TYPE OF SURGERY: PLANNED SURGERY: SURGICAL...

LION TV2 – 02/57

TYPE OF SURGERY: Cochlear Implant surgery with intraoperative monitoring

PLANNED SURGERY: Nucleus cochlear implantation 422 electrode (Right EAR)

SURGICAL TECHNIQUE The 422 electrode array will be introduced intraoperative EcochG recordings to show hearing preservation during insertion and intracochlear recordings after insertion

CASE 1/1 (09h15 – 10h30)

SURGEONS: William Gibson & Cathy Birman University Medical School Sydney (Australia)

William Gibson. Cochlear Implantation. Right ear

CLINICAL

History: 61 year old male (JI-C) with a congenital hearing loss first diagnosed at age 4-5 years which has gradually deteriorated.

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AUDIOMETRY

William Gibson. Cochlear Implantation. Right ear LION TV2 – 04/57

IMAGING:

William Gibson. Cochlear Implantation. Right ear

CT scan: normal aeration. No cochlear abnormality

MRI: normal

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TYPE OF SURGERY: Cochlear implant surgery

PLANNED SURGERY: Med El Flex Soft cochlear implantation for partial deafness treatment (RIGHT EAR)

SURGICAL TECHNIQUE 6 steps Skarzynski Surgical Procedure Round window approach

CASE 1/2 (09h15 – 10h30)

SURGEON: Henryk Skarzynski Institute of Hearing, Physiology & Pathology Warsaw (Poland)

LION TV2 – 06/57

Henryk Skarzynski. Cochlear Implantation. Right ear

CT-Scan: Midde and inner ear – anatomy normal

CLINICAL

History: 17 year old boy with history of bilateral progressive sensory - neural hearing loss since early chilchood, HA user since 3rd year of life, since 1 year no HA user due to limited benefit, difficulties in speech understanding,

Otoscopy: otoscopy in both sides- normal

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6 STEPS SKARZYNSKI SURGICAL PROCEDURE

STEP 1 – ANTROMASTOIDOTOMY

STEP 2 – POSTERIOR TYMPANOTOMY TO ALLOW VISUALIZATION OF THE ROUND WINDOW NICHE

STEP 3 – PUNCTURE AND INCISION OF THE ROUND WINDOW MEMBRANE

STEP 4 – APPROACH TO THE SCALA TYMPANI DIRECTLY THROUGH THE ROUND WINDOW MEMBRANE (PARTIAL INSERTION OF THE ELECTRODE ARRAY)

STEP 5 – ELECTRODE FIXATION IN THE ROUND WINDOW NICHE WITH FIBRINE GLUE (MEMBRANE MUST BE PARTIALLY

UNCOVERED TO PRESERVE ITS MOBILITY)

STEP 6 – FIXATION OF THE DEVICE IN THE WALL IN TEMPORAL BONE

LION TV2 – 08/57 Henryk Skarzynski. Cochlear Implantation. Right ear

PURE-TONE AUDIOMETRY

LION TV2 – 09/57 Henryk Skarzynski. Cochlear Implantation. Right ear


PLANNED SURGERY: Explantation Nucleus 512 CI (LEFT EAR) because of device failure & Re-implantation with Nucleus CI24RE (CA)

SURGICAL TECHNIQUE Retro-auricular approach. Dissection of the defective CI. Adaptation of the implant bed to the new CI. Explantation of the defective CI. Re-implantation with the new CI.

CASE 1/2 (09h15 – 10h30)

SURGEON: Erwin Offeciers. European Institute for ORL St Augustinus Hospital Antwerp (Belgium)

LION TV2 – 10/57

Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear

CLINICAL Male child °2003

History: Congenital deafness – connexine 26 / 30 del G Family history: one sibling with congenital bilateral deafness Right ear: CI Nucleus 24 RCA at age 0;8. Excellent result. Mainstream school at age 5 Left ear: CI Nucleus 512 at age 7;5. Excellent result. Both ears full phoneme and speech discrimination. Normal speech and language development. April 2012: device failure Left ear (Nucleus 512)

Otoscopy: Bilateral normal otoscopy

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PURE-TONE AUDIOMETRY – ABR – OAE 2003

Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear

Bilateral total deafness / No response on ABR / No OAE response

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SPEECH AUDIOMETRY - 2003

Unaided (head phones) and aided thresholds (free field) NVA-list (phoneme score): no response

Hearing aid trial: no progress

Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear LION TV2 – 13/57

Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear LION TV2 – 14/57

SURGEON: Thomas Lenarz Medizinische Hochschule Hannover (Germany)


PLANNED SURGERY: Med-El Flex28 Cochlear implantation (LEFT EAR)

CASE 1/2 (10h30 – 11h30)

LION TV2 – 15/57

Thomas Lenarz. Cochlear Implant Surgery. Left ear

CLINICAL

History: Progressive bilateral SNHL on both sides left > right in the high frequencies No previous history of ear surgery

Otoscopy: Normal findings Weber: to the right ear Rinne: right positive

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Thomas Lenarz. Cochlear Implant Surgery. Left ear LION TV2 – 17/57

MRI-CT-Scan

Thomas Lenarz. Cochlear Implant Surgery. Left ear LION TV2 – 18/57


PLANNED SURGERY: Nucleus Cochlear implantation 422 electrode (LEFT EAR)

SURGICAL TECHNIQUE Bony bead using two flap technique, posterior tympanotomy, “free hand” round window insertion

CASE 1/2 (10h30 – 11h30)

SURGEON: Alex Huber University Hospital Zurich (Switzerland)

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CLINICAL

History: 70 year old male. Progressive hearing loss for more than 40 years. Uses bilateral hearing aids (Phonak Naida VSP) since 1980. Has now no benefit using his left hearing aid.

Otoscopy: Normal Otoscopy

Alex Huber. Cochlear Implant Surgery. Left ear LION TV2 – 20/57

MRI-CT-Scan


TYPE OF SURGERY: Neurotology

PLANNED SURGERY: Vestibular neurotomy for Meniere’s disease (RIGHT EAR)

SURGICAL TECHNIQUE Vestibular neurotomy. Retrolabyrinthine approach Advanced cochlear monitoring & cochlear mapping

CASE 1/1 (10h30 – 12h00)

SURGEON: Jacques Magnan Causse Ear Clinic Béziers (France)

LION TV2 – 24/57

CLINICAL

History: 46 year old female. Right sided Meniere’s disease over 19 years getting worse since 1 year despite Medical treatment (steroids, betahistine, diuterique) Currently 1 severe attack of vertigo per month with simultaneous right-sided fluctuating hearing loss and tinnitus despite medical treatment Persistent imbalance

Otoscopy: Normal

MRI: Normal

Jacques Magnan. Vestibular neurotomy. Right ear LION TV2 – 25/57


Jacques Magnan. Vestibular neurotomy. Right ear LION TV2 – 26/57


PLANNED SURGERY: Nucleus Straight Array cochlear implantation (RIGHT EAR)

SURGICAL TECHNIQUE Lateral Labyrinthotomy Technique

CASE 1/1 (11h30 – 12h45)

SURGEON: Caglar Batman Marmara Medical University Istanbul (Turkey)

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Caglar Batman. Cochlear Implantation. Right ear

CLINICAL

History: 2 year old female child, born in 40th week of pregnancy Her mother and father are cousins. Newborn hearing screening(OAE) was said to be positive bilaterally at 1 month At 11th months SNHL was diagnosed. She was referred to our clinic 3.5 months ago and has been using hearing aids since 13 months.

Clinical examination: Oto-rhino-laryngological examination was normal.

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CT-Scan

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MRI

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MRI

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3D Imaging

Right Ear

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3D Imaging

Right Ear Left Ear

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PLANNED SURGERY: Advanced Bionics Cochlear implantation (LEFT EAR)

SURGICAL TECHNIQUE Supra meatal approach (SMA)

CASE 1/1 (11h30 – 12h45)

SURGEONS: Rinze Tange, Vedat Topsakal University Medical Center Utrecht (Netherlands)

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CLINICAL

History: 68 year old female with progressive SNHL of unknown etiology Personal history of hypertension, GER with B blocker and PPI

Otoscopy: Normal

Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear LION TV2 – 35/57


SPEECH AUDIOMETRY

LION TV2 – 36/57 Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear

CT-Scan


Supra Meatal Approach (SMA) *

* Kronenberg J, Migirov L, Dagan T. Suprameatal Approach: new surgical approach for cochlear implantation, J. Laryngol Otol 2001 Apr. 115(4)283-5


TYPE OF SURGERY: Vestibular schwannoma resection

PLANNED SURGERY: Tumor resection (LEFT EAR)

SURGICAL TECHNIQUE Middle Fossa approach

CASE 1/1 (12h00 – 13h30)

SURGEON: Instituto de Otologia Garcia-Ibanez & Centro Medico Teknon Barcelona (Spain)

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Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear

CLINICAL

History: 40 year-old male 2 months evolution • Left side Tongue disestesia • Taste distortion • Dizziness • Left side tinnitus • Left side migraine

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ELECTROPHYSIOLOGY

ENG VIIth nerve: normal

VNG: normal

ABR: right side normal left side retrocochlear response

Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear LION TV2 – 42/57

MRI


Left intrameatal 7 mm Vestibular schwannoma

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MRI


SURGEON: Witold Szyfter Poznan University of Medical Sciences Poznan (Poland)


PLANNED SURGERY: Hybrid Nucleus Cochlear implantation (RIGHT EAR)

SURGICAL TECHNIQUE Posterior tympanotomy approach and round window insertion of the hybrid electrode

CASE 2/2 (12h45 – 14h00)

LION TV2 – 46/57

Witold Szyfter. Cochlear Implant Surgery. Right ear

CLINICAL

History: 52 year old female with bilateral, progressive hearing loss in medium and high frequencies. Bilateral hearig aids last 17 years, more and more difficulties in speech comprehension

Otoscopy: Tympanic membranes, bilateraly pearly grey with normal light reflex

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Witold Szyfter. Cochlear Implant Surgery. Right ear LION TV2 – 48/57

CT-Scan

Witold Szyfter. Cochlear Implant Surgery. Right ear LION TV2 – 49/57

SURGEON: Nuri Ozgirgin Bayindir Hospital Sogutozu Ankara (Turkey)

TYPE OF SURGERY: Cochlear Implant Surgery

PLANNED SURGERY: Nucleus Cochlear Implantation (LEFT EAR)

SURGICAL TECHNIQUE Posterosuperior small incision, standard nastoidectomy with tympanotomy posterior, drilling the RW nich to expose the membrane, subperioteal pocket to host the implant body, RW insertion, obliterating with connective tissue

CASE 1/2 (13h45 – 14h45)

LION TV2 – 50/57

Nuri Ozgirgin. Cochlear Implant Surgery. Left ear

CLINICAL

History: 2 year-old; prelingual deafness

Otoscopy: Normal otoscopic findings

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Nuri Ozgirgin. Cochlear Implant Surgery. Left ear

HEARING THRESHOLD WITH ERA

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IMAGING

Nuri Ozgirgin. Cochlear Implant Surgery. Left ear LION TV2 – 53/57

TYPE OF SURGERY: Mastoid Meningocele + Atical Retraction Pocket

PLANNED SURGERY: Middle Fossa plus Trans mastoid approach (RIGHT EAR)

SURGICAL TECHNIQUE Customized Middle Fossa Approach + + Revision of canal wall up technique

CASE 2/2 (14h00 – 15h30)

SURGEON: Oswaldo Laercio Cruz Hospital Sirio-Libanès Sao Paulo (Brazil)

LION TV2 – 54/57

Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear

CLINICAL

History: MSZ, fem., 53 years old. Right ear presents recurrent infection since adolescence. In 2007 the diagnosis of cholesteatoma was made and she underwent surgery in another service. After 2 years without symptoms she started to fill some secretion and discomfort

Otoscopy: The external auditory canal presents dehiscence of its superior and posterior wall. It is possible to visualize the tympanic membrane with postero-superior retraction

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LION TV2 – 56/57 Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear

CT-Scan & MRI

LION TV2 – 57/57 Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear

TYPE OF SURGERY: PLANNED SURGERY: SURGICAL...

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