Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): a study protocol for a randomized single-blind controlled trial

Background In order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a “straight” lateral wall lying electrode array (LW) or a “pre-curved” perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that there is a difference in hearing preservation outcomes between the four possible treatment options. Methods We designed a monocenter, multi-arm, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of an electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is the comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar translocation, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG). Discussion Cochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relatively simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation. Trial registration Netherlands Trial Register (NTR) NL8586. Registered on 4 May 2020. Retrospectively registered; 3/48 participants were included before registration.

Foam Structure Preservation during Microwave-Assisted Vacuum Drying: Significance of Interfacial and Dielectric Properties of the Bulk Phase of Foams from Polysorbate 80–Maltodextrin Dispersions

This study aimed at examining the cause of differences in the structure preservation of polysorbate 80–maltodextrin foams during microwave-assisted vacuum drying (MWVD) versus conventional vacuum drying (CVD). Aqueous dispersions of 3% polysorbate 80 and 0–40% maltodextrin were characterized for their dielectric and interfacial properties, and results were related to their drying performance in a foamed state. Surface tension and surface dilatational properties as well as dielectric properties clearly responded to the variation in the maltodextrin content. Likewise, the foam structure preservation during CVD was linked to the maltodextrin concentration. Regarding MWVD, however, foams collapsed at all conditions tested. Nevertheless, if the structure during MWVD remained stable, the drying time was significantly reduced. Eventually, this finding could be linked to the dielectric properties of polysorbate 80 rather than its adsorption kinetics and surface film viscoelasticity as its resonant frequency fell within the working frequency of the microwave drying plant.