Therapeutic hypothermia to preserve residual hearing in veterans receiving cochlear implantation

这项建议的主要目标是测试和开发一种治疗低温的新应用 退伍军人接受人工耳蜗植入(CI)以保护残留听力和敏感神经 抗手术创伤的结构和改善植入后的听力结果。增加残余听力 在退伍军人中，CI后可能会改善他们的语音识别结果，改善安静时的语音感知， 总体而言，这些设备的患者受益和使用情况。越来越多的患者，包括我们的 退伍军人，在植入时有一定程度的残余听力，并可以受益于双峰电击 声学装置。存活的毛细胞活动，结果是一个功能器官的Corti和神经基质 最近被认为与言语感知结果有关。然而，植入过程中的创伤会导致炎症 和氧化应激，会加剧残余听力损失。治疗性干预措施的成功翻译 限制损伤的病理生理学尚未实现。本工作旨在开发应用程序(S) 局部治疗性亚低温对脑梗塞后毛细胞和神经基质的保护作用 退伍军人噪音和冲击波暴露所致耳蜗病。具体目标的动机是在以下方面存在差距 目前对耳蜗性CI的病理生理学的认识，及其与预后不良的关系 退伍军人，我们的初步数据显示，局部的、轻微的耳蜗亚低温是有效的 安全的治疗干预，以保留植入后的残余听力。这个项目的结果是 可以进一步扩展到退伍军人的其他内耳和中耳手术，这些手术也有 残留听力损失。

The primary goal of this proposal is to test and develop a novel application of therapeutic hypothermia for veterans receiving cochlear implantation (CI) with an aim to preserve residual hearing and sensitive neural structures against surgical trauma and improve hearing outcomes post-implantation. Increasing residual hearing in veterans post-CI will likely improve their speech recognition outcomes, improve speech perception in quiet, and overall, patient benefit and usage of these devices. An increasing number of patients, that include our veterans, have some level of residual hearing at the time of implantation and can benefit from bimodal electro- acoustic devices. Surviving hair cell activity and as a result a functioning organ of Corti and neural substrate has recently been linked to speech perception outcomes. However, trauma during implantation leads to inflammation and oxidative stress that can exacerbate residual hearing loss. Successful translation of therapeutic interventions to limit pathophysiology of the injury have yet to be achieved. The present work aims to develop application(s) of localized, therapeutic hypothermia for protection of hair cells and neural substrate following CI in compromised cochleae as a result of noise and blast exposures in veterans. The specific aims are motivated by a gap in knowledge currently of the pathophysiology of CI in compromised cochleae, its relation to poor outcomes in veterans, and our preliminary data showing that localized, mild hypothermia delivered to the cochlea is effective and safe therapeutic intervention for preserving residual hearing after implantation. The results from this project can be further extended to other inner and middle ear surgeries in veterans, surgeries that also carry a risk of residual hearing loss.