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Radomska K, Mielnik M, Gostyński M, Dzięciołowska-Baran E. Objective evaluation, using computed tomography, of round window access for cochlear implantation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08873-w. [PMID: 39098956 DOI: 10.1007/s00405-024-08873-w] [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: 04/18/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The aim of this study was to determine optimal radiological parameters for assessment of the round window approach in cochlear implantation surgery. MATERIALS AND METHODS Patients undergoing cochlear implantation at the Department of Otolaryngology in Szczecin, between 2015 and 2022 inclusive, were eligible for the study. Radiological assessments were performed according to eight parameters (seven proposed in the literature) and visibility clinical assessments were made intra-operatively on a scale of 1 to 5 (1 - not visible, 5 - fully visible). Visibility assessments of the round window niche (RWN) and round window membrane (RWM) allowed the difference (RWN minus RWM) to be used as a clinical assessment of the size of the overhang over the round window. RESULTS Computed tomography images of 57 ears from 52 patients were analyzed in terms of round window access. The study group included 26 females and 26 males, ranging in age from 1 year to 80 years, with a median age of 41 years. In clinical assessment, round window visibility was rated as 5, after removal of the bone overhang, in 69% of patients. Cochlear access through the round window was achieved in 39 (68%) cases, extended access through the round window in 13 (23%) cases and cochleostomy was performed in 5 (9%) cases. Statistically significant ordinal correlations with round-window access were found using one parameter from the literature (Chen_Angle) and from our proposal (RWM_prediction). From parameters describing the bone overhang of the round window, positive correlations (using Kendall rank tests) were found using parameters from the literature (Sarafraz_OH and Mehanna_OH). CONCLUSIONS Radiological measurements describing access to the round window which determine the angle based on the anatomy of the posterior wall of the auditory canal and the position of the facial nerve were found to be of the highest value. CLINICAL RELEVANCE STATEMENT In the future, the use of algorithms for computed tomography evaluation and robot-assisted surgery will require parameters for assessing round window access, for surgery planning and choice of electrode. The parameters proposed by various authors are summarized, allowing researchers to assess their usefulness in further clinical practice.
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Affiliation(s)
- Katarzyna Radomska
- Department of Otolaryngology, Pomeranian University of Medicine, Unii Lubelskiej 1, Szczecin, 71-252, Poland
| | - Michał Mielnik
- Department of Otolaryngology, Pomeranian University of Medicine, Unii Lubelskiej 1, Szczecin, 71-252, Poland.
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Koutná S, Kalitová P, Jeřábek J, Slabý K, Kučerová K, Bouček J, Čakrt O. Comparison of postural control and space perception outcomes between robotic and conventional cochlear implantation in adults. Eur Arch Otorhinolaryngol 2024; 281:3839-3843. [PMID: 38825603 DOI: 10.1007/s00405-024-08664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE The aim of the study is to capture the difference between the groups in direct relation to the type of electrode array insertion during cochlear implantation (CI). The robotic insertion is expected to be a more gently option. As recent studies have shown, there is a difference in perception of visual vertical (SVV) and postural control related to the CI. We assume that there can be differences in postural control and space perception outcomes depending on the type of the surgical method. METHODS In total, 37 (24 females, mean age ± SD was 42.9 ± 13.0) candidates for CI underwent an assessment. In 14 cases, the insertion of the electrode array was performed by a robotic system (RobOtol, Colin, France) and 23 were performed conventionally. In all of these patients, we performed the same examination before the surgery, the first day, and 3 weeks after the surgery. The protocol consists of static posturography and perception of visual vertical. RESULTS The both groups, RobOtol and conventional, responded to the procedure similarly despite the dissimilar electrode insertion. There was no difference between two groups in the dynamic of perception SVV and postural parameters. Patients in both groups were statistically significantly affected by the surgical procedure, SVV deviation appeared in the opposite direction from the implanted ear: 0.90° ± 1.25; - 1.67° ± 3.05 and - 0.19° ± 1.78 PRE and POST surgery (p < 0.001). And this deviation was spontaneously adjusted in FOLLOW-UP after 3 weeks (p < 0.01) in the both groups. We did not find a significant difference in postural parameters between the RobOtol and conventional group, even over time. CONCLUSION Although the robotic system RobOtol allows a substantial reduction in the speed of insertion of the electrode array into the inner ear, our data did not demonstrate a postoperative effect on vestibular functions (SVV and posturography), which have the same character and dynamics as in the group with standard manual insertion. REGISTRATION NUMBER The project is registered on clinicaltrials.gov (registration number: NCT05547113).
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Affiliation(s)
- Sára Koutná
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Petra Kalitová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Jeřábek
- Department of Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Klára Kučerová
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Bouček
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Čakrt
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Geerardyn A, Zhu M, Verhaert N, Quesnel AM. Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes. Otol Neurotol 2024; 45:245-255. [PMID: 38270168 PMCID: PMC10922381 DOI: 10.1097/mao.0000000000004102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
HYPOTHESIS Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis. BACKGROUND The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this. METHODS Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point. RESULTS Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the -26 to -18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations. CONCLUSION OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
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Affiliation(s)
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Kashani RG, Henslee A, Nelson RF, Hansen MR. Robotic assistance during cochlear implantation: the rationale for consistent, controlled speed of electrode array insertion. Front Neurol 2024; 15:1335994. [PMID: 38318440 PMCID: PMC10839068 DOI: 10.3389/fneur.2024.1335994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Cochlear implants (CI) have revolutionized the treatment of patients with severe to profound sensory hearing loss by providing a method of bypassing normal hearing to directly stimulate the auditory nerve. A further advance in the field has been the introduction of "hearing preservation" surgery, whereby the CI electrode array (EA) is carefully inserted to spare damage to the delicate anatomy and function of the cochlea. Preserving residual function of the inner ear allows patients to receive maximal benefit from the CI and to combine CI electric stimulation with acoustic hearing, offering improved postoperative speech, hearing, and quality of life outcomes. However, under the current paradigm of implant surgery, where EAs are inserted by hand, the cochlea cannot be reliably spared from damage. Robotics-assisted EA insertion is an emerging technology that may overcome fundamental human kinetic limitations that prevent consistency in achieving steady and slow EA insertion. This review begins by describing the relationship between EA insertion speed and generation of intracochlear forces and pressures. The various mechanisms by which these intracochlear forces can damage the cochlea and lead to worsened postoperative outcomes are discussed. The constraints of manual insertion technique are compared to robotics-assisted methods, followed by an overview of the current and future state of robotics-assisted EA insertion.
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Affiliation(s)
- Rustin G. Kashani
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | | | - Marlan R. Hansen
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Scheperle R, Etler C, Oleson J, Dunn C, Kashani R, Claussen A, Gantz BJ, Hansen MR. Evaluation of Real-Time Intracochlear Electrocochleography for Guiding Cochlear Implant Electrode Array Position. J Clin Med 2023; 12:7409. [PMID: 38068461 PMCID: PMC10707171 DOI: 10.3390/jcm12237409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 02/12/2024] Open
Abstract
This study evaluates intracochlear electrocochleography (ECochG) for real-time monitoring during cochlear implantation. One aim tested whether adjusting the recording electrode site would help differentiate between atraumatic and traumatic ECochG amplitude decrements. A second aim assessed whether associations between ECochG amplitude decrements and post-operative hearing loss were weaker when considering hearing sensitivity at the ECochG stimulus frequency compared to a broader frequency range. Eleven adult cochlear implant recipients who were candidates for electro-acoustic stimulation participated. Single-frequency (500-Hz) ECochG was performed during cochlear implantation; the amplitude of the first harmonic of the difference waveform was considered. Post-operative hearing preservation at 500 Hz ranged from 0 to 94%. The expected relationship between ECochG amplitude decrements and hearing preservation was observed, though the trend was not statistically significant, and predictions were grossly inaccurate for two participants. Associations did not improve when considering alternative recording sites or hearing sensitivity two octaves above the ECochG stimulus frequency. Intracochlear location of a moving recording electrode is a known confound to real-time interpretation of ECochG amplitude fluctuations, which was illustrated by the strength of the correlation with ECochG amplitude decrements. Multiple factors contribute to ECochG amplitude patterns and to hearing preservation; these results highlight the confounding influence of intracochlear recording electrode location on the ECochG.
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Affiliation(s)
- Rachel Scheperle
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Christine Etler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA
| | - Camille Dunn
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Rustin Kashani
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Alexander Claussen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Bruce J. Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Department of Molecular Physiology and Biophysics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Böttcher-Rebmann G, Schell V, Zuniga MG, Salcher R, Lenarz T, Rau TS. Preclinical evaluation of a tool for insertion force measurements in cochlear implant surgery. Int J Comput Assist Radiol Surg 2023; 18:2117-2124. [PMID: 37310560 PMCID: PMC10589184 DOI: 10.1007/s11548-023-02975-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Trauma that may be inflicted to the inner ear (cochlea) during the insertion of an electrode array (EA) in cochlear implant (CI) surgery can significantly decrease the hearing outcome of patients with residual hearing. Interaction forces between the EA and the cochlea are a promising indicator for the likelihood of intracochlear trauma. However, insertion forces have only been measured in laboratory setups. We recently developed a tool to measure the insertion force during CI surgery. Here, we present the first ex vivo evaluation of our tool with a focus on usability in the standard surgical workflow. METHODS Two CI surgeons inserted commercially available EAs into three temporal bone specimens. The insertion force and the orientation of the tool were recorded together with camera footage. The surgeons answered a questionnaire after each insertion to evaluate the surgical workflow with respect to CI surgery. RESULTS The EA insertion using our tool was rated successful in all 18 trials. The surgical workflow was evaluated to be equivalent to standard CI surgery. Minor handling challenges can be overcome through surgeon training. The peak insertion forces were 62.4 mN ± 26.7 mN on average. Peak forces significantly correlated to the final electrode insertion depth, supporting the assumption that the measured forces mainly correspond to intracochlear events and not extracochlear friction. Gravity-induced forces of up to 28.8 mN were removed from the signal, illustrating the importance of the compensation of such forces in manual surgery. CONCLUSION The results show that the tool is ready for intraoperative use. In vivo insertion force data will improve the interpretability of experimental results in laboratory settings. The implementation of live insertion force feedback to surgeons could further improve residual hearing preservation.
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Affiliation(s)
- Georg Böttcher-Rebmann
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Viktor Schell
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Geraldine Zuniga
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rolf Salcher
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas S Rau
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Maheo C, Marie A, Torres R, Archutick J, Leclère JC, Marianowski R. Robot-Assisted and Manual Cochlear Implantation: An Intra-Individual Study of Speech Recognition. J Clin Med 2023; 12:6580. [PMID: 37892718 PMCID: PMC10607818 DOI: 10.3390/jcm12206580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Cochlear implantation (CI) allows rehabilitation for patients with severe to profound hearing impairment. Although the use of a robotic assistant provides technical assistance to the surgeon, the assessment of the impact of its use on auditory outcomes remains uncertain. We aim to compare the hearing results of patients who underwent bilateral cochlear implantation; one side was performed with manual insertion and the other side with robot-assisted insertion. The electrode array intrascalar positioning and the surgery duration were also studied. This retrospective intra-individual study involved 10 patients who underwent bilateral cochlear implantation. The study included two infants and eight adults. The unique composition of this cohort enabled us to utilize each patient as their own control. Regarding speech disyllabic recognition, pure tone average, ECAP, ratio of array translocation, basilar membrane rupture, and percentage of translocated electrodes, there was no difference between manual and robot-assisted CI groups. This study is the first to compare intra-individual hearing performance after cochlear implantation, either manually or robot-assisted. The number of patients and the time delay between manual and robotic implantation may have led to a lack of power, but there was no apparent difference in hearing performance between manual and robotic implantation.
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Affiliation(s)
- Clémentine Maheo
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Antoine Marie
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Renato Torres
- Technologies et Theérapie Génique Pour la Surdité, Institut de l’Audition, Institut Pasteur/Université de Paris Cité/INSERM, 63 rue de Charenton, 75012 Paris, France;
| | - Jerrid Archutick
- Medicine Department, School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Jean-Christophe Leclère
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
| | - Remi Marianowski
- Department of Otolaryngology Head Neck Surgery, University Hospital Center, Hospital Morvan, 2 Avenue Foch, 29200 Brest, France; (A.M.); (J.-C.L.); (R.M.)
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Geiger L, Zuniga MG, Lenarz T, Majdani O, Rau TS. Drilling accuracy evaluation of a mouldable surgical targeting system for minimally invasive access to anatomic targets in the temporal bone. Eur Arch Otorhinolaryngol 2023; 280:4371-4379. [PMID: 37010602 PMCID: PMC10477231 DOI: 10.1007/s00405-023-07925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Minimally invasive cochlear implant surgery using a micro-stereotactic surgical targeting system with on-site moulding of the template aims for a reliable, less experience-dependent access to the inner ear under maximal reduction of trauma to anatomic structures. We present an accuracy evaluation of our system in ex-vivo testing. METHODS Eleven drilling experiments were performed on four cadaveric temporal bone specimens. The process involved preoperative imaging after affixing the reference frame to the skull, planning of a safe trajectory preserving relevant anatomical structures, customization of the surgical template, execution of the guided drilling and postoperative imaging for determination of the drilling accuracy. Deviation between the drilled and desired trajectories was measured at different depths. RESULTS All drilling experiments were successfully performed. Other than purposely sacrificing the chorda tympani in one experiment, no other relevant anatomy, such as facial nerve, chorda tympani, ossicles or external auditory canal were harmed. Deviation between the desired and achieved path was found to be 0.25 ± 0.16 mm at skulls' surface and 0.51 ± 0.35 mm at the target level. The closest distance of the drilled trajectories' outer circumference to the facial nerve was 0.44 mm. CONCLUSIONS We demonstrated the usability for drilling to the middle ear on human cadaveric specimen in a pre-clinical setting. Accuracy proved to be suitable for many applications such as procedures within the field of image-guided neurosurgery. Promising approaches to reach sufficient submillimetre accuracy for CI surgery have been outlined.
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Affiliation(s)
- Lena Geiger
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - M Geraldine Zuniga
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Ear Medical Group, San Antonio, TX, USA
- Tecnologico de Monterrey, Instituto de Otorrinolaringologia, Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Mexico
| | - Thomas Lenarz
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Omid Majdani
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas S Rau
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Leclère JC, Dulon D. Otoferlin as a multirole Ca 2+ signaling protein: from inner ear synapses to cancer pathways. Front Cell Neurosci 2023; 17:1197611. [PMID: 37538852 PMCID: PMC10394277 DOI: 10.3389/fncel.2023.1197611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Humans have six members of the ferlin protein family: dysferlin, myoferlin, otoferlin, fer1L4, fer1L5, and fer1L6. These proteins share common features such as multiple Ca2+-binding C2 domains, FerA domains, and membrane anchoring through their single C-terminal transmembrane domain, and are believed to play a key role in calcium-triggered membrane fusion and vesicle trafficking. Otoferlin plays a crucial role in hearing and vestibular function. In this review, we will discuss how we see otoferlin working as a Ca2+-dependent mechanical sensor regulating synaptic vesicle fusion at the hair cell ribbon synapses. Although otoferlin is also present in the central nervous system, particularly in the cortex and amygdala, its role in brain tissues remains unknown. Mutations in the OTOF gene cause one of the most frequent genetic forms of congenital deafness, DFNB9. These mutations produce severe to profound hearing loss due to a defect in synaptic excitatory glutamatergic transmission between the inner hair cells and the nerve fibers of the auditory nerve. Gene therapy protocols that allow normal rescue expression of otoferlin in hair cells have just started and are currently in pre-clinical phase. In parallel, studies have linked ferlins to cancer through their effect on cell signaling and development, allowing tumors to form and cancer cells to adapt to a hostile environment. Modulation by mechanical forces and Ca2+ signaling are key determinants of the metastatic process. Although ferlins importance in cancer has not been extensively studied, data show that otoferlin expression is significantly associated with survival in specific cancer types, including clear cell and papillary cell renal carcinoma, and urothelial bladder cancer. These findings indicate a role for otoferlin in the carcinogenesis of these tumors, which requires further investigation to confirm and understand its exact role, particularly as it varies by tumor site. Targeting this protein may lead to new cancer therapies.
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Affiliation(s)
- Jean-Christophe Leclère
- Department of Head and Neck Surgery, Brest University Hospital, Brest, France
- Laboratory of Neurophysiologie de la Synapse Auditive, Université de Bordeaux, Bordeaux, France
| | - Didier Dulon
- Laboratory of Neurophysiologie de la Synapse Auditive, Université de Bordeaux, Bordeaux, France
- Institut de l’Audition, Institut Pasteur & INSERM UA06, Paris, France
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Starovoyt A, Shaheen E, Putzeys T, Kerckhofs G, Politis C, Wouters J, Verhaert N. Anatomically and mechanically accurate scala tympani model for electrode insertion studies. Hear Res 2023; 430:108707. [PMID: 36773540 DOI: 10.1016/j.heares.2023.108707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/25/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
The risk of insertion trauma in cochlear implantation is determined by the interplay between individual cochlear anatomy and electrode insertion mechanics. Whereas patient anatomy cannot be changed, new surgical techniques, devices for cochlear monitoring, drugs, and electrode array designs are continuously being developed and tested, to optimize the insertion mechanics and prevent trauma. Preclinical testing of these developments is a crucial step in feasibility testing and optimization for clinical application. Human cadaveric specimens allow for the best simulation of an intraoperative setting. However, their availability is limited and it is not possible to conduct repeated, controlled experiments on the same sample. A variety of artificial cochlear models have been developed for electrode insertion studies, but none of them were both anatomically and mechanically representative for surgical insertion into an individual cochlea. In this study, we developed anatomically representative models of the scala tympani for surgical insertion through the round window, based on microCT images of individual human cochleae. The models were produced in transparent material using commonly-available 3D printing technology at a desired scale. The anatomical and mechanical accuracy of the produced models was validated by comparison with human cadaveric cochleae. Mechanical evaluation was performed by recording insertion forces, counting the number of inserted electrodes and grading tactile feedback during manual insertion of a straight electrode by experienced cochlear implant surgeons. Our results demonstrated that the developed models were highly representative for the anatomy of the original cochleae and for the insertion mechanics in human cadaveric cochleae. The individual anatomy of the produced models had a significant impact on the insertion mechanics. The described models have a promising potential to accelerate preclinical development and testing of atraumatic insertion techniques, reducing the need for human cadaveric material. In addition, realistic models of the cochlea can be used for surgical training and preoperative planning of patient-tailored cochlear implantation surgery.
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Affiliation(s)
- Anastasiya Starovoyt
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, UZ Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Tristan Putzeys
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Laboratory for Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, University of Leuven, Leuven, Belgium
| | - Greet Kerckhofs
- Biomechanics lab, Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium; Department of Materials Engineering, KU Leuven, University of Leuven, Leuven, Belgium; IREC, Institute of Experimental and Clinical Research, UCLouvain, Woluwé-Saint-Lambert, Belgium; Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, UZ Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Nicolas Verhaert
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, University Hospitals of Leuven, Leuven, Belgium.
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11
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Human cochlear microstructures at risk of electrode insertion trauma, elucidated in 3D with contrast-enhanced microCT. Sci Rep 2023; 13:2191. [PMID: 36750646 PMCID: PMC9905077 DOI: 10.1038/s41598-023-29401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Cochlear implant restores hearing loss through electrical stimulation of the hearing nerve from within the cochlea. Unfortunately, surgical implantation of this neuroprosthesis often traumatizes delicate intracochlear structures, resulting in loss of residual hearing and compromising hearing in noisy environments and appreciation of music. To avoid cochlear trauma, insertion techniques and devices have to be adjusted to the cochlear microanatomy. However, existing techniques were unable to achieve a representative visualization of the human cochlea: classical histology damages the tissues and lacks 3D perspective; standard microCT fails to resolve the cochlear soft tissues; and previously used X-ray contrast-enhancing staining agents are destructive. In this study, we overcame these limitations by performing contrast-enhanced microCT imaging (CECT) with a novel polyoxometalate staining agent Hf-WD POM. With Hf-WD POM-based CECT, we achieved nondestructive, high-resolution, simultaneous, 3D visualization of the mineralized and soft microstructures in fresh-frozen human cochleae. This enabled quantitative analysis of the true intracochlear dimensions and led to anatomical discoveries, concerning surgically-relevant microstructures: the round window membrane, the Rosenthal's canal and the secondary spiral lamina. Furthermore, we demonstrated that Hf-WD POM-based CECT enables quantitative assessment of these structures as well as their trauma.
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12
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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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13
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Claussen AD, Shibata SB, Kaufmann CR, Henslee A, Hansen MR. Comparative Analysis of Robotics-Assisted and Manual Insertions of Cochlear Implant Electrode Arrays. Otol Neurotol 2022; 43:1155-1161. [PMID: 36201552 PMCID: PMC10962863 DOI: 10.1097/mao.0000000000003707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Robotics-assisted cochlear implant (CI) insertions will result in reduced intracochlear trauma when compared with manual, across multiple users. BACKGROUND Whether intracochlear trauma and translocations are two factors that may contribute to significant variability in CI outcomes remains to be seen. To address this issue, we have developed a robotics-assisted insertion system designed to aid the surgeon in inserting electrode arrays with consistent speeds and reduced variability. This study evaluated the effect of robotics-assisted insertions on the intracochlear trauma as compared with manual insertions in cadaveric cochleae in a simulated operative environment. METHODS Twelve neurotologists performed bilateral electrode insertions into cochleae of full cadaveric heads using both the robotics-assisted system and manual hand insertion. Lateral wall electrodes from three different manufacturers (n = 24) were used and randomized between surgeons. Insertion angle of the electrode and trauma scoring were evaluated using high-resolution three-dimensional x-ray microscopy and compared between robotics-assisted and manual insertions. RESULTS Three-dimensional x-ray microscopy provided excellent resolution to characterize the in situ trauma and insertion angle. Robotics-assisted insertions significantly decreased insertional intracochlear trauma as measured by reduced trauma scores compared with manual insertions (average: 1.3 versus 2.2, device versus manual, respectively; p < 0.05). There was no significant difference between insertion angles observed for manual and robotics-assisted techniques (311 ± 131° versus 307 ± 96°, device versus manual, respectively). CONCLUSIONS Robotics-assisted insertion systems enable standardized electrode insertions across individual surgeons and experience levels. Clinical trials are necessary to investigate whether insertion techniques that reduce insertional variability and the likelihood of intracochlear trauma also improve CI auditory outcomes.
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Affiliation(s)
| | - Seiji B Shibata
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa
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14
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Robot-Assisted Electrode Insertion in Cochlear Implantation Controlled by Intraoperative Electrocochleography-A Pilot Study. J Clin Med 2022; 11:jcm11237045. [PMID: 36498620 PMCID: PMC9737018 DOI: 10.3390/jcm11237045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Robotics in otology has been developing in many directions for more than two decades. Current clinical trials focus on more accurate stapes surgery, minimally invasive access to the cochlea and less traumatic insertion of cochlear implant (CI) electrode arrays. In this study we evaluated the use of the RobOtol® (Collin, Bagneux, France) otologic robot to insert CI electrodes into the inner ear with intraoperative ECochG analysis. This prospective, pilot study included two adult patients implanted with Advanced Bionics (Westinghouse PI, CA, USA) cochlear implant, with HiFocus™ Mid-Scala electrode array. The standard surgical approach was used. For both subjects, who had residual hearing in the implanted ear, intraoperative and postoperative ECochG was performed with the AIMTM system. The surgeries were uneventful. A credible ECochG response was obtained after complete electrode insertion in both cases. Preoperative BC thresholds compared to intraoperative estimated ECochG thresholds and 2-day postoperative BC thresholds had similar values at frequencies where all thresholds were measurable. The results of the ECochG performed one month after the surgery showed that in both patients the hearing residues were preserved for the selected frequencies. The RobOtol® surgical robot allows for the correct, safe and gentle insertion of the cochlear implant electrode inside the cochlea. The use of electrocochleography measurements during robotic cochlear implantation offers an additional opportunity to evaluate and modify the electrode array insertion on an ongoing basis, which may contribute to the preservation of residual hearing.
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15
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Robotics and cochlear implant surgery: goals and developments. Curr Opin Otolaryngol Head Neck Surg 2022; 30:314-319. [PMID: 36036531 DOI: 10.1097/moo.0000000000000837] [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
PURPOSE OF REVIEW Cochlear implantation (CI) is a viable option for patients with severe sensorineural hearing loss. Advances in CI have focused on minimizing cochlear trauma to improve hearing preservation outcomes, and in doing so expanding candidacy to patients with useful cochlear reserve. Robotics holds promise as a potential tool to minimize intracochlear trauma with electrode insertion, improve surgical efficiency, and reduce surgical complications. The purpose of this review is to summarize efforts and advances in the field of robotic-assisted CI. RECENT FINDINGS Work on robotics and CI over the past few decades has explored distinct surgical aspects, including image-based surgical planning and intraoperative guidance, minimally invasive robotic-assisted approaches mainly through percutaneous keyhole direct cochlear access, robotic electrode insertion systems, robotic manipulators, and drilling feedback control through end effector sensors. Feasibility and safety have been established and many devices are undergoing clinical trials for clinical adoption, with some having already achieved approval of national licensing bodies. SUMMARY Significant work has been done over the past two decades that has shown robotic-assisted CI to be feasible and safe. Wider clinical adoption can potentially result in improved hearing preservation and quality of life outcomes to more CI candidates.
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16
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Rau TS, Ehmann T, Zuniga MG, Plaskonka K, Keck A, Majdani O, Lenarz T. Toward a cochlear implant electrode array with shape memory effect for post-insertion perimodiolar positioning. J Biomed Mater Res B Appl Biomater 2022; 110:2494-2505. [PMID: 35678249 DOI: 10.1002/jbm.b.35107] [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: 12/07/2021] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Thomas S Rau
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Tim Ehmann
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - M Geraldine Zuniga
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | | | | | - Omid Majdani
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany.,Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
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Conversations in Cochlear Implantation: The Inner Ear Therapy of Today. Biomolecules 2022; 12:biom12050649. [PMID: 35625577 PMCID: PMC9138212 DOI: 10.3390/biom12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
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18
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Van de Heyning P, Roland P, Lassaletta L, Agrawal S, Atlas M, Baumgartner WD, Brown K, Caversaccio M, Dazert S, Gstoettner W, Hagen R, Hagr A, Jablonski GE, Kameswaran M, Kuzovkov V, Leinung M, Li Y, Loth A, Magele A, Mlynski R, Mueller J, Parnes L, Radeloff A, Raine C, Rajan G, Schmutzhard J, Skarzynski H, Skarzynski PH, Sprinzl G, Staecker H, Stöver T, Tavora-Viera D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Wimmer W, Zernotti M, Gavilan J. Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events. Front Surg 2022; 9:823219. [PMID: 35402479 PMCID: PMC8987358 DOI: 10.3389/fsurg.2022.823219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. Methods A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. Results A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4–6.6%) of ETFO, 28.6% (26.6–30.6%) of ESD, and 0.53% (0.2–1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1–1.3%), 11% (9.2–13.0%), and 3.2% (2.5–3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. Conclusion Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.
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Affiliation(s)
- Paul Van de Heyning
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- *Correspondence: Paul Van de Heyning
| | - Peter Roland
- Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marcus Atlas
- Ear Sciences Institute Australia, Lions Hearing Clinic, Perth, WA, Australia
| | | | - Kevin Brown
- UNC Ear and Hearing Center at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Marco Caversaccio
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | | | - Rudolf Hagen
- Würzburg ENT University Hospital, Würzburg, Germany
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Vladislav Kuzovkov
- St. Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - Martin Leinung
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Andreas Loth
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Magele
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner” Rostock University Medical Center, Rostock, Germany
| | - Joachim Mueller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Andreas Radeloff
- Division of Oto-Rhino-Laryngology, Evangelisches Krankenhaus Oldenburg, Research Center of Neurosensory Sciences, University Oldenburg, Oldenburg, Germany
| | - Chris Raine
- Bradford Royal Infirmary Yorkshire Auditory Implant Center, Bradford, United Kingdom
| | - Gunesh Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Medical Sciences Department of Health Sciences and Medicine. University of Lucerne, Luzern, Switzerland. Otolaryngology, Head & Neck Surgery, Medical School University of Western Australia, Perth, WA, Australia
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H. Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Georg Sprinzl
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Hinrich Staecker
- Kansas University Center for Hearing and Balance Disorders, Kansas City, KS, United States
| | - Timo Stöver
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Vedat Topsakal
- Department of ENT HNS, University Hospital Brussels, Brussels, Belgium
| | - Shin-Ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Mario Zernotti
- Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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