[A novel cryo-grinding technique for evaluating new cochlear implant electrodes after ex vivo insertions in temporal bone specimens]. / Entwicklung einer Kryo-Schlifftechnik für Felsenbeinpräparate: eine neue Möglichkeit zur Beurteilung ex vivo implantierter CI-Test-Elektroden.

BACKGROUND: Prior to clinical application, newly developed prototypes of cochlear implant electrode arrays must prove their suitability with the smallest possible tissue damage in ex vivo temporal bones. So far, after insertion of the electrodes the temporal bone specimens have to be processed in a rather intricate technique, including embedding, sectioning or grinding prior to histological evaluation. The question remains whether for special indications this time-consuming method, which even causes artifacts, can be replaced by a new technique based on cryo-grinding. MATERIALS AND METHODS: The main principle of the method described is to grind the temporal bone with the inserted electrode in a frozen state, provided by a fixation device filled with dry ice. After creating a plane surface and staining it (still in a frozen state), the specimen can be examined and photographed with a projection microscope. This procedure is continued by subsequently grinding and examining new surfaces in defined distances. RESULTS: In numerous trial runs the method proved feasible, saving much time and manpower. After grinding, each plane could be examined sufficiently; the site of the electrodes and the corresponding tissue damage could be documented properly. DISCUSSION: The new concept of cryo-grinding provides relatively easy and fast examinations of temporal bones after inserting test electrodes. The examiner is enabled to correlate his "sensations" during the insertion (e.g., smoothness, resistances) almost directly with the morphologic findings, without having to wait a long time while the temporal bone specimens are being processed conventionally. Furthermore, this method avoids artifacts due to soft tissue shrinking during drying. In further steps of development, the grinding device will be optimized for standard use.

Temporal bone investigations on landmarks for conventional or endosteal insertion of cochlear electrodes.

CONCLUSION: Our anatomical findings place special emphasis on the requirement to follow an infero-anterior approach to the round window, to expose the scala tympani safely for 'normal' cochlear implantation. It is also known how easily the basilar membrane may be accidentally damaged, despite exercising considerable caution in the approach used. With regard to an 'endosteal electrode' it can be stated that there are no really specific indicators to locate the spiral ligament, or each of the scalae, on the lateral aspect of the tissue layer encasing the cochlea. For the concept of an endosteal electrode, however, the soft tissue layer of the lateral aspect of the cochlea is considered to be sufficiently thick to serve as a physical barrier between the electrode and the inner ear fluid. OBJECTIVES: To re-evaluate surgical techniques of gaining access to the scala tympani for cochlear implantation (cochleostomy, 'fenestration'). There are two reasons for this study. First, recent publications show that in a significant number of patients the electrode array was unintentionally inserted into the 'wrong' scala (sc. vestibuli). Second, dealing with an alternative concept proposed by Lehnhardt for patients with residual hearing ('endosteal electrode'), the anatomical site of the spiral ligament should be known. In a study on human temporal bones the topography of the middle and inner ear is revised with regard to the presence of anatomical or surgical landmarks that may guide the surgeon. MATERIALS AND METHODS: Anatomical examinations were performed on 10 temporal bones (5 fresh specimens and 5 fixed in formalin), in which the bone of the promontory was carefully milled. The consistency of identification and the relative location of specific surgical indicators or landmarks such as 'blue lines' and 'gray lines' were evaluated for 10 temporal bones. Furthermore, the projection of the lateral attachment of the basilar membrane on the promontory was determined with regard to round window anatomy. RESULTS: In all cases, a major blue line indicated the lateral aspect of the basal cochlear turn while milling the promontorial bone. In a limited number of cases (20%), an additional gray line potentially indicated the spiral ligament before the last shell of bone was removed. In 80% of the cases it was possible to remove the bony layer and leave the endosteum intact as a precondition for a potential endosteal electrode insertion. In addition, through the examination of these models, the relative anatomical location of structures, such as the scala vestibuli, scala tympani, spiral ligament, and basilar membrane, is reviewed.

Changes of oral trigeminal sensitivity in patients after middle ear surgery.

OBJECTIVES: The specific aim of this study was to re-investigate the effect of chorda tympani damage on both trigeminal sensitivity and taste ability. STUDY DESIGN: Prospective study. METHODS: Capsaicin-impregnated filter paper strips (5 concentrations, 0.0001-1%) were used to measure trigeminal thresholds. The strips were placed on the anterior tongue for 10 seconds. Thresholds were estimated in two ways: 1) thresholds related to sensory perception and 2) intensity-related thresholds. The test was applied to 29 patients who underwent middle ear surgery (mean age, 49 yr; 16 females, 13 males). Results were compared with those of 63 healthy subjects (mean age, 40 yr; 36 females, 29 males). In addition to trigeminal thresholds, measures of gustatory function were also obtained using both the validated "taste strips" test kit and electrogustometry. RESULTS: For lateralized testing with capsaicin, significant differences were found between preoperative and postoperative thresholds and between the operated and nonoperated side, with thresholds being higher postoperatively on the operated side. The sensation-related thresholds from the operated tongue side exhibited a correlation with the corresponding postoperative electrogustometric thresholds. A higher degree of chorda manipulation was associated with higher postoperative capsaicin thresholds at the operated tongue side. CONCLUSION: Pain-related sensitivity of the tongue decreases after middle ear surgery, indicating that chorda tympani function also influences intraoral trigeminal sensitivity.