ALESSANDRA RUSSO MD GRUPPO OTOLOGICO

Transcription

1 Gruppo Otologico Simultaneous Labyrinthectomy with Cochlear Implantation Cenacolo di Audiovestibologia, Chieti, 24-25/06/2016 ALESSANDRA RUSSO MD GRUPPO OTOLOGICO

2 MENIERE DISEASE Therapeutic Steps 1 step =medical therapy 2 step =intratympanic gentamicin 3 step =another gentamicin application 4 step =vestibular neurectomy(good hearing) 5 step =labyrinthectomy (bad hearing) 6 step =labyrinthectomy with simultaneous cochlear implant 2

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4 Gruppo Otologico COCHLEAR IMPLANT Electronic device that stimulates the acoustic nerve fibers bypassing the sensory air cells

5 Cochlear Implant System Gruppo Otologico Internal component - receiver stimulator - electrode array External component - transmitter system - microphone - external processor

6 Gruppo Otologico BASIC CONCEPT Trasmission of the signal directly to the cochlear fibers

7 BASIC CONCEPT Anatomical position of the electrode array in the cochlea

8 Gruppo Otologico CLASSIC INDICATIONS FOR CI Severe to profound bilateral SNHL PTA (pure tone average) 70 db SDS <40% with hearing aids

9 Gruppo Otologico EXTENDED INDICATION FOR MENIERE DISEASE bilateral Meniere Meniere in the only hearing ear (CI in the controlateral deaf ear)

10 Gruppo Otologico MENIERE DISEASE Hearing loss + Vertigo/unsteadiness Simulatenous Labyrinthectomy + CI

11 Simultaneous Cochlear Implant + Labyrinthectomy Cochlear Fibrosis after labyrinthectomy may affect the array insertion 11

12 Staged surgery Gruppo Otologico 1993 Zwalan et al: First simultaneous surgical labyrinthectomy with Cochlear Implantation

13 Surgical technique Gruppo Otologico Cochlear & Facial nerve monitoring

14 Surgical technique Gruppo Otologico Placement of skin incision

15 Surgical technique Gruppo Otologico Left retroauricolar approach

16 Surgical technique Gruppo Otologico Opening of the canals

17 Surgical technique Gruppo Otologico Opening of the vestibule

18 Surgical technique Gruppo Otologico Facial recess approach

19 Surgical technique Gruppo Otologico Incudo-stapedial joint visualization

20 Surgical technique Gruppo Otologico Round window visualization

21 Surgical technique Gruppo Otologico Round window visualization

22 Surgical technique Gruppo Otologico Visualization of the round window membrane

23 Surgical technique Gruppo Otologico Cochlear Implant fixation

24 Surgical technique Gruppo Otologico Array insertion

25 Surgical technique Gruppo Otologico Round window obliteration

26 Surgical technique Gruppo Otologico Electrophisiological test

27 Post-op control Gruppo Otologico Stenvers view CT scan

28 Gruppo Otologico VIDEO

29 Gruppo Otologico Gruppo Otologico series : 400 CI 5 simoultaneous CI+Labyrinthectomy for Meniere Disease 2 staged surgery - after 48 months - after 36 months

30 Gruppo Otologico Results: simultaneous 1 no FU 1 FU 1 month 1 FU 2 years SR 0% 1 FU 4 years SR 85 % 1 FU 5 years SR 70 %

31 Gruppo Otologico Results: staged 1 FU 9 months SR 85 % 1 FU 3 years SR 90 %

32 Gruppo Otologico CONCLUSIONS In selective cases the combination of cochlear implant and labyrinthectomy allows to solve both hearing and vestibular problems of the patient And also in some cases it reduces tinnitus

33 Gruppo Otologico CONCLUSIONS Labyrinthectomy +Cochlear Implant represent a new frontier in treatment of Meniere Disease In according with results this pathology is with less fear 33

34 Gruppo Otologico CONCLUSIONS Auditory performances of these patients are similar to the standard cases

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