Andrzej Zarowski’s research while affiliated with Sint-Augustinus Hospital and other places

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Publications (47)


Current status of pediatric auditory brainstem implantation in inner ear malformations; consensus statement of the Third International Pediatric ABI Meeting
  • Article
  • Full-text available

November 2024

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189 Reads

Cochlear Implants International

Levent Sennaroglu

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Thomas Lenarz

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Objectives: This study aims to synthesize current knowledge and outcomes related to pediatric auditory brainstem implantation (ABI) in children with severe inner ear malformations (IEMs). It highlights the clinical management practices, challenges, and potential future directions for consensus development in this field. Methods: A systematic review of findings presented at the Third International Pediatric ABI Symposium organized by the Hacettepe Cochlear Implant team between 3 and 5 September 2020 was conducted, incorporating data from 41 departments across 19 countries. Relevant clinical outcomes, imaging techniques, surgical approaches, and rehabilitation strategies were analyzed to identify key trends and variability in practices. Results: The review indicates that children receiving ABIs exhibit diverse auditory outcomes influenced by individual anatomical variations and developmental factors. Early implantation, particularly before the age of three, positively correlates with better auditory and language development. Multicenter experiences underscore the necessity of tailored decision-making, which considers both surgical candidacy and comprehensive rehabilitation resources. Discussion: The variability in outcomes emphasizes the need for improved consensus and guidelines regarding eligibility, surgical techniques, and multidisciplinary rehabilitation approaches. Notable complications and the necessity for thorough imaging assessments were also identified as critical components affecting clinical decisions. Conclusion: A formal consensus statement is warranted to standardize best practices in ABI management. This will not only enhance patient outcomes but also guide future research efforts to address the remaining challenges in the treatment of children with severe IEMs. Enhanced collaboration among team members will be pivotal in achieving these objectives.

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Figure 2. The variations in VAS scores across various experiment conditions. First box: maximum VAS irrespective of the experimental stimulation pattern; minus CI inactive VAS. Second box: maximum VAS minus CI active VAS, independent of experimental stimulation pattern. Third box: CI active VAS minus CI inactive VAS. VAS, Visual Analog Scale.
Demographics of the Patients
The Patients' Responses During the Experiment for Each Phase
Tinnitus Suppression with Electrical Stimulation at the Most Basal Contact of the Cochlear Implant Electrode as a Model for Round Window Stimulation

September 2024

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7 Reads

The Journal of International Advanced Otology

Background The objective of this research was to test whether efficient tinnitus suppression could be achieved by electrical stimulation of the single most basal electrode contact of a cochlear implant. This approach simulates the effects of electrical stimulation using a round-window electrode. Methods The study was performed in 10 adult cochlear implant patients showing complete or almost complete tinnitus suppression during electrical stimulation with their standard fitting-MAP. In all patients, tinnitus appeared again when the implant was switched off. Five Nucleus implant (1 CI532, 4 CI24RE CA) users and 5 Mi12xx series with FLEX28 electrodes with at least 6 months of CI experience were included. Two types of stimulation were presented at the most basal CI contact: a constant pulse train and a modulated pulse train. The variation in pulse rates was low rate (100-300 pps) and high (≥900 pps), and the current level ranged from the C-level to less than the T-level for both stimulation types. The effect of acute electrical stimulation at the most basal electrode contact was compared to the effect obtained with multichannel stimulation with the patient’s current fitting MAP. Electrical stimulation was paused between tests with different stimulation types until tinnitus returned to baseline intensity. Patients reported Visual Analog Scale (VAS) scores for tinnitus loudness and intrusiveness during normal CI use and for each single contact stimulation type. Results Eight participants perceived complete suppression with one or more stimulation patterns. In 2 patients, suppression was less efficient than full-band CI stimulation. Louder stimuli are generally perceived as annoying and less effective in reducing tinnitus. In FLEX28 patients, it was also possible to obtain full tinnitus suppression with current amplitudes under the thresholds for auditory perception (this was not tested in patients with the Nucleus device). Conclusion In 8 of the 10 included patients, we were able to obtain complete or almost complete tinnitus suppression with electrical stimulation at only 1 most basal electrode contact. Therefore, round-window stimulation with a single electrode may be a potential treatment for tinnitus in patients with significant residual hearing. The long-term effects of this therapy should be confirmed in future studies.



Beyond the otoscope: an imaging review of congenital cholesteatoma

August 2024

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28 Reads

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1 Citation

Insights into Imaging

Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs. Clinical relevance statement This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications. Key Points Timely diagnosis of CCs is imperative for avoiding complications. Imaging is key in detection, preoperative evaluation, and postoperative management. Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques. Graphical Abstract



Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial

June 2024

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28 Reads

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1 Citation

Journal of the American Society for Experimental NeuroTherapeutics

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder where individuals consistently feel self-motion, often triggered by motion like being on a boat (MT-MdDS). Due to the unknown pathophysiological mechanism, available treatment options for managing symptoms are limited. Our objective was to develop a virtual reality application (VRA) to simulate the full field optokinetic stimulation (OKS) booth and evaluate its efficacy compared to the standard treatment. In our randomized, open, non-inferiority clinical trial with 30 MT-MdDS patients, 15 received the OKS booth and 15 the new VRA over four consecutive days. Two 4-min treatment blocks were scheduled in the morning and afternoon, with a total of four blocks. Treatment effectiveness was evaluated through questionnaires and posturography. Our findings suggest that the choice of modality does not significantly differ in achieving an overall improvement in symptoms. We advocate that the VRA can be used as an accessible alternative to the booth method worldwide, effectively mitigating MdDS symptoms and enhancing the QoL of numerous MdDS patients.


Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome

March 2024

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114 Reads

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2 Citations

Introduction Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder. Patients experience almost continuously a perception of self-motion. This syndrome can be motion-triggered (MT-MdDS), such as on a boat, or occur spontaneously or have other triggers (SO-MdDS) in the absence of such motion. Because the pathophysiological mechanism is unknown, treatment options and symptom management strategies are limited. One available treatment protocol involves a readaptation of the vestibular ocular reflex (VOR). This study assesses the effectiveness of vestibulo-ocular reflex (VOR) readaptation in 131 consecutive patients with a fixed protocol. Methods We administered 131 treatments involving optokinetic stimulation (OKS) paired with a fixed head roll at 0.167 Hz over two to five consecutive days. Each day, four-minute treatment blocks were scheduled twice in the morning and afternoon. Treatment effectiveness was evaluated through questionnaires and posturography. Results We observed significant improvements in the visual analog scale (VAS), MdDS symptom questionnaire, and posturography measures from pre- to post-treatment. No significant differences were found in outcome variables between MT- and SO-MdDS onsets. Conclusion Symptoms improved subjectively and objectively in patients’ post-treatment. The overall success rate was 64.1%, with no significant difference between MT (64.2%) and SO (63.3%). This study supports the conclusion that VOR readaptation treatment provides relief for two-thirds of MdDS patients, irrespective of the onset type. Based on consistency in the findings, we propose a standardized method for treatment of MdDS based on the OKS with head roll paradigm.



The Need for Vestibular Implants in a Tertiary Referral Ear, Nose, and Throat Center and Its Relation to Hearing Status

December 2023

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16 Reads

The Journal of International Advanced Otology

Background: Patients with bilateral vestibulopathy (BVP) are at increased risk of falling and have poor quality of life. Several research groups are currently developing and investigating vestibular implants to treat BVP. The goal was to identify how many patients can be considered eligible for vestibular implantation. Methods: The objective vestibular implantation criteria for research were applied to the results of the caloric irrigation test, the sinusoidal harmonic acceleration test, the video head impulse test, and the cervical and ocular vestibular evoked myogenic potential tests. Results: Vestibular implant eligibility was situated between 3.6% and 15.7% (semicircular canal implant: 3.6%; otolith implant: 15.7%; combined implant: 4.8%). Only 16 out of the 29 patients (55%) eligible for a vestibular implant had bilateral severe-to-profound hearing loss. The remaining 45% (13/29) thus have better hearing in at least 1 ear. Conclusion: Vestibular implant eligibility in an ear, nose, and throat department was situated between 3.6% and 15.7%, depending on the type of implant that was considered. In addition, the data showed that 45% of the eligible patients had normal-to-moderate hearing in at least 1 ear. In other words, only recruiting patients with (bilateral) severe-to-profound hearing loss for vestibular implantation leads to the systematic exclusion of about half of the candidates. Structure-preserving surgical techniques are thus a major future challenge in the field of vestibular implantation.


Stimulation Crosstalk Between Cochlear And Vestibular Spaces During Cochlear Electrical Stimulation

November 2023

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63 Reads

The Laryngoscope

Objectives Possible beneficial “crosstalk” during cochlear implant stimulation on otolith end organs has been hypothesized. The aim of this case–control study is to analyze the effect of electrical cochlear stimulation on the vestibule (otolith end‐organ), when using a cochleo‐vestibular implant, comparing vestibular stimulation (VI) and cochlear stimulation (CI). Methods Four patients with bilateral vestibulopathy were included. A double electrode array research implant was implanted in all cases. Dynamic Gait Index (DGI), VOR gain measured by using vestibular head impulse test (vHIT), acoustic cervical myogenic responses (cVEMP) recordings, and electrical cVEMP were used in all cases. Trans‐impedance Matrix (TIM) analysis was used to evaluate the current flow from the cochlea to the vestibule. Results While patients did not have any clinical vestibular improvement with the CI stimulation alone, gait metrics of the patients revealed improvement when the vestibular electrode was stimulated. The average improvement in the DGI was 38% when the vestibular implant was activated, returning to the normal range in all cases. Our findings suggest that any current flow from the cochlear space to the otolith organs was insufficient for effective cross‐stimulation. The functional results correlated with the data obtained in TIM analysis, confirming that there is no current flow from the cochlea to the vestibule. Conclusion The only way to produce effective electrical otolith end‐organ stimulation, demonstrated with this research implant, is by direct electrical stimulation of the otolith end organs. No effective cross‐stimulation was found from cochlear electrode stimulation. Level of Evidence 4 Laryngoscope , 2023


Citations (33)


... Although MdDS involves a sensation of phantom motion, it is not described as genuine rotational vertigo, and patients usually do not report symptoms Duzce Med J, 2024;X(X) 2 of motion sickness (2). MdDS is classified into two as motion-triggered (MT-MdDS) and non-motion-triggered MdDS (non-MT MdDS), which start spontaneously or in other ways (3). Unlike dizziness from vestibular disorders or motion sickness, MdDS symptoms typically improve when the person is re-exposed to motion (4). ...

Reference:

Virtual Reality in Vestibular Rehabilitation for Mal de Débarquement Syndrome: A Case Report
Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial
  • Citing Article
  • June 2024

Journal of the American Society for Experimental NeuroTherapeutics

... Although various treatment options such as pharmacological therapies, neuromodulation, and vestibulo-ocular reflex (VOR) rehabilitation are available, access to these methods is limited, and they often focus on addressing secondary symptoms rather than resolving the underlying issue. Therefore, finding effective treatment options that can alleviate MdDS symptoms is of great importance (5). Symptoms are typically triggered by sea, air, and car travel (6). ...

Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome

... The first, unusually prolonged intervention with the new electrode is shown but was excluded from the analysis. Although the p-value of 0.124 was not statistically significant, this suggests a tendency for the average duration of surgery to decrease with each implantation [22][23][24]. Coping strategies such as these contribute to the achievement of correct electrode placement during cochlear implantation by helping to identify problems within the intervention, thereby reducing the need for revision surgery. ...

Cochlear implant electrode array tip-foldover detection by electrode voltage telemetry
  • Citing Article
  • November 2022

Cochlear Implants International

... Aufblähkurve ab. MED-EL verwendet dafür das Duoton-Verfahren[20]. Diese Methode setzt Paare von Reintonsignalen zur Ermittlung der Hörschwelle ein. ...

Home-Based Audiometry With a Smartphone App: Reliable Results?

... Bioimpedance measurements recorded at a CI's intracochlear electrode contacts are potential biomarkers of fibrotic tissue growth [30][31][32][33][34]. Impedances typically rise following cochlear implantation, with greater increases observed at the base than at the apex [35]. ...

Novel Impedance Measures as Biomarker for Intracochlear Fibrosis
  • Citing Article
  • June 2022

Hearing Research

... W przypadku wrodzonej jednostronnej głuchoty, we wczesnym etapie rozwoju dziecka, czyli w okresie wysokiej neuroplastyczności, brak obustronnej stymulacji dźwiękowej powoduje wzmocnienie przetwarzania informacji słuchowych w ośrodkowym układzie nerwowym ze strony ucha słyszącego. W wyniku tego następuje reorganizacja kory słuchowej na korzyść ucha zdrowego opisywana w literaturze jako aural preference [38][39][40]. W trakcie tej reorganizacji dochodzi do adaptacyjnych zmian morfologicznych i funkcjonalnych kory słuchowej. Po ukończeniu przez dziecko 36. ...

Longitudinal auditory data of children with prelingual single-sided deafness managed with early cochlear implantation

... FastCAP and T-level (with DC adjustment) Allam and Eldegwi, 2019), and ECAP thresholds tend to fall above T-levels due to temporal integration and the stimulation rate differences between ECAP (slow single pulses) and behavioral (fast pulse trains) stimuli (McKay et al., 2013;McKay and Smale, 2017;Biesheuvel et al., 2018). The relationship between ECAP and behavioral thresholds remains unclear de Vos et al., 2018;Sismono et al., 2022). Allam and Eldegwi (2019) discovered a strong positive correlation between C-level and neural response telemetry level measurements (r = 0.76), as well as between T-level and neural response telemetry level measurements (r = 0.79). ...

3D-localisation of cochlear implant electrode contacts in relation to anatomical structures from in vivo cone-beam computed tomography
  • Citing Article
  • May 2022

Hearing Research

... Some studies investigated eye movements due to direct stimulation by a CI. 11,12 In other studies, e-VEMPs using direct electrical input via the CI were recorded. [13][14][15] Acoustic stimuli delivered through an audio processor, i.e., acoustic stimulation converted to electric stimulation, was used in another study 16 to elicit e-VEMPs. ...

Vestibular Co-stimulation in Adults with a Cochlear Implant

The Journal of International Advanced Otology

... However, the primary limitation of these devices is their maximum output force level. Increasing this level can enhance speech recognition, better processing of spatial information, and subjective sound quality [11][12][13] . Another approach to achieve these benefits is to enhance the stimulation efficacy of bone conduction implants, and thus the perceived loudness related to the output force level. ...

Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss

Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

... An equalization of possible latency differences across ears in patients with couplings to different middle-ear structures across ears, therefore, may lead to improved sound localization, as has recently been shown for patients with cochlear implants and contralateral hearing aids (Zirn et al., 2019) and patients with different hearing aid processing types across ears (Keidser et al., 2006). However, in the study performed by Zirn et al. (2019) loudspeakers were positioned 30 degrees apart, and therefore monaural level cues, monaural spectral cues and/ or the use of the direction-specific timbre of sound, might have dominated the localization behavior in these conditions (Arras et al., 2022). ...

Instant improvement in monaural spatial hearing abilities through cognitive feedback

Experimental Brain Research