Otolaryngology - Theses
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ItemIntraoperative monitoring during cochlear implantation and correlations to preservation of hearing( 2019)Cochlear implants having been widely used over the past few decades to restore or provide hearing to profoundly deaf individuals. Recently the benefit of combining electrical stimulation from a cochlear implant with low frequency natural hearing or acoustically amplified hearing have been recognised. Benefits include better speech understanding in noise and better appreciation of music (Gantz et al., 2005). Unfortunately inserting a cochlear implant presents significant risk to a patient’s natural hearing therefore, although there are great potential benefits, there is also risk. There are numerous causes of hearing loss after cochlear implant surgery (Rowe et al., 2016). One of those causes is physical damage to the fine structures in the cochlear during array insertion. Electrophysiological monitoring is used to maintain the integrity of important structures for many operations such as facial nerve monitoring in many major ear or parotid gland operations and recurrent laryngeal nerve monitoring in thyroid gland surgery. Electrophysiological monitoring of hearing has been used when resecting tumours near the auditory nerve (Cueva, 2012). Monitoring hearing during cochlear implantation seems a logical extension of a surgeon’s arsenal of monitoring tools. This thesis explores the role of intraoperative monitoring of hearing during cochlear implantation with a goal to reduce postoperative hearing loss by avoiding implant related trauma at the time of surgery. This thesis takes a pragmatic approach focussing only on measurement modalities and methodologies which would be feasible to be use in a day-to-day clinical setting. This work involved: 1. Developing a novel electrophysiological recording system leveraging the telemetry capabilities of commercial cochlear implants. 2. A small animal study to technically validate the function of the system. 3. A small human study to validate the practical use of the system and define stimulus parameters and expected response patterns. 4. A larger human study demonstrating the correlation between adverse intraoperative measurements and failure to preserve operative hearing.