Therapeutic hypothermia to preserve residual hearing in veterans receiving cochlear implantation

该提案的主要目标是测试和开发一种新的治疗性低温应用， 接受人工耳蜗植入（CI）的退伍军人，旨在保留残余听力和敏感的神经 结构，防止手术创伤和改善植入后的听力结果。增强残余听力 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， 以及这些器械的总体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，可以从双峰电- 声学装置存活的毛细胞活动，并作为一个功能器官的Corti和神经基板， 最近与言语感知结果有关。然而，植入过程中的创伤会导致炎症 和氧化应激会加重残余听力损失。成功翻译治疗干预措施 限制损伤的病理生理学尚未实现。目前的工作旨在开发应用程序（S） 局部治疗性低温对脑梗死后毛细胞和神经基质的保护作用 退伍军人因噪音和爆炸暴露而导致的耳蜗损伤。具体目标的动机是在以下方面的差距： 目前的知识，CI的病理生理学受损耳蜗，其关系到不良的结果， 我们的初步数据显示，局部，轻度低温传递到耳蜗是有效的 和安全的治疗干预以保留植入后的残余听力。这个项目的成果 可以进一步扩展到退伍军人的其他内耳和中耳手术，手术也有风险， 残余听力损失

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.