Comparação da telemetria de resposta neural via cocleostomia ou via janela redonda no implante coclear A comparison between neural response telemetry via cochleostomy or the round window approach in cochlear implantation

Abstract

Existem duas técnicas para inserção dos eletrodos do implante coclear (IC): Via cocleostomia ou via janela redonda (JR). OBJETIVO: Comparar a telemetria de resposta neural (NRT) no pós-operatório imediato, verificando se há diferenças na estimulação do nervo auditivo entre estas duas técnicas. MÉTODOS: Prospectivo e transversal. Foram avaliados 23 pacientes. Seis submetidos à cirurgia via cocleostomia e 17 via JR. RESULTADOS: Comparação das unidades de corrente médias (UCM) para sons agudos: via JR com média de 190,4 (± 29,2) e via cocleostomia 187,8 (± 32,7), p = 0,71. Comparação das UCM para sons intermediários: via JR, média de 192,5 (± 22) e via cocleostomia 178,5 (± 18.5), p = 0,23. Comparação das UCM para sons graves: via JR, média de 183,3 (± 25) e via cocleostomia 163,8 (± 19,3), p = 0,19. CONCLUSÃO: Este estudo não mostrou diferença na captação do potencial de ação da porção distal do nervo auditivo em pacientes usuários do implante coclear multicanal submetidos à cirurgia via cocleostomia ou via JR, utilizando o próprio implante para eliciar o estímulo e gravar as respostas. Portanto, ambas as técnicas estimulam de maneira igual o nervo coclear, e baseado nisto conclui-se, também, que realizar o implante coclear via cocleostomia ou RW é uma escolha que depende da experiência cirúrgica e opção do cirurgião.There are two techniques for cochlear implant (CI) electrode placement: cochleostomy and the round window (RW) approach. OBJECTIVE: This study aims to compare neural response telemetry (NRT) results immediately after surgery to check for possible differences on auditory nerve stimulation between these two techniques. MATERIALS AND METHODS: This is a prospective cross-sectional study. Twenty-three patients were enrolled. Six patients underwent surgery by cochleostomy and 17 had it through the RW approach. RESULTS: Mean charge units (MCU) for high frequency sounds: patients submitted to the RW approach had a mean value of 190.4 (± 29.2) while cochleostomy patients averaged 187.8 (± 32.7); p = 0.71. MCU for mid frequency sounds: patients submitted to the RW approach had a mean value of 192.5 (± 22) while cochleostomy patients averaged 178.5 (± 18.5); p = 0.23. MCU for low frequency sounds: patients submitted to the RW approach had a mean value of 183.3 (± 25) while cochleostomy patients averaged 163.8 (± 19.3); p = 0.19. CONCLUSION: This study showed no differences in the action potential of the distal portion of the auditory nerve in patients with multichannel cochlear implants submitted to surgery by cochleostomy or through the RW approach, using the implant itself to generate stimuli and record responses. Both techniques equally stimulate the cochlear nerve. Therefore, the choice of approach can be made based on the surgeon's own preference and experience.

Keywords

• implante coclear
• janela da cóclea
• telemetria
• cochlear implants
• round window
• ear
• telemetry