognition ability were moderate, suggesting that the mechanisms contributing to subjective quality and speech-recognition ability do not completely overlap.

Cochlear implant place psychophysics 1. Pitch estimation with deeply inserted electrodes.

Numerical estimation of pitch was performed by 8 adult subjects implanted with cochlear prostheses manufactured by Cochlear Limited. The electrode arrays had been inserted into the scale tympani to between one and one and a half turns of the cochlea. Using bipolar stimulation, the pitch estimates for each subjects showed an overall reduction with insertion depth of the stimulated electrode. However, for several subjects, after decreasing regularly for the more basal electrodes, pitch estimates showed an abrupt decrease, followed in some cases by a region of low pitch. Two of the subjects, implanted with a modified electrode array, the '20 + 2' which allowed monopolar in addition to bipolar stimulation, exhibited an abrupt decrease in pitch estimate with bipolar but not with monopolar stimulation. In these two subjects, for stimulating electrodes inserted more deeply than about three quarters of a turn, bipolar stimuli produced lower pitch sensations, and presumably more apical neural excitation patterns, than monopolar stimuli.

Cochlear implant place psychophysics. 2. Comparison of forward masking and pitch estimation data.

Results for forward masking and numerical estimation of pitch were compared in a group of 6 adult subjects implanted with cochlear prostheses manufactured by Cochlear Limited. Data were collected for bipolar + 1 stimulation in all subjects, and for stimulation in one other mode, either common ground or monopolar, for all subjects but one. The pitch data show various irregularities and in each case can be seen to be broadly consistent with the corresponding forward masking data. It is shown that a 'centre of gravity' of the forward masking distribution varies with masker electrode in a manner that is qualitatively very similar to the variation of pitch estimate. It is suggested that, while pitch estimation results are consistent with those from forward masking, the latter contain more detailed information that may be useful in understanding intersubject variations in speech comprehension.

Strial dysfunction in a melanocyte deficient mutant rat (Ws/Ws rat).

A homozygous mutant rat at the white spotting (Ws) locus showing a deficiency of melanocytes has recently been found (4, 5). The function and morphology of the inner ear of the Ws/Ws rat were examined by auditory brainstem response (ABR), endocochlear DC potential (EP), and electron microscopy. The mean ABR threshold of the Ws/Ws rat was significantly higher than that of the control +/+ rat. Most Ws/Ws rats showed no or very little EP. In electron microscopy, the stria vascularis of the Ws/Ws rat proved to be very thin and flat with poor interdigitation of marginal cells, and absence of intermediate cells. The organ of Corti appeared to be intact in both the +/+ rat and the Ws/Ws rat. These electrophysiological and morphological findings suggest that the Ws/Ws rat suffered from severe hearing loss caused by strial dysfunction.

Electrocochleography in experimental endolymphatic hydrops.

This study investigated whether dominant negative summating potential (DNSP) is absent at all stages of induced hydrops development, including the early stages of hydrops formations. Electrocochleography (ECoG) was done 3 days to 20 weeks after obliteration of the endolymphatic sac in guinea pigs, by electrodes attached to the cochlear bony wall on the scala vestibuli of the basal turn. DNSP was noticed only during the early stages of endolymphatic hydrops formation, before hydrops was fully developed. There was no DNSP when the distension of Reissner's membrane was marked. Increased endolymphatic pressure and/or changes in biochemical composition were thought to be the causes of DNSP.

Inner ear injury caused by air intrusion to the scala vestibuli of the cochlea.

In a previous communication, we demonstrated that the introduction of air into the scala tympani of the cochlea causes a decrease of cochlear potentials; however, the change in endocochlear dc potential (EP) was mild and the decreased cochlear microphonics (CM) and compound action potentials (CAP) were, at least partially, reversible. In contrast, we have now found that air perfusion (3-60 microliters/min) in the scala vestibuli decreased cochlear potentials more drastically than that in the scala tympani. The change in the EP after air perfusion in the scala vestibuli was characterized by a decrease of the negative EP in response to anoxia. The CM drastically decreased upon the initiation of air perfusion and no recovery was observed after refilling of the perilymph. Histological examination showed collapse of Reissner's membrane in 12 out of 17 cochleas examined. The extent and frequency of the collapse increased with an increase in the amount of air perfused in the scala vestibuli. As the minimal amount of air needed to cause inner ear damage by air perfusion in the scala vestibuli is as small as 3 microliters, it is possible that the prognosis is worse in cases with fistula of the oval window compared to that of the round window area, if the pneumolabyrinth is involved in the pathophysiology of perilymphatic fistula. It is also indicated that air inflation of the middle ear is dangerous in cases with fistula in the oval window.

Differential physiologic effects of perfusion of scala tympani versus scala vestibuli in the ischemic cochlea.

The effectiveness of perilymphatic perfusion with oxygenated artificial media upon the endocochlear potential (EP) was measured during systemic ischemia in the guinea pig. Differences in the effects of perfusion of the two perilymphatic scalae were determined. Perfusion of scala vestibuli with oxygenated artificial perilymph at a high flow rate resulted in complete recovery of the EP to the pre-ischemic level, whereas perfusion of scala tympani with the same medium was unable to effect complete recovery. The recovery obtained by perfusion of scala tympani was about half that obtained of scala vestibuli. The pO2 in scala media was measured during perfusion by means of oxygen-sensitive microelectrodes. perfusion of scala vestibuli led to an approximately two-fold higher pO2 in scala media than perfusion of scala tympani. During perfusion, the pO2 in scala media varied dependent upon depth of electrode insertion, with a gradient decreasing toward the stria vascularis, a direction opposite to that seen under normal metabolic conditions. These findings suggest that, in the ischemic cochlea, oxygen enters scala media more easily from scala vestibuli across Reissner's membrane than from scala tympani via the basilar membrane/organ of Corti complex.

Effects of bacterial endotoxin applied to the guinea pig cochlea.

The ototoxic potential of bacterial endotoxin present in middle ear effusions was evaluated by inoculating endotoxin solutions of 10 micrograms/mL or 1000 micrograms/mL directly into the scala tympani of the guinea pig cochlea. Median auditory brainstem response threshold shifts of 12.5 and 20 dB were observed in the experimental ears exposed to the higher dose at days 2 and 4, respectively, with gradual improvement to near baseline by day 28. Histologic examination revealed inflammatory infiltrates in the scala tympani and scala vestibuli of several of these cochleas. The lower concentration, closer to that found in human effusions, elicited no significant loss of hearing and a milder inflammatory response. It is concluded that brief exposure of the cochlea to endotoxin from middle ear effusions is insufficient to cause hearing loss. Under chronic conditions, however, persistent inflammation within the cochlea may result in a sensorineural deficit.

Time-related alteration of endolymph composition in an experimental model of endolymphatic hydrops.

The electrochemical changes of the inner ear fluids were studied in the guinea pig during the development of endolymphatic hydrops in an experimental model of Meniere's disease obtained by the blockage of the vestibular aqueduct. The endocochlear potential (first and third turns) was recorded, and the sodium, potassium, and chloride concentrations, and osmolality of the endolymph (first and third turns) and perilymph were determined at different intervals from 2 to 24 weeks after the induction of the hydrops. The development of hydrops was monitored by the compound action potential once a week during the observation period. In normal, nonoperated guinea pigs, longitudinal endolymphatic gradients of endocochlear potential, potassium and chloride concentrations, and osmolality, increasing from the apex to the base of the cochlea, were observed. After 2 weeks of hydrops, no alteration of this pattern was detected. After 6 and 9 weeks of hydrops, a progressive decrease of endocochlear potential, potassium and chloride concentrations, and osmolality was noticed at the first turn (6 and 9 weeks) and then at the third turn (9 weeks) which resulted in the disappearance of longitudinal gradients. At 24 weeks, the endocochlear potential was still diminished by 60%, whereas potassium and chloride concentrations and osmolality increased as compared to 9-week values but remained lower than in controls. The changes in composition of endolymph induced by the development of the hydrops could be related to the progressive alteration of the ionic permeability of the cochlear epithelium, which should be localized at the distended Reissner's membrane.