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Fatani N, Abdelsamad Y, Alsanosi A. Influence of Cochlear Anatomy on Intraoperative Electrically Evoked Compound Action Potentials. J Clin Med 2024; 13:4716. [PMID: 39200858 PMCID: PMC11355649 DOI: 10.3390/jcm13164716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/10/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Objective: The electrically evoked compound action potential (ECAP) is an objective measure to indirectly assess spiral ganglion neurons. The ECAP provides inputs about the prognoses of cochlear implant (CI) recipients. Several factors such as cochlear morphology can affect ECAP measurements. This study aims to investigate the variation effect of cochlear parameters on intraoperative ECAP thresholds. Methods: This is a retrospective study on patients who underwent CI surgery with normal inner ear morphology at our center between 2017 and 2023. Cochlear anatomical parameters, including diameter (A value), width (B value), and height (H value), as well as cochlear duct length (CDL), were measured pre-operatively using OTOPLAN software (Version 3.0). Cochlear implant intraoperative objective measures were also collected. The correlation between the cochlear parameters and intraoperative objective measures was studied. Results: A total of 45 patients underwent cochlear implantation. The mean age was 2.4 ± 0.9 years. The mean CDL and cochlear coverage values were 33.2 ± 2.0 mm and 76.0 ± 5.7%, respectively. The ECAP threshold increased toward basal electrodes, with ECAP values as follows: apical 13.1 ± 3.8; middle 14.3 ± 3.7; and basal 15.6 ± 4.8. Additionally, the A, B, and H values showed a positive correlation with ECAP thresholds in different cochlear regions. The B value showed a significant moderate correlation with ECAP thresholds in the middle and basal electrodes but not in the apical electrodes. Conclusions: Cochlear anatomical parameters correlate with intraoperative ECAP thresholds. The B value showed a significant association with ECAP thresholds in the middle and basal electrodes. These findings could delineate the impact of the B value in CI and optimize electrode selection. Further research is required to study this correlation and its impact on postoperative outcomes.
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Affiliation(s)
- Nawaf Fatani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh 11411, Saudi Arabia
| | | | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh 11411, Saudi Arabia
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Alahmadi A, Abdelsamad Y, Dhanasingh A, Almuhawas F, Alsanosi A. Enhancing cochlear duct length estimation by incorporating second-turn parameters. Sci Rep 2023; 13:21496. [PMID: 38057331 PMCID: PMC10700305 DOI: 10.1038/s41598-023-48641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
Estimating insertion depth, cochlear duct length (CDL), and other inner ear parameters is vital to optimizing cochlear implantation outcomes. Most current formulas use only the basal turn dimensions for CDL prediction. In this study, we investigated the importance of the second turn parameters in estimating CDL. Two experienced neuro-otologists blindly used segmentation software to measure (in mm) cochlear parameters, including basal turn diameter (A), basal turn width (B), second-turn diameter (A2), second-turn width (B2), CDL, first-turn length, and second-turn length (STL). These readings were taken from 33 computed tomography (CT) images of temporal bones from anatomically normal ears. We constructed regression models using A, B, A2, and B2 values fitted to CDL, two-turn length, and five-fold cross-validation to ensure model validity. CDL, A value, and STL were longer in males than in females. The mean B2/A2 ratio was 0.91 ± 0.06. Adding A2 and B2 values improved CDL prediction accuracy to 86.11%. Therefore, we propose a new formula for more accurate CDL estimation using A, B, A2, and B2 values. In conclusion, the findings of this study revealed a notable improvement in the prediction of two-turn length (2TL), and CDL by clinically appreciable margins upon adding A2 and B2 values to the prediction formulas.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), King Saud University Medical City (KSUMC), College of Medicine, King Saud University, P.O. Box: 245, 11411, Riyadh, Saudi Arabia.
| | | | | | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), King Saud University Medical City (KSUMC), College of Medicine, King Saud University, P.O. Box: 245, 11411, Riyadh, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), King Saud University Medical City (KSUMC), College of Medicine, King Saud University, P.O. Box: 245, 11411, Riyadh, Saudi Arabia
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Swarup A, Karakkandy V, Chappity P, Naik S, Behera SK, Parida PK, Grover M, Gupta G, Giri PP, Sarkar S, Pradhan P, Samal DK, Kallyadan Veetil A, Adhikari A, Nayak S. Comparing accuracy of cochlear measurements on magnetic resonance imaging and computed tomography: A step towards radiation-free cochlear implantation. J Otol 2023; 18:208-213. [PMID: 37877072 PMCID: PMC10593569 DOI: 10.1016/j.joto.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
Objective Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are commonly employed in pre-operative evaluation for cochlear implant surgery. However, with a decrease in the age of implantation, even minor radiation exposure can cause detrimental effects on children over their lifetime. The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation. Methods A longitudinal observational study was conducted on 94 ears/47 children, employing CT and MRI scans. The CT and MRI scan measurements include, A value, B value, Cochlear duct length (CDL), two-turn cochlear length, alpha and beta angles to look for cochlear orientation. Cochlear nerve diameter was measured using MRI. The values were compared. Results The mean difference between measurements from CT and MRI scans for A value, B value, CDL, and two-turn cochlear length values was 0.567 ± 0.413 mm, 0.406 ± 0.368 mm, 2.365 ± 1.675 mm, and 2.063 ± 1.477 mm respectively without any significant difference. The alpha and beta angle measures were comparable, with no statistically significant difference. Conclusion The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population. There is no significant difference between the measurements obtained from CT and MRI scans. However, observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery. This aspect must be addressed to ensure positive outcomes for patients.
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Affiliation(s)
- Anurita Swarup
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Vinusree Karakkandy
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Preetam Chappity
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sanjay Kumar Behera
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Pradipta Kumar Parida
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Mohnish Grover
- Department of ENT, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Gaurav Gupta
- Department of ENT, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Prajna Paramita Giri
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Saurav Sarkar
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Pradeep Pradhan
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Dillip Kumar Samal
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Aswathi Kallyadan Veetil
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Asutosh Adhikari
- Department of ENT and HNS, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Saurav Nayak
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Curtis DP, Baumann AN, Jeyakumar A. Variation in cochlear size: A systematic review. Int J Pediatr Otorhinolaryngol 2023; 171:111659. [PMID: 37459768 DOI: 10.1016/j.ijporl.2023.111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/22/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Advancements in imaging and implantation technology have invited reexamination of the classic teaching that the human cochlea maintains uniform size across demographics. Yet, studies yield conflicting results and relatively few broad systematic reviews have examined cochlear size variation. PURPOSE The purpose of this study is to quantify cochlear variability across eight different measurement categories and suggest normative values and ranges for each with consideration of disease state and gender where possible. METHODS A systematic search was conducted up to October 1, 2022, using the search terms "Cochlea/anatomy and histology"[Mesh]) AND 'size'" with filters "Humans" and "English" across three databases (PubMed, CINAHL, Medline). Further inclusion criteria involved reporting of numerical measurements in any of the eight included categories. RESULTS Of the 625 articles manually reviewed for relevance by title and abstract, 91 were selected for full-text review and 33 met all eligibility criteria. 5,791 cochleae were included and weighted means and ranges were calculated: "A" value (defined as the distance from the round window, through the modiolus, to the oppsite lateral wall) = 9.23 mm (8.43-10.4 mm, n = 2559); cochlear duct length (CDL) = 33.04 mm (range 28.2-36.4 mm, n = 2252); cochlear height = 5.14 mm (2.8-6.9 mm, n = 2098); the basal turn lumen diameter = 2.09 mm (1.7-2.2 mm, n = 617); "B" value (defined as perpendicular to "A" value and in the same plane) = 6.52 mm (5.73-6.9 mm, n = 908); width of the basal turn = 6.4 mm (6.22-6.86 mm, n = 356); height of the basal turn = 1.96 mm (1.77-2.56 mm, n = 204); length of the basal turn 21.87 mm (21.03-22.5 mm, n = 384). CONCLUSION A notable size range exists across the eight different cochlear parameters considered and we provide normative values for each measurement. Females tend to have smaller CDL and "A" value than males and the sensorineural hearing loss patients had smaller CDL and "A" value but larger cochlear height than the general population.
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Affiliation(s)
| | | | - Anita Jeyakumar
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, OH, 44512, USA
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Alothman N, Almuhawas F, Badghaish R, Alotaibi AH, Alhabib SF, Alzhrani F, Hagr A. Cochlear Implantation in Pediatrics: The Effect of Cochlear Coverage. J Pers Med 2023; 13:jpm13030562. [PMID: 36983743 PMCID: PMC10051355 DOI: 10.3390/jpm13030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
The effect of insertion depth and position of cochlear implant (CI) electrode arrays on speech perception remains unclear. This study aimed to determine the relationship between cochlear coverage and speech performance in children with prelingual hearing loss with CI. Pure tone audiometry (PTA) and speech audiometry, including speech reception threshold (SRT) using spondee words and speech discrimination score (SDS) using phonetically balanced monosyllabic words, were tested. The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scales were also used. Thirty-one ears were implanted with the FLEX 28 electrode array, and 54 with the FORM 24 were included in the current study. For the studied ear, the mean cochlear duct length was 30.82 ± 2.24 mm; the mean cochlear coverage was 82.78 ± 7.49%. Cochlear coverage was a significant negative predictor for the mean pure tone threshold across frequecnies of 0.5, 1, 2, and 4 kHz (PTA4) (p = 0.019). Cochlear coverage was a significant positive predictor of SDS (p = 0.009). In children with cochlear coverage ≥ 82.78%, SDS was significantly better than in those with coverage < 82.78% (p = 0.04). Cochlear coverage was not a significant predictor of the SRT, CAP, or SIR. In conclusion, the cochlear coverage of the CI electrode array has an impact on the users' SDS. Further long-term studies with larger sample sizes should be conducted to address the most critical factors affecting CI recipients' outcomes.
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Affiliation(s)
- Noura Alothman
- Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 84428, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Reem Badghaish
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Al Hanouf Alotaibi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Salman F Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
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Ren LJ, Yu Y, Zhang YH, Liu XD, Sun ZJ, Yao WJ, Zhang TY, Wang C, Li CL. Three-dimensional finite element analysis on cochlear implantation electrode insertion. Biomech Model Mechanobiol 2022; 22:467-478. [PMID: 36513945 DOI: 10.1007/s10237-022-01657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Studying the insertion process of cochlear implant (CI) electrode array (EA) is important to ensure successful, sufficient, and safe implantation. A three-dimensional finite element (FE) model was developed to simulate the insertion process. The cochlear structures were reconstructed from an average statistical shape model (SSM) of human cochlea. The electrode is simplified as a long and tapered beam of homogeneous elastic materials, contacting and interacting with the stiff cochlear structures. A quasi-static insertion simulation was conducted, the insertion force and the contact pressure between the electrode and the cochlear wall, were calculated to evaluate the smoothness of insertion and the risk of potential cochlear trauma. Based on this model, different EA designs were analyzed, including the Young's modulus, the straight or bended shape, the normal or a more tapped section size. The influence of the insertion angle was also discussed. Our simulations indicate that reducing the EA Young's modulus, tapering and pre-bending are effective ways to ensure safe and successful EA implantation. This model is beneficial for optimizing EA designs and is potentially useful for designing patient-specific CI surgery.
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Affiliation(s)
- Liu-Jie Ren
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Yi Yu
- School of Medical Instrumentation, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yu-Heng Zhang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Xin-Dong Liu
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Zeng-Jun Sun
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Wen-Juan Yao
- School of Mechanics and Engineering Science, Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai, 200444, China
| | - Tian-Yu Zhang
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Cheng Wang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China.
| | - Chen-Long Li
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China.
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de Boer J, Hardy A, Krumbholz K. Could Tailored Chirp Stimuli Benefit Measurement of the Supra-threshold Auditory Brainstem Wave-I Response? J Assoc Res Otolaryngol 2022; 23:787-802. [PMID: 35984541 PMCID: PMC9789297 DOI: 10.1007/s10162-022-00848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/08/2022] [Indexed: 01/06/2023] Open
Abstract
Auditory brainstem responses (ABRs) to broadband clicks are strongly affected by dyssynchrony, or "latency dispersion", of their frequency-specific cochlear contributions. Optimized chirp stimuli, designed to compensate for cochlear dispersion, can afford substantial increase in broadband ABR amplitudes, particularly for the prominent wave-V deflection. Reports on the smaller wave I, however, which may be useful for measuring cochlear synaptopathy, have been mixed. This study aimed to test previous claims that ABR latency dispersion differs between waves I and V, and between males and females, and thus that using wave- and/or sex-tailored chirps may provide more reliable wave-I benefit. Using the derived-band technique, we measured responses from frequency-restricted (one-octave-wide) cochlear regions to energy-matched click and chirp stimuli. The derived-band responses' latencies were used to assess any wave- and/or sex-related dispersion differences across bands, and their amplitudes, to evaluate any within-band dispersion differences. Our results suggest that sex-related dispersion difference within the lowest-frequency cochlear regions (< 1 kHz), where dispersion is generally greatest, may be a predominant driver of the often-reported sex difference in broadband ABR amplitude. At the same time, they showed no systematic dispersion difference between waves I and V. Instead, they suggest that reduced chirp benefit on wave I may arise as a result of chirp-induced desynchronization of on- and off-frequency responses generated at the same cochlear places, and resultant reduction in response contributions from higher-frequency cochlear regions, to which wave I is thought to be particularly sensitive.
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Affiliation(s)
- Jessica de Boer
- Hearing Sciences, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Science Road, Nottingham, NG7 2RD UK
- Nottingham Biomedical Research Centre, Queens Medical Centre, Hearing Theme, Nottingham, NG7 2UH UK
| | - Alexander Hardy
- Hearing Sciences, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Science Road, Nottingham, NG7 2RD UK
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - Katrin Krumbholz
- Hearing Sciences, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Science Road, Nottingham, NG7 2RD UK
- Nottingham Biomedical Research Centre, Queens Medical Centre, Hearing Theme, Nottingham, NG7 2UH UK
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Dhanasingh AE, Weiss NM, Erhard V, Altamimi F, Roland P, Hagr A, Van Rompaey V, Van de Heyning P. A novel three-step process for the identification of inner ear malformation types. Laryngoscope Investig Otolaryngol 2022; 7:2020-2028. [PMID: 36544941 PMCID: PMC9764783 DOI: 10.1002/lio2.936] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022] Open
Abstract
Objective We hypothesize that visualizing inner-ear systematically in both cochlear view (oblique coronal plane) and in mid-modiolar section (axial plane) and following three sequential steps simplifies, identification of inner-ear malformation types. Methods Pre-operative computer-tomography (CT) scans of temporal bones of 112 ears with various inner ear malformation (IEM) types were taken for analysis. Images were analyzed using DICOM viewers, 3D slicer, and OTOPLAN®. The inner-ear was captured in the oblique-coronal plane for the measurement of length and width of cochlear basal turn which is also called as A-, and B-values respectively (Step 1). In the same plane, the angular-turns of lateral-wall (LW) of cochlear basal turn were measured (Step 2). As Step 3, the mid-modiolar section of inner ear was captured in the axial plane by following the A-value and perpendicular to cochlear view. From the mid-modiolar section, the outer-contour of inner ear was captured manually by following contrasting gray area between fluid filled and bony promontory and was compared to known resembling objects to identify IEM types (Step 3). Results Following reference values have emerged from our analysis: A-, and B-values (Step 1) on average are >8 mm and >5.5 mm respectively, in normal cochleae (NA), enlarged vestibular aqueduct syndrome (EVAS), incomplete partition (IP) type-I and -II, whereas it is <8 mm and <5.5 mm respectively, in IP type-III and cochlear hypoplasia (CH). Angular-turn of LW is consistently observed in cochlear basal turn (Step 2), is 540° in NA and EVAS, 450° in IP-II, and 360° in IP types I & III. In subjects with CH type, angular-turn of LW is either 360° or 450° or 540°. In true mid-modiolar section, outer-contour of inner-ear (Step-3), other than in CH and cystic inner-ear malformations, resembles recognizable shapes of known objects. Absence of EVA is an additional characteristic that confirms diagnosis of CH when the A-, B-values, and angular-turn of LW can be similar to other anatomical types. Drawing a straight line along posterior edge of internal auditory canal (IAC) in axial view can differentiate a true common cavity (CC) from cochlear aplasia-vestibular cavity (VC). Conclusion Three-step process proposed in this study captures inner-ear in cochlear view as well in mid-modiolar sections visualizing key features of inner-ear in identification of IEM types. Level of Evidence Level 1.
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Affiliation(s)
- Anandhan E. Dhanasingh
- Research and Development Department, MED‐ELInnsbruckAustria,Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Nora M. Weiss
- Department of Otorhinolaryngology‐Head and Neck SurgeryRuhr‐University Bochum, St. Elisabeth‐Hospital BochumBochumGermany
| | | | - Fahad Altamimi
- Cochlear Implant CenterKing Saud Medical CityRiyadhSaudi Arabia,Otolaryngology Head and Neck Surgery, College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Peter Roland
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC)King Saud UniversityRiyadhSaudi Arabia
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium,Department of Otorhinolaryngology and Head & Neck SurgeryAntwerp University HospitalAntwerpBelgium
| | - Paul Van de Heyning
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium,Department of Otorhinolaryngology and Head & Neck SurgeryAntwerp University HospitalAntwerpBelgium
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Baguant A, Cole A, Vilotitch A, Quatre R, Schmerber S. Difference in cochlear length between male and female patients. Cochlear Implants Int 2022; 23:326-331. [PMID: 35860840 DOI: 10.1080/14670100.2022.2101534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To compare cochlear duct length (CDL) between male and female patients by evaluating the diameter of the basal turn (distance A) on CT scans.Method: All temporal bone CT scans performed between 2014 and 2020 were reviewed in our medical center. Using multiplanar reconstructions, the length A, which is the greatest distance of the basal turn was measured on both sides. We performed an analysis of variance considering two factors: sex and side. Two different physicians carried out the measurements, an otolaryngologist and a neuroradiologist. The patients who had several CT scans allowed us to evaluate the reliability of our procedure.Results: Among the 888 CT scans reviewed, 8 were excluded because of cochlear malformations. The inter-sex difference of length A was found to be 0.29 millimeters(mm) 95% IC [0.26-0.34] and was longer in the male group (p < 0.0001). Using Alexiades' equation, we found that CDL was 34.5mm [34.37-34.61] in the male group and 33.3mm [33.13-33.38] in the female group. When one side was compared to the other, there was no significant difference (p = 0.226). An intra-class correlation found a good absolute agreement between the two screeners of 0.79.Conclusion: Males have a statistically significant longer CDL than females.
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Affiliation(s)
- Ashley Baguant
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Anthony Cole
- Neuroradiology and MR Unit, CS 10217- Grenoble University Hospital, Grenoble, France
| | - Antoine Vilotitch
- French National Center for Scientific Research, Department of Public Health, Grenoble University, Grenoble, France
| | - Raphaele Quatre
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Sebastien Schmerber
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.,School of Medicine, Domaine de la Merci, Grenoble Alpes University, Grenoble, France
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10
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Walia A, Shew MA, Ettyreddy A, Lefler SM, Jiramongkolchai P, Wick CC, Durakovic N, Buchman CA, Herzog JA. Early Hearing Preservation Outcomes Following Cochlear Implantation With New Slim Lateral Wall Electrode Using Electrocochleography. Otol Neurotol 2022; 43:443-451. [PMID: 35170555 PMCID: PMC8959404 DOI: 10.1097/mao.0000000000003475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe early hearing preservation (HP) cochlear implantation (CI) outcomes using a new slim lateral wall electrode (SLWE). STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. PATIENTS Adult CI candidates with preoperative low-frequency pure-tone average (LFPTA; 125, 250, 500 Hz) ≤60 dB HL. INTERVENTION CI with and without intracochlear real-time electrocochleography (RT-ECochG). MAIN OUTCOME MEASURE HP (LFPTA ≤80 dB HL), LFPTA shift, speech-perception performance measures, postoperative CT reconstruction. RESULTS Forty-two subjects were implanted with the SLWE. Thirty patients underwent full insertion without RT-ECochG feedback, and HP was maintained at 3-months postactivation for 7 (23.3%) patients with mean LFPTA shift of 57.5 ± 25.6 dB HL. RT-ECochG feedback was utilized on 12 patients, of whom 6 patients had full insertions and 6 patients had anywhere from 1 to 3 electrodes left outside of the cochlea based on RT-ECochG feedback. At 3 months postoperatively, HP was achieved on 10 (83.3%) patients and mean LFPTA shift was 18.9 c 11.7 dB HL. Mean difference between LFPTA threshold shift at 3-months postactivation with and without RT-ECochG was 38.6 dB HL (95% CI, 25.6-51.67). There was an improvement in delta CNC from preoperative to 3-months postactivation when using RT-ECochG, with mean difference 20.7% (95% CI, 3.3-38.1). CONCLUSIONS Use of RT-ECochG monitoring during SLWE placement results in fewer full electrode insertions and significantly better HP rates and speech-perception outcomes when compared with unmonitored insertions. Further investigation is needed to evaluate long-term audiologic outcomes to better understand the relationships among ECochG, cochlear trauma, functional outcomes, and HP.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Matthew A. Shew
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Abhinav Ettyreddy
- Department of Otolaryngology—Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shannon M. Lefler
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Pawina Jiramongkolchai
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Cameron C. Wick
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Craig A. Buchman
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Jacques A. Herzog
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
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11
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Walia A, Shew MA, Lefler SM, Kallogjeri D, Wick CC, Holden TA, Durakovic N, Ortmann AJ, Herzog JA, Buchman CA. Is Characteristic Frequency Limiting Real-Time Electrocochleography During Cochlear Implantation? Front Neurosci 2022; 16:915302. [PMID: 35937872 PMCID: PMC9354607 DOI: 10.3389/fnins.2022.915302] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Electrocochleography (ECochG) recordings during cochlear implantation have shown promise in estimating the impact on residual hearing. The purpose of the study was (1) to determine whether a 250-Hz stimulus is superior to 500-Hz in detecting residual hearing decrement and if so; (2) to evaluate whether crossing the 500-Hz tonotopic, characteristic frequency (CF) place partly explains the problems experienced using 500-Hz. Design Multifrequency ECochG comprising an alternating, interleaved acoustic complex of 250- and 500-Hz stimuli was used to elicit cochlear microphonics (CMs) during insertion. The largest ECochG drops (≥30% reduction in CM) were identified. After insertion, ECochG responses were measured using the individual electrodes along the array for both 250- and 500-Hz stimuli. Univariate regression was used to predict whether 250- or 500-Hz CM drops explained low-frequency pure tone average (LFPTA; 125-, 250-, and 500-Hz) shift at 1-month post-activation. Postoperative CT scans were performed to evaluate cochlear size and angular insertion depth. Results For perimodiolar insertions (N = 34), there was a stronger linear correlation between the largest ECochG drop using 250-Hz stimulus and LFPTA shift (r = 0.58), compared to 500-Hz (r = 0.31). The 250- and 500-Hz CM insertion tracings showed an amplitude peak at two different locations, with the 500-Hz peak occurring earlier in most cases than the 250-Hz peak, consistent with tonotopicity. When using the entire array for recordings after insertion, a maximum 500-Hz response was observed 2-6 electrodes basal to the most-apical electrode in 20 cases (58.9%). For insertions where the apical insertion angle is >350 degrees and the cochlear diameter is <9.5 mm, the maximum 500-Hz ECochG response may occur at the non-apical most electrode. For lateral wall insertions (N = 14), the maximum 250- and 500-Hz CM response occurred at the most-apical electrode in all but one case. Conclusion Using 250-Hz stimulus for ECochG feedback during implantation is more predictive of hearing preservation than 500-Hz. This is due to the electrode passing the 500-Hz CF during insertion which may be misidentified as intracochlear trauma; this is particularly important in subjects with smaller cochlear diameters and deeper insertions. Multifrequency ECochG can be used to differentiate between trauma and advancement of the apical electrode beyond the CF.
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12
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Fan Y, Zhang D, Banalagay R, Wang J, Noble JH, Dawant BM. Hybrid active shape and deep learning method for the accurate and robust segmentation of the intracochlear anatomy in clinical head CT and CBCT images. J Med Imaging (Bellingham) 2021; 8:064002. [PMID: 34853805 DOI: 10.1117/1.jmi.8.6.064002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: Robust and accurate segmentation methods for the intracochlear anatomy (ICA) are a critical step in the image-guided cochlear implant programming process. We have proposed an active shape model (ASM)-based method and a deep learning (DL)-based method for this task, and we have observed that the DL method tends to be more accurate than the ASM method while the ASM method tends to be more robust. Approach: We propose a DL-based U-Net-like architecture that incorporates ASM segmentation into the network. A quantitative analysis is performed on a dataset that consists of 11 cochlea specimens for which a segmentation ground truth is available. To qualitatively evaluate the robustness of the method, an experienced expert is asked to visually inspect and grade the segmentation results on a clinical dataset made of 138 image volumes acquired with conventional CT scanners and of 39 image volumes acquired with cone beam CT (CBCT) scanners. Finally, we compare training the network (1) first with the ASM results, and then fine-tuning it with the ground truth segmentation and (2) directly with the specimens with ground truth segmentation. Results: Quantitative and qualitative results show that the proposed method increases substantially the robustness of the DL method while having only a minor detrimental effect (though not significant) on its accuracy. Expert evaluation of the clinical dataset shows that by incorporating the ASM segmentation into the DL network, the proportion of good segmentation cases increases from 60/177 to 119/177 when training only with the specimens and increases from 129/177 to 151/177 when pretraining with the ASM results. Conclusions: A hybrid ASM and DL-based segmentation method is proposed to segment the ICA in CT and CBCT images. Our results show that combining DL and ASM methods leads to a solution that is both robust and accurate.
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Affiliation(s)
- Yubo Fan
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | | | - Rueben Banalagay
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| | - Jianing Wang
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| | - Jack H Noble
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| | - Benoit M Dawant
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
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13
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Cooperman SP, Aaron KA, Fouad A, Tran E, Blevins NH, Fitzgerald MB. Influence of electrode to cochlear duct length ratio on post-operative speech understanding outcomes. Cochlear Implants Int 2021; 23:59-69. [PMID: 34590531 DOI: 10.1080/14670100.2021.1979289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess whether the pre-operative electrode to cochlear duct length ratio (ECDLR), is associated with post-operative speech recognition outcomes. STUDY DESIGN A retrospective chart review study. SETTING Tertiary referral center. PATIENTS The study included sixty-one adult CI recipients with a pre-operative computed tomography scan and a speech recognition test 12 months after implantation. INTERVENTIONS The average of two raters' cochlear duct length (CDL) measurements and the length of the recipient's cochlear implant electrode array formed the basis for the electrode-to-cochlear duct length ratio (ECLDR). Speech recognition tests were compared as a function of ECDLR and electrode array length itself. MAIN OUTCOME MEASURES The relationship between ECDLR and percent correct on speech recognition tests. RESULTS A second order polynomial regression relating ECDLR to percent correct on the CNC words speech recognition test was statistically significant, as was a fourth order polynomial regression for the AzBio Quiet test. In contrast, there was no statistically significant relationship between speech recognition scores and electrode array length. CONCLUSIONS ECDLR values can be statistically associated to speech-recognition outcomes. However, these ECDLR values cannot be predicted by the electrode length alone, and must include a measure of CDL.
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Affiliation(s)
- Shayna P Cooperman
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Ksenia A Aaron
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Ayman Fouad
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA.,Otolaryngology Department, Tanta University, Tanta, Egypt
| | - Emma Tran
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Nikolas H Blevins
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Matthew B Fitzgerald
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
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14
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Eser MB, Atalay B, Kalcıoğlu MT. Is Cochlear Length Related to Congenital Sensorineural Hearing Loss: Preliminary Data. J Int Adv Otol 2021; 17:1-8. [PMID: 32147598 DOI: 10.5152/iao.2020.7863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study used the data from patients with congenital sensorineural hearing loss (CSNHL) and those with normal hearing to measure and compare the length of the cochlea with high-resolution computed tomography (HRCT). MATERIALS AND METHODS HRCT images of patients who were diagnosed with CSNHL and were candidates for cochlear implantation were evaluated retrospectively. Sixty-three ears of 33 patients were included in the study. The control group comprised 66 ears of 33 individuals. The measurements were conducted by an experienced radiologist, using three-dimensional curved multiplanar reconstruction. All the measurements were performed thrice, and the average was calculated. RESULTS The data were distributed normally. The lengths of the cochlear components for the CSNHL and control groups were as follows: basal turn 21.66±1.01 (21.30-22.02) and 22.57±0.68 (22.32-22.81) mm, middle turn 11.58±0.69 (11.34-11.83) and 12.39±0.46 (12.23-12.56) mm, and apical turn 6.45±0.92 (6.12-6.77) and 7.12±0.65 (6.89-7.35) mm, respectively. The mean cochlear lateral wall (LW) length was significantly shorter in the CSNHL patients [39.71±1.32 (39.25-40.18) mm] than in the controls [42.09±1.17 (41.67-42.51) mm], (p<0.001). The intra-rater reliability was 0.878 (confidence interval 95%: 0.841-0.908 p<0.001). The cut-off value was 40.81 mm (sensitivity: 0.91, specificity: 0.94, and accuracy: 0.90). CONCLUSION There were microanatomic dissimilarities between the length of the cochlea in subjects from the CSNHL group and those from the control group.
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Affiliation(s)
- Mehmet Bilgin Eser
- Department of Radiology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Başak Atalay
- Department of Radiology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Mahmut Tayyar Kalcıoğlu
- Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul Medeniyet University School of Medicine, İstanbul, Turkey
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15
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Spiegel JL, Polterauer D, Hempel JM, Canis M, Spiro JE, Müller J. Variation of the cochlear anatomy and cochlea duct length: analysis with a new tablet-based software. Eur Arch Otorhinolaryngol 2021; 279:1851-1861. [PMID: 34050805 PMCID: PMC8930796 DOI: 10.1007/s00405-021-06889-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/17/2021] [Indexed: 01/06/2023]
Abstract
Purpose In cochlear implantation, thorough preoperative planning together with measurement of the cochlear duct length (CDL) assists in choosing the correct electrode length. For measuring the CDL, different techniques have been introduced in the past century along with the then available technology. A tablet-based software offers an easy and intuitive way to visualize and analyze the anatomy of the temporal bone, its proportions and measure the CDL. Therefore, we investigated the calculation technique of the CDL via a tablet-based software on our own cohort retrospectively. Methods One hundred and eight preoperative computed tomography scans of the temporal bone (slice thickness < 0.7 mm) of already implanted FLEX28™ and FLEXSOFT™ patients were found eligible for analysis with the OTOPLAN software. Measurements were performed by two trained investigators independently. CDL, angular insertion depth (AID), and cochlear coverage were calculated and compared between groups of electrode types, sex, sides, and age. Results Mean CDL was 36.2 ± 1.8 mm with significant differences between sex (female: 35.8 ± 0.3 mm; male: 36.5 ± 0.2 mm; p = 0.037), but none concerning side or age. Differences in mean AID (FLEX28: 525.4 ± 46.4°; FLEXSOFT: 615.4 ± 47.6°), and cochlear coverage (FLEX28: 63.9 ± 5.6%; FLEXSOFT: 75.8 ± 4.3%) were significant (p < 0.001). Conclusion A broad range of CDL was observed with significant larger values in male, but no significant differences concerning side or age. Almost every cochlea was measured longer than 31.0 mm. Preoperative assessment aids in prevention of complications (incomplete insertion, kinking, tipfoldover), attempt of atraumatic insertion, and addressing individual necessities (hearing preservation, cochlear malformation). The preferred AID of 720° (two turns of the cochlea) was never reached, opening the discussion for the requirement of longer CI-electrodes versus a debatable audiological benefit for the patient in his/her everyday life. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06889-0.
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Affiliation(s)
- Jennifer L Spiegel
- Department of Otorhinolaryngology, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
| | - Daniel Polterauer
- Department of Otorhinolaryngology, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - John-Martin Hempel
- Department of Otorhinolaryngology, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Judith E Spiro
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Joachim Müller
- Department of Otorhinolaryngology, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
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16
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Cooperman SP, Aaron KA, Fouad A, Tran E, Blevins NH, Fitzgerald MB. Assessment of Inter- and Intra-Rater Reliability of Tablet-Based Software to Measure Cochlear Duct Length. Otol Neurotol 2021; 42:558-565. [PMID: 33492059 DOI: 10.1097/mao.0000000000003015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to build upon previous work validating a tablet-based software to measure cochlear duct length (CDL). Here, we do so by greatly expanding the number of cochleae (n = 166) analyzed, and examined whether computed tomography (CT) slice thickness influences reliability of CDL measurements. STUDY DESIGN Retrospective chart review study. SETTING Tertiary referral center. PATIENTS Eighty-three adult cochlear implant recipients were included in the study. Both cochleae were measured for each patient (n = 166). INTERVENTIONS Three raters analyzed the scans of 166 cochleae at 2 different time points. Each rater individually identified anatomical landmarks that delineated the basal turn diameter and width. These coordinates were applied to the elliptic approximation method (ECA) to estimate CDL. The effect of CT scan slice thickness on the measurements was explored. MAIN OUTCOME MEASURES The primary outcome measure is the strength of the inter- and intra-rater reliability. RESULTS The mean CDL measured was 32.84 ± 2.03 mm, with a range of 29.03 to 38.07 mm. We observed no significant relationship between slice thickness and CDL measurement (F1,164 = 3.04; p = 0.08). The mean absolute difference in CDL estimations between raters was 1.76 ± 1.24 mm and within raters was 0.263 ± 0.200 mm. The intra-class correlation coefficient (ICC) between raters was 0.54 and ranged from 0.63 to 0.83 within raters. CONCLUSIONS This software produces reliable measurements of CDL between and within raters, regardless of CT scan thickness.
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Affiliation(s)
- Shayna P Cooperman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Ksenia A Aaron
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Ayman Fouad
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
- Otolaryngology Department, Tanta University, Tanta, Egypt
| | - Emma Tran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Matthew B Fitzgerald
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
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17
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Khurayzi T, Almuhawas F, Alsanosi A, Abdelsamad Y, Doyle Ú, Dhanasingh A. A novel cochlear measurement that predicts inner-ear malformation. Sci Rep 2021; 11:7339. [PMID: 33795738 PMCID: PMC8016924 DOI: 10.1038/s41598-021-86741-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
The A-value used in cochlear duct length (CDL) estimation does not take malformed cochleae into consideration. The objective was to determine the A-value reported in the literature, to assess the accuracy of the A-value measurement and to evaluate a novel cochlear measurement in distinguishing malformed cochlea. High resolution Computer Tomography images in the oblique coronal plane/cochlear view of 74 human temporal bones were analyzed. The A-value and novel C-value measurement were evaluated as predictors of inner ear malformation type. The proximity of the facial nerve to the basal turn was evaluated subjectively. 26 publications report on the A-value; but they do not distinguish normal vs. malformed cochleae. The A-values of the normal cochleae compared to the cochleae with cochlear hypoplasia, incomplete partition (IP) type I, -type II, and -type III were significantly different. The A-value does not predict the C-value. The C-values of the normal cochleae compared to the cochleae with IP type I and IP type III were significantly different. The proximity of the facial nerve to the basal turn did not relate to the type of malformation. The A-value is different in normal vs. malformed cochleae. The novel C-value could be used to predict malformed anatomy, although it does not distinguish all malformation types.
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Affiliation(s)
- Tawfiq Khurayzi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia. .,King Fahad Central Hospital, Ministry of Health, Jizan, 82666, Saudi Arabia.
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia
| | | | - Úna Doyle
- Research and Development Department, MED-EL GmbH, Innsbruck, Austria
| | - Anandhan Dhanasingh
- Research and Development Department, MED-EL GmbH, Innsbruck, Austria.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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18
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Singh A, Kumar R, Manchanda S, Bhalla AS, Sagar P, Irugu DVK. Radiographic Measurement of Cochlear Duct Length in an Indian Cadaveric Population - Importance of Custom Fit Cochlear Implant Electrodes. Int Arch Otorhinolaryngol 2020; 24:e492-e495. [PMID: 33101517 PMCID: PMC7575389 DOI: 10.1055/s-0040-1701272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction
Successful cochlear implantation requires an appropriate insertion depth of the electrode, which depends on cochlear duct length CDL). The CDL can vary due to ethnic factors.
Objective
The objective of the current study was to determine the CDL in an Indian adult cadaveric population.
Methods
The present was a cadaveric study using the temporal bones obtained after permission of the Institutional Review Board. The temporal bones were subjected to high-resolution computed tomography (HRCT), and the double oblique reformatted CT images were reconstructed through the basal turn of the cochlea. The reformatted images were then viewed in the minimum-intensity projection (minIP) mode, and the ‘A’ value (the diameter of the basal turn of the cochlea) was calculated. The CDL was then measured using the formula CDL = 4.16A - 4 (Alexiades et al). The data analysis was performed using the Microsoft Excel software, version 2016.
Results
A total of 51 temporal bones were included for imaging analysis. The CDL varied from 27.6 mm to 33.4 mm, with a mean length of 30.7 mm. There was no statistically significant difference between the two sides.
Conclusion
The CDL can be calculated with preoperative high-resolution CT, and can provide a roadmap for effective cochlear implant electrode insertion. The population-based anatomical variability needs to be taken into account to offer the most efficient and least traumatic insertion of the electrode.
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Affiliation(s)
- Anup Singh
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - David Victor Kumar Irugu
- Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Curvilinear Multiplanar Reconstruction to Predict Useful Length and Diameter of Cochlear Lumen for Cochlear Implantation. Otol Neurotol 2020; 41:e1207-e1213. [PMID: 32976342 DOI: 10.1097/mao.0000000000002829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate the useful length and the diameter of the cochlear lumen (CL) using routine imaging before cochlear implantation to study inter-individual variability and its impact on the insertion depth of the electrode carrier (EC). STUDY DESIGN Prospective cross-sectional study. SETTING Tertiary referral center. PATIENTS Thirty-one preoperative and postimplantation temporal bone CT scans were analyzed by two investigators. INTERVENTION Images were analyzed via orthogonal multiplanar reconstruction (Osirix) to measure the lengths of the entire CL and the basal turn. By means of curvilinear reconstruction, the CL was unfolded and the diameters of the CL and of the EC were measured every 2 mm from the round window (RW) to the apex. RESULTS Very high-inter individual variability was found for the length of the basal turn (RSD > 1000%), the entire CL length (RSD > 800%), and the CL diameter at the RW (RSD > 600%). CL diameter was not correlated to the CL length. The inserted EC/total visible CL length ratio was 1.0 ± 0.12. Reliability of the measures was acceptable for the CL length and the diameter at 16 mm from the RW (Crohnbach's alpha > 0.7, n = 31). CONCLUSION CL length and diameter can be directly measured in a reliable manner by commercially available tools. These parameters potentially influence the EC insertion and should be assessed before cochlear implant surgery.
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Dhanasingh A. The rationale for FLEX (cochlear implant) electrode with varying array lengths. World J Otorhinolaryngol Head Neck Surg 2020; 7:45-53. [PMID: 33474544 PMCID: PMC7801259 DOI: 10.1016/j.wjorl.2019.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/28/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022] Open
Abstract
With cochlear implantation (CI) being the standard of care for profoundly deaf cases, more and more patients with low frequency residual hearing are currently being treated with CI. In view of preserving the residual hearing, the ultimate aim of both the surgeons and the CI companies is to achieve zero-degree of electrode insertion trauma. Variations in the size and shape of cochlea, cross-sectional dimensions of ST, electrode insertion techniques with and without metal stylet rod and the experience level of the operating surgeons, all play a role in the electrode array related insertion trauma. An effective electrode design must include flexible array to accommodate the cochlear shape variation, electrode with variety of array lengths to support the concept of cochlear size specific electrode array and finally smaller cross-sectional dimensions of electrode array in matching the cross-sectional dimensions of ST. As per published reports, FLEX electrode array design offers minimal degree of electrode insertion trauma along with the possibility of patient specific electrode array length matching their cochlear size. Looking at the cross-sectional dimensions of FLEX electrode array along with its volume, it appear to be highly safe to the cochlea by not taking too much volume inside the ST. To offer additional support, otological pre-planning software tool like OTOPLAN is now clinically available in measuring the cochlear size in finding the best electrode array match along with the possibilities of anatomy based post-operative speech processor fitting.
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Bramhall N, Beach EF, Epp B, Le Prell CG, Lopez-Poveda EA, Plack CJ, Schaette R, Verhulst S, Canlon B. The search for noise-induced cochlear synaptopathy in humans: Mission impossible? Hear Res 2019; 377:88-103. [DOI: 10.1016/j.heares.2019.02.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Dhanasingh A. Variations in the Size and Shape of Human Cochlear Malformation Types. Anat Rec (Hoboken) 2019; 302:1792-1799. [PMID: 30980504 PMCID: PMC6767414 DOI: 10.1002/ar.24136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/08/2019] [Accepted: 01/28/2019] [Indexed: 02/04/2023]
Abstract
The objective of this study is to determine the variations in size and shape of the most widely recognized cochlear malformation types using three-dimensional (3D) visualization. Using 3D slicer freeware, the complete inner-ear structures were segmented from 46 anonymized high-resolution computed tomography (HRCT) image datasets. Cochlear height, internal auditory canal height, and width were measured from the axial plane. Cochlear basal turn diameter was measured from the oblique coronal plane. Number of cochlear turns was measured from the 3D images and the corresponding cochlear duct length (CDL) was estimated using the CDL equations given in Alexiades et al. [Otol Neurotol 36 (2015) 904-907]. Out of 46 preoperative HRCT image datasets of human temporal bone, cochlear anatomy types including normal anatomy (4), enlarged vestibular aqueduct syndrome (3), cochlear aplasia (2), incomplete partition Types I (8), II (Mondini's deformity) (3), and III (X-linked) (4), cochlear hypoplasia (CH) (17), and common cavity (CC) (5) were identified. Majority of CH cases had cochlear height shorter than 4 mm whereas the CC cases measured cochlear height above 6 mm. For all the other malformation types, cochlear height was between 4 and 6 mm. In terms of "A" value, majority of CH cases showed shorter "A" value of <7.5 mm, which is in the lower end in comparison to the rest of the malformation types reported in this study. 3D-visualization shows the size and shape variations of all the structures of inner ear and also improves the clinicians' ability to visualize cochlear anatomy and nearby structures much easier than from the 2D image slices. Anat Rec, 302:1792-1799, 2019. © 2019 The Author. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association for Anatomy.
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Skarzynski H, Lorens A, Dziendziel B, Rajchel J, Matusiak M, Skarzynski P. Electro-Natural Stimulation in Partial Deafness Treatment of Adult Cochlear Implant Users: Long-Term Hearing Preservation Results. ORL J Otorhinolaryngol Relat Spec 2019; 81:63-72. [DOI: 10.1159/000497060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022]
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Dhanasingh A. Cochlear duct length along the outer wall vs organ of corti: Which one is relevant for the electrode array length selection and frequency mapping using Greenwood function? World J Otorhinolaryngol Head Neck Surg 2018; 5:117-121. [PMID: 31334491 PMCID: PMC6617526 DOI: 10.1016/j.wjorl.2018.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/09/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022] Open
Abstract
Cochlear duct length (CDL) measurement or estimation is a hot topic for various research groups in the cochlear implant (CI) field as of today. Getting the CDL along the outer wall (LW) and organ of corti (OC) is possible but considering the clinical application especially in the selection of the electrode array length and applying Greenwood's frequency function, we need to have a clear understanding on the CDL in general and as well on the Greenwood's frequency function. It is very clear from the histology images of the cochlea with straight electrode inside, that the electrode locates itself right under the basilar membrane. Also the Greenwood's frequency function involves a variable that corresponds to the CDL at the basilar membrane/organ of corti level. This brings us to conclude that the CDL at the OC is relevant for the selection of electrode array length and in applying Greenwood's frequency function. The ratio between CDL (LW) and CDL (OC) is 0.9 which is a very important number that needs to be remembered when converting CDL (LW) to CDL (OC).
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Nash R, Otero S, Lavy J. Use of MRI to determine cochlear duct length in patients undergoing cochlear implantation. Cochlear Implants Int 2018; 20:57-61. [PMID: 30465634 DOI: 10.1080/14670100.2018.1549186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES It is recognised that CT can be used to determine the cochlear duct length (CDL) when selecting an electrode for cochlear implantation. It is the practice of our institution to routinely use MRI as the sole modality of pre-operative imaging in the assessment of children referred for consideration of cochlear implantation. We therefore wanted to determine whether MRI could be reliably used to determine cochlear duct length. METHODS An analysis of 40 ears that had undergone MRI and CT of the temporal bones was undertaken. The diameter of the basal turn was independently measured for each ear using the two modalities, and CDL was then calculated. RESULTS The mean error of measurement was 0.26 mm (range 0-0.8 mm), leading to a difference in calculated CDL of 0.96 mm (range 0-2.92 mm). CDL did not predict full insertion of 28 mm cochlear implant electrodes in 30 ears. CONCLUSIONS MRI can be used to reliably determine cochlear duct length.
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Affiliation(s)
- Robert Nash
- a Cochlear Implant Department , Royal National Throat Nose and Ear Hospital , London , UK
| | - Sofia Otero
- b Radiology Department , Royal National Throat Nose and Ear Hospital , London , UK
| | - Jeremy Lavy
- a Cochlear Implant Department , Royal National Throat Nose and Ear Hospital , London , UK
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Zahara D, Dewi RD, Aboet A, Putranto FM, Lubis ND, Ashar T. Variations in Cochlear Size of Cochlear Implant Candidates. Int Arch Otorhinolaryngol 2018; 23:184-190. [PMID: 30956703 PMCID: PMC6449142 DOI: 10.1055/s-0038-1661360] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction
The cochlear anatomy varies in each individual, and that has an impact on decisions regarding the insertion of electrodes. The measurement of the cochlear size is the routine examination required to choose the proper cochlear implant (CI) electrodes.
Objective
To acquire normative data on the size of the cochlea (length, width, height, scala timpani [ST] height, cochlear duct length [CDL]) of CI candidates in Medan, Indonesia.
Methods
This descriptive study was conducted based on high-resolution computed tomography (HRCT) temporal bone data and on HRCT temporal data manipulated to reconstruct three-dimensional (3D) multiplanar images with OsiriX MD DICOM Viewer version 9.5.1 (Pixmeo SARL, Bernex, Geneva, Switzerland) viewer of 18 patients (36 ears) who were CI candidates in Medan, Indonesia, in order to determine cochlear length (A), cochlear width, cochlear height, ST height and CDL, calculated through a simple mathematical function.
Results
The average cochlear length (A) was 8.75 mm (standard deviation [SD] = 0.31 mm); the average cochlear width was 6.53 mm (SD = 0.35 mm); the average cochlear height was 3.26 mm (SD = 0.24 mm) and the average ST height at the basal cochlea was 1.00 mm (SD = 0.1 mm); and 0.71 mm (SD = 0.1 mm) at the half turn of cochlea. The average total CDL was 32.45 mm (SD = 1.31 mm; range: 30.01–34.83 mm).
Conclusion
The cochlear size varies in each individual; therefore, the temporal bone measurement of CI candidates using HRCT is essential: for the selection of suitable implant electrodes; to minimize cochlear damages at the insertion of the electrode arrays; and to maximize the hearing improvements.
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Affiliation(s)
- Devira Zahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Rima Diana Dewi
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Askaroellah Aboet
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Fikri Mirza Putranto
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, and Health Sciences, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Jakarta, Indonesia
| | - Netty Delvrita Lubis
- Department of Radiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Taufik Ashar
- Department of Environmental Health, Faculty of Public Health, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
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Abstract
BACKGROUND There are no data on cochlear duct lengths (CDL) among Middle East populations. OBJECTIVES The main aims of this study were to estimate the average CDL in the Saudi population and to compare it with the reported CDL in other regions/ethnic groups outside the Middle East. DESIGN Retrospective study. SETTING Tertiary otolaryngology head and neck surgery center. SUBJECTS AND METHODS Temporal bone CT scans were reviewed to determine CDL. We excluded any CT scan of an ear with a congenital inner ear anomaly or acquired pathology. MAIN OUTCOME MEASURES CDL. SAMPLE SIZE 441 temporal bone CT scans. RESULTS The overall CDL mean was 31.9 mm (range 20.3-37.7 mm). The cochleae of males was significantly longer than of females and cochleae from the left side were significantly longer than of the right side. No significant difference was found between children and adults. Inter-study comparison revealed a significant difference in CDL between the Saudi population in our study and European and Australian studies, but not between the present study and North American studies. CONCLUSIONS The CDL differed significantly according to side of the cochlea and sex, but not by age. Geographically and ethnically, the mean CDL for Saudis was significantly different from the CDL of subjects of some ethnic backgrounds, but not others. Due to this diversity, we recommend that the CDL be measured before cochlear implant surgery. LIMITATIONS All the measurements were done by one person, and the subjects' physical measurements, such as height or head circumference, were not included. CONFLICT OF INTEREST None.
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Affiliation(s)
- Alaa Alanazi
- Alaa Alanazi, College of Medicne,, King Saud University,, PO Box 245, Riyadh 11411, KSA, alaa.a.alanazi@gmail. com, ORCID: http://orcid.org/0000.0001-8096-9118
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