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Related Concept Videos

The Cochlea01:13

The Cochlea

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The cochlea is a coiled structure in the inner ear that contains hair cells—the sensory receptors of the auditory system. Sound waves are transmitted to the cochlea by small bones attached to the eardrum called the ossicles, which vibrate the oval window that leads to the inner ear. This causes fluid in the chambers of the cochlea to move, vibrating the basilar membrane.
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Related Experiment Video

Updated: Jul 3, 2025

Author Spotlight: Optimizing EAS with Long Electrodes for Enhanced Cochlear Coverage and Hearing Preservation
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Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect.

Simon Ignacio Angeli, C Scott Brown1, Meredith A Holcomb2

  • 1Atlanta Institute for ENT, Atlanta, Georgia.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|February 16, 2024
PubMed
Summary

Pharmacological treatment with prednisone and L-N-acetylcysteine (STE + NAC) significantly improved functional hearing preservation after cochlear implantation. This "Miami Cocktail" approach demonstrated superior outcomes compared to intraoperative steroids alone, with no serious side effects reported.

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Pharmacology

Background:

  • Cochlear implantation (CI) aims to restore hearing, but preserving residual functional hearing is crucial for optimal outcomes.
  • Intraoperative steroids are commonly used, but their efficacy in long-term hearing preservation is variable.

Purpose of the Study:

  • To evaluate the impact of perioperative prednisone and L-N-acetylcysteine (STE + NAC), termed the "Miami Cocktail," on functional hearing preservation in cochlear implant recipients.
  • To compare the efficacy of STE + NAC with intraoperative steroids alone in maintaining low-frequency hearing.

Main Methods:

  • A longitudinal case-control study involving 61 pediatric and adult CI recipients with preimplantation functional hearing (low-frequency pure-tone average [LFPTA] <80 dB).
  • Patients received either intraoperative dexamethasone plus perioperative STE + NAC (n=41) or intraoperative dexamethasone alone (n=20).
  • Audiometry was performed preoperatively and at 1-year postoperatively to assess LFPTA and functional hearing preservation.

Main Results:

  • The STE + NAC group showed a significantly higher proportion of functional hearing preservation at 1 year (83%) compared to the control group (55%; p=0.0302).
  • The median LFPTA change was significantly better in the STE + NAC group (8.33 dB) versus the control group (18.34 dB; p=0.0401), indicating approximately 10 dB better hearing preservation.
  • Preimplantation low-frequency hearing thresholds were predictive of postimplantation hearing, and no serious adverse events were reported with STE + NAC.

Conclusions:

  • Perioperative administration of prednisone and L-N-acetylcysteine (STE + NAC) is safe and effective for enhancing functional hearing preservation 1 year after cochlear implantation.
  • The "Miami Cocktail" regimen is superior to intraoperative steroids alone in preserving low-frequency hearing in CI patients.