title: An "endosteal electrode" for cochlear implantation in cases with residual hearing? Feasibility study: preliminary temporal bone experiments.
abstract: BACKGROUND
  Over the years, an increasing number of patients with some degree of residual hearing have received cochlear implants. In these cases, the marginal benefit provided by hearing aids alone is not sufficient; however, as experience has already shown, when hearing aids are used in combination with a cochlear implant, more benefit may be obtained. As a prerequisite, this requires that residual hair cell function must remain intact postoperatively. One of the European pioneers of cochlear implants, Ernst Lehnhardt, questioned whether residual hearing might better be preserved if the implanted electrode permits the fluid-filled inner ear space to remain intact. Subsequently, he proposed insertion of a very flat electrode array design into the extraluminal space between the spiral ligament and the bony cochlear wall (endosteum).
  
  
  OBJECTIVE
  Our study aimed to determine whether it is feasible to insert an endosteal electrode model intracochlearly but extraluminarily, anatomically, and ultimately surgically and to determine the impact on surrounding intracochlear structures.
  
  
  METHODS
  Insertion of two silicon models of an endosteal electrode were carried out in 15 human temporal bones. Histologic examination of the temporal bones after electrode insertion was performed on both fresh and fixed specimens to determine whether the desired anatomic site of insertion was achieved. In combination with light reflected and electron microscopic techniques, the extent to which the surrounding structures were impacted was also examined.
  
  
  RESULTS
  Successful insertion of the prototype silicon endosteal electrodes was performed intracochlearly and extraluminarly in 11 of the 15 temporal bone specimens, confirming the anatomic feasibility of insertion into the crevice between the spiral ligament and endosteum.
  
  
  CONCLUSIONS
  On the basis of the anatomy of the human temporal bone, insertion of an "endosteal electrode" is feasible. Subsequently, in vivo animal studies are needed to determine the physical effects of insertion of an endosteal electrode design prototype upon the functionality of the surrounding intracochlear structures and in particularly the ability to preserve hearing function.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Medical School, Rostock, Germany. hans-wilhelm.pau@med.uni-rostock.de
authors.forename: Hans Wilhelm
authors.initials: HW
authors.lastname: Pau
authors.forename: Tino
authors.initials: T
authors.lastname: Just
authors.forename: Ernst
authors.initials: E
authors.lastname: Lehnhardt
authors.forename: Horst
authors.initials: H
authors.lastname: Hessel
authors.forename: Detlef
authors.initials: D
authors.lastname: Behrend
mesh_terms: D003051:Cochlea / Q000473:pathology; D019929:Cochlear Implantation / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004867:Equipment Design; D006309:Hearing; D006801:Humans; D008855:Microscopy, Electron, Scanning; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*