The three layered structure of orbicularis oris and buccinator complex with partial connection at the modiolus and partial direct continuation.

PURPOSE: This study aimed to clarify the structural arrangement of the orbicularis oris (OOr), the buccinator, and the other perioral muscles around the modiolus. METHODS: The perioral muscles in seventeen cadavers fixed with formalin were dissected in situ and/or in isolated muscle specimens, and their layers were reconstructed schematically upon pantomographic view of the skeleton to evaluate their actions. RESULTS: The buccinator was composed of three parts including upper and lower oblique parts in its superficial layer and a middle transverse part in its deep layer. The superior and inferior OOr were composed of an inner marginal part (IM) and an outer labial part (OL) in each. The perioral muscles as a whole were arranged in three layers. The first layer consisted of the depressor anguli oris and the OL of superior OOr connected at the modiolus in a vertical direction. The second layer consisted of the upper and inner oblique part of buccinator and a part of the OL of inferior OOr connected at the modiolus in a horizontal direction. The third layer contained the middle transverse part of buccinator continuous with the IM of both OOr and a part of the OL of inferior OOr without connection to the modiolus. CONCLUSIONS: The different arrangement of the three layers of perioral muscles around the modiolus could serve as a good basis to predict the actions of the individual perioral muscles on the movement of lips in open/close of the oral fissure and widening/narrowing of the lip width.

Rome-Celsus (ca 25BC to ca. 50AD).

Celsus gave an adequate description of the bones and sutures of the calvarium. His classification of injuries was simple including fissures and depressions. He is the first to relate specific symptoms to specific tissue injury. In addition, he was aware that fractures could be present in the absence of typical findings. He was also the first to note the meningeal vessels could rupture producing severe localized pain. His treatment was more conservative than that of Hippocrates. Plasters were to be used and if there was no deterioration trepanation was avoided. He described the use of the crown trepan (modiolus) and the instrument with a smaller tip which expands rapidly to prevent penetration. He also described the technique of rotating the trepan between the palms. His description of operations for depressed fractures were unusually clear and relevant even by modern standards. His wound care is strikingly different from that of Hippocrates as he advocates various dressings soaked in vinegar and as time passes plasters should be softened with rose oil. Regrettably, Celsus influence would not be felt until the time of the Renaissance, because his texts were lost. However, his "De Medicina" was rediscovered and became the first medical text to be published using the new moveable type printing press, in the year 1478. Thus, his influence was minimal in the Arabic world and the early Renaissance. Thereafter it was profound.

Endoscopic Temporalis Tendon Extension (ETTE).

Many techniques have been proposed to restore facial symmetry in facial nerve palsies. This study presents our surgical approach called Endoscopic Temporalis Tendon Extension (ETTE). After nasotracheal intubation, a 4 cm skin incision is made at the nasolabial fold. Under endoscopic view, the medial face of the masseter muscle is detached from the mandibular ramus. The coronoid process is then sectioned by Piezosurgery®. Finally, a fascia lata graft is suspended between the temporalis tendon and the orbicularis oris. ETTE is a mixed technique, with a static suspension component and a dynamic contraction one. The preservation of the temporalis muscle insertion in temporal fossa allows for an optimal contraction. A fascia lata graft is necessary for reasons of length. The scar produced by the nasolabial incision allows to recreate the missing nasolabial fold. The endoscopic assistance provides greater precision during the procedure and entails a shorter learning curve.

Evaluation of CI electrode position from imaging: comparison of an automated technique with the established manual method.

BACKGROUND: A manual evaluation of the CI electrode position from CT and DVT scans may be affected by diagnostic errors due to cognitive biases. The aim of this study was to compare the CI electrode localization using an automated method (image-guided cochlear implant programming, IGCIP) with the clinically established manual method. METHODS: This prospective experimental study was conducted on a dataset comprising N=50 subjects undergoing cochlear implantation with a Nucleus® CI532 or CI632 Slim Modiolar electrode. Scalar localization, electrode-to-modiolar axis distances (EMD) and angular insertion depth (aDOI) were compared between the automated IGCIP tool and the manual method. Two raters made the manual measurements, and the interrater reliability (±1.96·SD) was determined as the reference for the method comparison. The method comparison was performed using a correlation analysis and a Bland-Altman analysis. RESULTS: Concerning the scalar localization, all electrodes were localized both manually and automatically in the scala tympani. The interrater differences ranged between ±0.2 mm (EMD) and ±10° (aDOI). There was a bias between the automatic and manual method in measuring both localization parameters, which on the one hand was smaller than the interrater variations. On the other hand, this bias depended on the magnitude of the EMD respectively aDOI. A post-hoc analysis revealed that the deviations between the methods were likely due to a different selection of mid-modiolar axis. CONCLUSIONS: The IGCIP is a promising tool for automated processing of CT and DVT scans and has useful functionality such as being able to segment the cochlear using post-operative scans. When measuring EMD, the IGCIP tool is superior to the manual method because the smallest possible distance to the axis is determined depending on the cochlear turn, whereas the manual method selects the helicotrema as the reference point rigidly. Functionality to deal with motion artifacts and measurements of aDOI according to the consensus approach are necessary, otherwise the IGCIP is not unrestrictedly ready for clinical use.

"Untying the knot": The primitive orofacial muscle architecture in the gorilla (Gorilla gorilla) as a key to the evolution of hominin facial movement.

The anatomical underpinnings of primate facial expressions are essential to exploring their evolution. Traditionally, it has been accepted that the primate face exhibits a "scala natura" morphocline, ranging from primitive to derived characteristics. At the primitive end, the face consists of undifferentiated muscular sheets, while at the derived end there is greater complexity with more muscles and insertion points. Among these, the role of the human modiolus ("knoten" in German) has been emphasized. Recent studies have challenged this view by revealing significant complexity in the faces of several non-human primates, thereby rejecting the linear notion of facial evolution. However, our knowledge of the facial architecture in gorillas, the second closest living relatives to modern humans, remains a significant gap in the literature. Here, we present new findings based on dissection and histological analysis of one gorilla craniofacial specimen, alongside 30 human hemifaces. Our results indicate that while the number and overall arrangement of facial muscles in the gorilla are comparable to those of chimpanzees and modern humans, several orofacial features distinguish the gorilla's anatomy from that of hominins. Among these are the absence of a modiolus, the continuity of muscular fibers over the region of the mouth corner, the flat (uncurving) sheet of the orbicularis oris muscle, and the insertion of direct labial tractors both anterior and posterior to it. Collectively, the anatomical characteristics observed in the gorilla suggest that the complex anatomy of the hominin face should be considered synapomorphic (shared-derived) within the Pan-Homo clade.

High Signal Intensity of the Cochlear Modiolus on Unenhanced T1-Weighted Images in Classical Infratentorial Superficial Siderosis.

Background: Superficial siderosis (SS) results from chronic bleeding in the subarachnoid space. SS can be classified as infratentorial SS (i-SS) and supratentorial SS (s-SS). The cochlear modiolus (CM) normally shows low signal intensity (SI) on Tl-weighted images (T1WI). We noticed persistently high SI of the CM on unenhanced thin-sliced T1WI in patients with i-SS. The purpose of this study was to evaluate the correlation between SS and high SI of the CM on unenhanced T1WI. Methods: This retrospective study analyzed three cases with i-SS, eight cases with s-SS, and 23 normal controls (NC) evaluated on unenhanced thin-sliced T1WI with a three-dimensional spoiled gradient-recalled echo sequence. CM-T1SI scores of 0, 1, and 2 indicated low, iso, and high SI, respectively. In cases with scores of 2 evaluated several times, all scores were reviewed for each case. The CM-T1SI ratio was defined as the contrast ratio between the CM and the cerebellum. Differences between the three groups were statistically analyzed based on the CM-T1SI score and ratio. Receiver operative curve (ROC) analysis was used to determine the cut-off values for differentiating the i-SS group from the NC group based on the CM-T1SI ratio. Results: Two patients with i-SS had a score of 2 on all evaluations. The CM-T1SI score and ratio differed significantly between the i-SS and NC groups. The accuracy of the CM-T1SI ratio for discriminating i-SS from NC was 98.9% at a cutoff value of 0.628. Conclusion: High SI of the CM on unenhanced TIWI can be an additional characteristic finding of i-SS.

Ti3 C2 Tx MXene Composite 3D Hydrogel Potentiates mTOR Signaling to Promote the Generation of Functional Hair Cells in Cochlea Organoids.

Organoids have certain cellular composition and physiological features in common with real organs, making them promising models of organ formation, function, and diseases. However, Matrigel, the commonly used animal-derived matrices in which they are developed, has limitations in mechanical adjustability and providing complex physicochemical signals. Here, the incorporation of Ti3 C2 Tx MXene nanomaterial into Matrigel regulates the properties of Matrigel and exhibits satisfactory biocompatibility. The Ti3 C2 Tx MXene Matrigel composites (MXene-Matrigel) regulate the development of Cochlear Organoids (Cochlea-Orgs), particularly in promoting the formation and maturation of organoid hair cells. Additionally, regenerated hair cells in MXene-Matrigel are functional and exhibit better electrophysiological properties compared to hair cells in Matrigel. MXene-Matrigel potentiates the amycin (mTOR) signaling pathway to promote hair cell differentiation, and mTOR signaling inhibition restrains hair cell differentiation. Moreover, MXene-Matrigel facilitates innervation establishment between regenerated hair cells and spiral ganglion neurons (SGNs) growing from the Cochlea modiolus in a co-culture system, as well as promotes synapse formation efficiency. The approach overcomes some limitations of the Matrigel-dependent culture system and greatly accelerates the application of nanomaterials in organoid development and research on therapies for hearing loss.

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to compare round window (RW) and cochleostomy (C) surgical approaches for the placement of cochlear implants (CIs). After obtaining the Institutional Review Board (IRB) approval, 213 peer-reviewed articles published between January 1, 2000, and August 1, 2021, comparing RW and C approaches were identified via a search on Google Scholar, Cochrane, and PubMed. The inclusion criteria were articles having an English version and involving only human subjects (cadaveric or alive). Statistical analysis of compiled electrode-to-modiolus distances was performed with two-sample independent t-tests. Live patients were categorized as having complete hearing preservation (<10 dB threshold shift), partial hearing preservation (10-20 dB shift), or minimal hearing preservation (>20 dB shift). Chi-squared testing was used to compare the distribution of hearing preservation categories between surgical approaches. Due to the heterogeneous nature of the data, only summative information was provided on the effects of approaches on trauma, electrical impedance, speech perception, vestibular dysfunction, ease of scala tympani insertion, and scalar shift. A total of 3,797 CI patients were evaluated. The RW approach resulted in a smaller (0.15 mm smaller on average, p<0.05) electrode-to-modiolus distance when compared to the C approach. The RW approach (93.0%) led to statistically better hearing preservation than the C approach (84.3%) (p<0.05). The RW approach was also associated with better outcomes in terms of speech perception, ease of scala tympani insertion, and reduced scalar shift. No difference between approaches was found with regard to trauma, electrical impedance, and vestibular dysfunction. Based on our findings, the RW approach appears to have several benefits compared to the C approach.

Toward a cochlear implant electrode array with shape memory effect for post-insertion perimodiolar positioning.

For cochlear implants (CI) a final position of the electrode array (EA) along the inner wall of the spirally shaped cochlea is considered to be beneficial because it results in a closer proximity to the auditory nerve fibers. A shape memory effect (SME) could facilitate such shift of the EA toward the cochlear inner wall, but its implementation remains to be solved. The current study presents an EA prototype featuring the SME with minute adjustments of the material properties of Nitinol, a shape memory alloy, in combination with a suitable cooling strategy to prevent premature curling. Ten samples were successfully inserted by a CI surgeon into an artificial cochlear model submerged into a temperature-controllable water bath to simulate temporary hypothermia of the inner ear (31°C). Gentle insertions were possible, with an average insertion speed of 0.81 ± 0.14 mm/s. After recovery of body temperature, the desired position shift toward the modiolus was observed in all trials. Angular insertion depth increased by approximately 81.8° ± 23.4°. We demonstrate for the first time that using the body temperature responsive SME for perimodiolar EA positioning is feasible and does not impede a gentle surgical insertion.

Quality-assured training in the evaluation of cochlear implant electrode position: a prospective experimental study.

BACKGROUND: The objective of this study was to demonstrate the utility of an approach in training predoctoral medical students, to enable them to measure electrode-to-modiolus distances (EMDs) and insertion-depth angles (aDOIs) in cochlear implant (CI) imaging at the performance level of a single senior rater. METHODS: This prospective experimental study was conducted on a clinical training dataset comprising patients undergoing cochlear implantation with a Nucleus® CI532 Slim Modiolar electrode (N = 20) or a CI512 Contour Advance electrode (N = 10). To assess the learning curves of a single medical student in measuring EMD and aDOI, interrater differences (senior-student) were compared with the intrarater differences of a single senior rater (test-retest). The interrater and intrarater range were both calculated as the distance between the 0.1th and 99.9th percentiles. A "deliberate practice" training approach was used to teach knowledge and skills, while correctives were applied to minimize faulty data-gathering and data synthesis. RESULTS: Intrarater differences of the senior rater ranged from - 0.5 to 0.5 mm for EMD and - 14° to 16° for aDOI (respective medians: 0 mm and 0°). Use of the training approach led to interrater differences that matched this after the 4th (EMD) and 3rd (aDOI) feedback/measurement series had been provided to the student. CONCLUSIONS: The training approach enabled the student to evaluate the CI electrode position at the performance level of a senior rater. This finding may offer a basis for ongoing clinical quality assurance for the assessment of CI electrode position.

Cochlear Pathomorphogenesis of Incomplete Partition Type II in Slc26a4-Null Mice.

Incomplete partition type II (IP-II) is frequently identified in ears with SLC26A4 mutations. Cochleae with IP-II are generally observed to have 1½ turns; the basal turns are normally formed, and the apical turn is dilated or cystic. The objective of this study was to characterize the pathomorphogenesis of the IP-II cochlear anomaly in Slc26a4-null mice. Otic capsules were dissected from Slc26a4Δ/+ and Slc26a4Δ/Δ mice at 1 and 8 days of age and at 1 and 3 months of age. X-ray micro-computed tomography was used to image samples. We used a multiplanar view and three-dimensional reconstructed models to calculate the cochlear duct length, cochlear turn rotation angle, and modiolus tilt angle. The number of inner hair cells was counted, and the length of the cochlear duct was measured in a whole-mount preparation of the membranous labyrinth. X-ray micro-computed tomography mid-modiolar planar views demonstrated cystic apical turns in Slc26a4Δ/Δ mice resulting from the loss or deossification of the interscalar septum, which morphologically resembles IP-II in humans. Planes vertical to the modiolus showed a similar mean rotation angle between Slc26a4Δ/+ and Slc26a4Δ/Δ mice. In contrast, the mean cochlear duct length and mean number of inner hair cells in Slc26a4Δ/Δ mice were significantly smaller than in Slc26a4Δ/+ mice. In addition, there were significant differences in the mean tilt angle and mean width of the modiolus. Our analysis of Slc26a4-null mice suggests that IP-II in humans reflects loss or deossification of the interscalar septum but not a decreased number of cochlear turns.

MR Imaging of Cochlear Modiolus and Endolymphatic Hydrops in Patients With Menière's Disease.

Background: Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD. Purpose: Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD? Methods: We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops. Results: No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area. Conclusion: No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.

Facial Muscles and Its Modiolus: A Review of Embryology, Comparative Anatomy, Morphology and Applied Anatomy

@#The modiolus of the face manifests the interesting landmark for facial muscles attachment. The strong connective tissue fibres play an important role in the clinical setting, especially in the aesthetic and dental surgeries. In the fourth week of intrauterine life, the development of the modiolus evolves in accordance with the growth of muscles of facial expression. Microscopically, a white, tendinous structure with the thick irregular collagenous connective tissue of collagen fibres predominance appeared to be the modiolus. Modiolus is morphologically a fibromuscular muscle situated on the lateral border of the mouth. The formation of the nasolabial fold is important and a well-developed modiolus provide a toned face. Several works of literature forementioned the number of facial muscles attached to the modiolus but no definitive similarity are identified. This review summarizes the updated morphological features and applied anatomy of the facial modiolus with its muscle attachment.

Comunicación preliminar acerca de la disposición morfológica, la funcionalidad y las implicancias clínicas del modiolo del ángulo oral (Modiolus anguli oris) / Preliminary communication about the morphological arrangement, functionality and clinical implications of modiolus of angulus oris (Modiolus anguli oris)

RESUMEN: La disposición anatómica de los músculos faciales es de una notable complejidad y requiere de un estudio pormenorizado para lograr su reconomiento preciso. La comprensión de la disposición morfológica y la funcionalidad del modiolo del ángulo oral (Modiolus angulis oris) es de gran relevancia al momento de analizar la constitución muscular de la comisura labial, y para comprender clínicamente las lesiones del ángulo de la cavidad oral, lo que permitirá un abordaje terapéutico adecuado, crucial para la preservación y reconstitución de la armonía facial.

SUMMARY: The anatomical arrangement of the facial muscles is of considerable complexity and requires a detailed study to achieve its precise recognition. The understanding of the morphological disposition and the functionality of the angle of the mouth (Modiolus angulis oris) is of great relevance when analyzing the muscular constitution of the labial commissure, and to understand clinically the injuries of the angulus oris, what that will allow an adequate therapeutic approach, crucial for the preservation and reconstitution of facial harmony.

Presence of the spiral ganglion cell bodies beyond the basal turn of the human cochlea.

The purpose of this study was to obtain a better understanding of the number and distribution of spiral ganglion cell bodies (SGCB) in the central modiolus trunk of the human cochlea with normal hearing as well as with hearing loss due to various pathological conditions. A literature review was performed using the key words 'human spiral ganglion cell population', 'analysis of spiral ganglion cell population', 'survival of human spiral ganglion cells', 'human Rosenthal's canal', 'human ganglion cell counts', and 'distribution of human spiral ganglion cells' to identify articles published between 1968 and 2018. Articles were included if the number of SGCB in the four segments of the human cochlea and angular depth distribution of the SGCB were stated. Of 236 articles initially identified, 19 articles met the inclusion criteria. SGCB inside the Rosenthal's canal (RC) in the modiolus trunk extended to an angular depth of 630-680° which is near the end of the second turn of the cochlea. SGCBs in Segment IV of the cochlea account for approximately 25-30% of the entire SGCB population irrespective of the cochlear condition (normal vs. pathologic). In normal hearing subjects, the total number of SGCB ranged between 23,910 and 33,702 and in patients with hearing loss between 5733 and 28,220. This literature review elaborates on the current state of knowledge about the number and distribution of SGCB in the human cochlea.

[The distance from the modiolus of perimodiolar electrode arrays of cochlear implants. A radiological study to evaluate the difference in perimodiolar properties]. / Cochlearis implantátumok különbözo, elore görbített elektródasorainak elhelyezkedése a cochlea tengelyéhez viszonyítva. Radiológiai vizsgálat a perimodiolaritás mértékének megállapítására.

Introduction: The cochlear implants vary in electrodes in terms of length, width and proximity to the modiolus. The precurved electrode arrays could be placed closer to the modiolus and the ganglion cells compared to straight electrodes. The two types of electrode arrays provide different electrophysiological characteristics; however, proximity to the modiolus may lead to better hearing performance. Aim: To investigate our preliminary electrophysiological results that suggest that the Slim Modiolar (SM) electrode array has the potential to elicit similar neural responses as the thicker perimodiolar (Contour Advance, CA) electrode from the same generation of implants. Method: Subjects that were implanted either with CA or SM electrodes were enrolled, 54 consecutive subjects in each group. All electrodes were introduced into the cochlea via the round window. The diameter of the largest turn of the electrode arrays within the cochlea was measured through postoperative radiography. The energy consumption parameters were estimated 2 months after implantation. Results: The mean of the largest turns of the arrays within the cochlea was 4.2 ± 0.5 mm in the SM group and 4.9 ± 1.1 mm in the CA group. 'Auto power' was 44.81 ± 5.05% and 50.85 ± 8.35% with SM and CA, respectively. Estimated energy consumption was lower with SM. The differences were statistically significant. Conclusion: Our measurements for a large cohort in each group suggest that the SM electrode array takes a significantly closer position to the modiolus than the CA. This finding supports our earlier electrophysiological result and indicates better performance abilities. Orv Hetil. 2019; 160(31): 1216-1222.

PCR and histology identify new bivalve hosts of Apicomplexan-X (APX), a common parasite of the New Zealand flat oyster Ostrea chilensis.

Apicomplexan-X (APX) is a significant pathogen of the flat oyster Ostrea chilensis in New Zealand. The life cycle and host range of this species are poorly known, with only the zoite stage identified. Here, we report the use of molecular approaches and histology to confirm the presence of APX in samples of green-lipped mussels Perna canaliculus, Mediterranean mussels Mytilus galloprovincialis and hairy mussels Modiolus areolatus collected from widely distributed locations in New Zealand. The prevalence of APX infection estimated by PCR was 22.2% (n = 99) and 50% (n = 30) in cultured green-lipped mussels from Nelson and Coromandel, respectively; 0.8% (n = 258), 3.3% (n = 150) and 35.3% (n = 17) in wild Mediterranean mussels from Nelson, Foveaux Strait and Golden Bay, respectively; and 46.7% (n = 30) in wild hairy mussels from Foveaux Strait. Histology detected all cases of PCR that were positive with APX and appeared to be more sensitive. The prevalence of APX estimated by histology in green-lipped mussels from Coromandel was 60% versus 50% by PCR, and 4.3%, 10.7% and 52.9% by histology versus 0.8%, 3.3% and 35.3% by PCR in wild Mediterranean mussels from Nelson, Foveaux Strait and Golden Bay, respectively. The specific identity of the parasite found in mussels was determined by sequencing PCR products for a portion (676 bp) of the 18S rRNA gene; the resulting sequences were 99-100% similar to APX found in flat oysters. Phylogenetic analyses also confirmed that all isolates from green-lipped, Mediterranean and hairy mussels grouped with APX isolates previously identified from flat oysters. This study indicates the wide geographical distribution of APX and highlights the potentially multi-host specific distribution of the parasite in commercially important bivalve shellfish.

The complete mitochondrial genome of a marine mussel, Modiolus comptus (Mollusca: Mytilidae), and its phylogenetic implication.

In this study, the complete mitochondrial genome of Modiolus comptus was determined and annotated for the first time. The 15,591 bp circular genome has a base composition of 24.3% A, 38.6% T, 12.5% C, and 24.5% G, demonstrating a bias of higher AT content (63.0%) than GC content (27.0%). The mitochondrial genome contains 12 protein-coding genes (PCGs), 20 transfer RNA genes (tRNA), 2 ribosomal RNA genes (12S rRNA and 16S rRNA), and one control region. All genes of M. comptus were encoded on the heavy strand, except trnT(ugu) gene. The whole mitochondrial genome of M. comptus and 21 mitogenomes of other Mytilidae species were used for phylogenetic analysis. The result indicated the newly sequenced species had the closest relationship with Modiolus nipponicus (MK721547) and was clustered within the clade of genus Modiolus.

Cochleostomy and facial recess packing alter cochlear implant electrode location in a human cochlea model.

PURPOSE: Determine the effect of cochleostomy and facial recess packing on cochlear implant electrode distance from the modiolus. MATERIALS AND METHODS: Two otolaryngology residents (PGY5 and PGY6) and one attending ear surgeon performed electrode insertions on a human cochlea model using perimodiolar (Cochlear® Slim Modiolar 532™, CI532) and lateral wall electrodes (Cochlear® Slim Straight 522™, CI522) via a cochleostomy. Packing material was simulated using cotton and placed in the cochleostomy and facial recess under the following conditions: 1) inferior to the electrode, 2) superior, 3) both inferior and superior, and 4) no packing. Distance of the electrode from the modiolus at the proximal, middle, and distal basal turn of the cochlea were measured by photomicrograph analysis. RESULTS: Packing superior to the CI532 resulted in a significant decrease in distance from the modiolus at the middle and distal basal turn compared to the inferior condition, with the largest effect in the middle basal turn (0.25 mm vs. 1.92 mm, respectively, p < 0.001). For the CI522, packing superior similarly resulted in decreased distance to the modiolus when compared to the inferior packing condition at the middle and distal basal turn regions, with the largest effect in the middle basal turn (1.25 mm vs. 1.75 mm, respectively, p = 0.002). CONCLUSIONS: Packing of the cochleostomy site and facial recess has a significant effect on electrode distance from the modiolus in the middle and distal basal turn using a model of a human cochlea. Effects were more pronounced when using the perimodiolar (CI532) electrode.

Protection alone may not promote natural recovery of biogenic habitats of high biodiversity damaged by mobile fishing gears.

The horse mussel Modiolus modiolus (L.) is a large marine bivalve that aggregates to create complex habitats of high biodiversity. As a keystone species, M. modiolus is of great importance for the functioning of marine benthic ecosystems, forming biogenic habitats used to designate Marine Protected Areas (MPAs). The present study investigates the condition of M. modiolus beds historically subjected to intense scallop fishing using mobile fishing gears. The study, conducted seven years after the introduction of legislation banning all forms of fishing, aimed to establish whether natural habitat recovery occurs after protection measures are put in place. Lower biodiversity and up to 80% decline in densities of M. modiolus were recorded across the current distributional range of the species in Strangford Lough, Northern Ireland. The decline in biodiversity in most areas surveyed was consistent with that observed in biogenic reefs impacted by mobile fishing gears elsewhere. Epifauna, including sponges, hydroids and tunicates, experienced the most substantial decline in biodiversity, with up to 64% fewer taxa recorded in 2010 compared with 2003. Higher variability in community composition and a shift towards faunal assemblages dominated by opportunistic infaunal species typical of softer substrata were also detected. Based on these observations we suggest that, for biogenic habitats, the designation of MPAs and the introduction of fishing bans alone may not be sufficient to reverse or halt the negative effects caused by past anthropogenic impacts. Direct intervention, including habitat restoration based on translocation of native keystone species, should be considered as part of management strategies for MPAs which host similar biogenic reef habitats where condition and natural recovery have been compromised.