1
|
Amini S, Choi H, Seche W, Blagojevic A, May N, Lefler BM, Davis SL, Elyahoodayan S, Tavousi P, May SJ, Caputo GA, Lowe TC, Hettinger J, Shahbazmohamadi S. Sustainability inspired fabrication of next generation neurostimulation and cardiac rhythm management electrodes via reactive hierarchical surface restructuring. MICROSYSTEMS & NANOENGINEERING 2024; 10:125. [PMID: 39251609 PMCID: PMC11384795 DOI: 10.1038/s41378-024-00754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/05/2024] [Accepted: 06/23/2024] [Indexed: 09/11/2024]
Abstract
Over the last two decades, platinum group metals (PGMs) and their alloys have dominated as the materials of choice for electrodes in long-term implantable neurostimulation and cardiac rhythm management devices due to their superior conductivity, mechanical and chemical stability, biocompatibility, corrosion resistance, radiopacity, and electrochemical performance. Despite these benefits, PGM manufacturing processes are extremely costly, complex, and challenging with potential health hazards. Additionally, the volatility in PGM prices and their high supply risk, combined with their scarce concentration of approximately 0.01 ppm in the earth's upper crust and limited mining geographical areas, underscores their classification as critical raw materials, thus, their effective recovery or substitution worldwide is of paramount importance. Since postmortem recovery from deceased patients and/or refining of PGMs that are used in the manufacturing of the electrodes and microelectrode arrays is extremely rare, challenging, and highly costly, therefore, substitution of PGM-based electrodes with other biocompatible materials that can yield electrochemical performance values equal or greater than PGMs is the only viable and sustainable solution to reduce and ultimately substitute the use of PGMs in long-term implantable neurostimulation and cardiac rhythm management devices. In this article, we demonstrate for the first time how the novel technique of "reactive hierarchical surface restructuring" can be utilized on titanium-that is widely used in many non-stimulation medical device and implant applications-to manufacture biocompatible, low-cost, sustainable, and high-performing neurostimulation and cardiac rhythm management electrodes. We have shown how the surface of titanium electrodes with extremely poor electrochemical performance undergoes compositional and topographical transformations that result in electrodes with outstanding electrochemical performance.
Collapse
Affiliation(s)
- Shahram Amini
- Research and Development, Pulse Technologies Inc., Quakertown, PA, USA.
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA.
| | - Hongbin Choi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Wesley Seche
- Research and Development, Pulse Technologies Inc., Quakertown, PA, USA
| | | | - Nicholas May
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Benjamin M Lefler
- Department of Materials Science and Engineering, Drexel University, Philadelphia, PA, USA
| | - Skyler L Davis
- Department of Metallurgical and Materials Engineering, Colorado School of Mines, Golden, CO, USA
| | - Sahar Elyahoodayan
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Pouya Tavousi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, USA
| | - Steven J May
- Department of Materials Science and Engineering, Drexel University, Philadelphia, PA, USA
| | - Gregory A Caputo
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, USA
| | - Terry C Lowe
- Department of Metallurgical and Materials Engineering, Colorado School of Mines, Golden, CO, USA
| | - Jeffrey Hettinger
- Department of Physics and Astronomy, Rowan University, Glassboro, NJ, USA
| | | |
Collapse
|
2
|
Kirchhoff L, Arweiler-Harbeck D, Meyer M, Buer J, Lang S, Steinmann J, Bertram R, Deuss E, Höing B. Bacterial biofilm formation on headpieces of Cochlear implants. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08835-2. [PMID: 39042175 DOI: 10.1007/s00405-024-08835-2] [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: 04/17/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Bacterial biofilm formation on medical devices, such as Cochlear implants (CI), can lead to chronic infections. Not only the inner parts of the implant but also the externally located headpiece might be associated with prolonged superficial skin eczema resulting in the inability of wearing the headpiece. In this study, the surface of three CI headpieces from different manufacturers were examined for bacterial biofilm formation. MATERIALS AND METHODS Two bacterial species associated with implant-related infections were tested: Pseudomonas aeruginosa (ATCC9027) and Staphylococcus aureus (ATCC6538). Biofilms were formed over 24 h in tryptic soy broth at 36 °C. Biofilm formation was detected in form of biomass measurement by crystal violet staining. CI headpiece dummies of three manufacturers were used. RESULTS Both tested bacterial species formed biofilms on the examined CI headpiece-surfaces in a species-dependent manner with higher biofilm formation of P. aeruginosa. For both, S. aureus and P. aeruginosa, biofilm formation on the CI components was comparable to a polystyrene control surface. Between the three manufacturers, no significant difference in biofilm formation was found. DISCUSSION The tested bacteria displayed biofilm formation on the CI headpieces in a species-specific manner with higher amount of biofilm formed by P. aeruginosa. The biofilm formation was comparable between the manufacturers. In this study, an enhanced biofilm formation on CI headpieces could not be demonstrated. These in vitro tests suggest a minor role of bacterial biofilm on the CI headpiece in skin infections under the CI headpiece.
Collapse
Affiliation(s)
- Lisa Kirchhoff
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Moritz Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg- Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Ralf Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuremberg, Nuremberg, Germany
| | - Eric Deuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Essen, Germany.
| |
Collapse
|
3
|
Carlson ML, Carducci V, Deep NL, DeJong MD, Poling GL, Brufau SR. AI model for predicting adult cochlear implant candidacy using routine behavioral audiometry. Am J Otolaryngol 2024; 45:104337. [PMID: 38677145 DOI: 10.1016/j.amjoto.2024.104337] [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: 02/23/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To describe an AI model to facilitate adult cochlear implant candidacy prediction based on basic demographical data and standard behavioral audiometry. METHODS A machine-learning approach using retrospective demographic and audiometric data to predict candidacy CNC word scores and AzBio sentence in quiet scores was performed at a tertiary academic center. Data for the model were derived from adults completing cochlear implant candidacy testing between January 2011 and March 2023. Comparison of the prediction model to other published prediction tools and benchmarks was performed. RESULTS The final dataset included 770 adults, encompassing 1045 AzBio entries, and 1373 CNC entries. Isophoneme scores and word recognition scores exhibited strongest importance to both the CNC and AzBio prediction models, followed by standard pure tone average and low-frequency pure tone average. The mean absolute difference between the predicted and actual score was 15 percentage points for AzBio sentences in quiet and 13 percentage points for CNC word scores, approximating anticipated test-retest constraints inherent to the variables incorporated into the model. Our final combined model achieved an accuracy of 87 % (sensitivity: 90 %; precision: 80 %). CONCLUSION We present an adaptive AI model that predicts adult cochlear implant candidacy based on routine behavioral audiometric and basic demographical data. Implementation efforts include a public-facing online prediction tool and accompanying smartphone program, an embedded notification flag in the electronic medical record to alert providers of potential candidates, and a program to retrospectively engage past patients who may be eligible for cochlear implantation based on audiogram results.
Collapse
Affiliation(s)
- Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
| | - Valentina Carducci
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, United States of America
| | - Melissa D DeJong
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Gayla L Poling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Santiago Romero Brufau
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States of America; Department of Biostatistics, Harvard University, Boston, MA, United States of America
| |
Collapse
|
4
|
Khosla H, Seche W, Ammerman D, Elyahoodayan S, Caputo GA, Hettinger J, Amini S, Feng G. Development of antibacterial neural stimulation electrodes via hierarchical surface restructuring and atomic layer deposition. Sci Rep 2023; 13:19778. [PMID: 37957282 PMCID: PMC10643707 DOI: 10.1038/s41598-023-47256-9] [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: 07/20/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Miniaturization and electrochemical performance enhancement of electrodes and microelectrode arrays in emerging long-term implantable neural stimulation devices improves specificity, functionality, and performance of these devices. However, surgical site and post-implantation infections are amongst the most devastating complications after surgical procedures and implantations. Additionally, with the increased use of antibiotics, the threat of antibiotic resistance is significant and is increasingly being recognized as a global problem. Therefore, the need for alternative strategies to eliminate post-implantation infections and reduce antibiotic use has led to the development of medical devices with antibacterial properties. In this work, we report on the development of electrochemically active antibacterial platinum-iridium electrodes targeted for use in neural stimulation and sensing applications. A two-step development process was used. Electrodes were first restructured using femtosecond laser hierarchical surface restructuring. In the second step of the process, atomic layer deposition was utilized to deposit conformal antibacterial copper oxide thin films on the hierarchical surface structure of the electrodes to impart antibacterial properties to the electrodes with minimal impact on electrochemical performance of the electrodes. Morphological, compositional, and structural properties of the electrodes were studied using multiple modalities of microscopy and spectroscopy. Antibacterial properties of the electrodes were also studied, particularly, the killing effect of the hierarchically restructured antibacterial electrodes on Escherichia coli and Staphylococcus aureus-two common types of bacteria responsible for implant infections.
Collapse
Affiliation(s)
- Henna Khosla
- Department of Mechanical Engineering, Villanova University, Villanova, PA, 19085, USA
| | - Wesley Seche
- Pulse Technologies Inc., Research and Development, Quakertown, PA, 18951, USA
| | - Daniel Ammerman
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, 08028, USA
| | - Sahar Elyahoodayan
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Gregory A Caputo
- Department of Chemistry and Biochemistry, Rowan University, Glassboro, NJ, 08028, USA
| | - Jeffrey Hettinger
- Department of Physics and Astronomy, Rowan University, Glassboro, NJ, 08028, USA
| | - Shahram Amini
- Pulse Technologies Inc., Research and Development, Quakertown, PA, 18951, USA.
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA.
| | - Gang Feng
- Department of Mechanical Engineering, Villanova University, Villanova, PA, 19085, USA
| |
Collapse
|
5
|
Khurana L, Harczos T, Moser T, Jablonski L. En route to sound coding strategies for optical cochlear implants. iScience 2023; 26:107725. [PMID: 37720089 PMCID: PMC10502376 DOI: 10.1016/j.isci.2023.107725] [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] [Indexed: 09/19/2023] Open
Abstract
Hearing loss is the most common human sensory deficit. Severe-to-complete sensorineural hearing loss is often treated by electrical cochlear implants (eCIs) bypassing dysfunctional or lost hair cells by direct stimulation of the auditory nerve. The wide current spread from each intracochlear electrode array contact activates large sets of tonotopically organized neurons limiting spectral selectivity of sound coding. Despite many efforts, an increase in the number of independent eCI stimulation channels seems impossible to achieve. Light, which can be better confined in space than electric current may help optical cochlear implants (oCIs) to overcome eCI shortcomings. In this review, we present the current state of the optogenetic sound encoding. We highlight optical sound coding strategy development capitalizing on the optical stimulation that requires fine-grained, fast, and power-efficient real-time sound processing controlling dozens of microscale optical emitters as an emerging research area.
Collapse
Affiliation(s)
- Lakshay Khurana
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- The Doctoral Program “Sensory and Motor Neuroscience”, Göttingen Graduate Center for Neurosciences, Biophysics, and Molecular Biosciences (GGNB), Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Tamas Harczos
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
| | - Tobias Moser
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Lukasz Jablonski
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
6
|
Tawk K, Goshtasbi K, Frank M, Martin EC, Abouzari M, Djalilian HR. Triamcinolone Injection for Cochlear Implant Magnet Adherence Issues. Otol Neurotol 2023; 44:e572-e576. [PMID: 37550870 PMCID: PMC10529445 DOI: 10.1097/mao.0000000000003974] [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] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of triamcinolone injections in treating external magnet displacement in cochlear implant (CI) patients with adhesions problems of their processor. PATIENTS We present seven CI patients with magnet adhesion issues who presented to our tertiary care neurotology clinic. None of the patients had a history of head trauma, postimplant MRI, or surgery in the head and neck other than the cochlear implantation. INTERVENTION Triamcinolone 40 mg/mL injected subcutaneously at the CI magnet site. MAIN OUTCOME MEASURE Reduction of scalp thickness and successful magnet retention. RESULTS Our cohort consisted of seven patients (eight implant sites) of which five were overweight or obese. The temporoparietal scalp thickness measured on preoperative CT scans varied between 8.4 and 15.9 mm. Initial conservative measures such as hair shaving at the magnet site, using a headband, and increasing magnet strength failed in all patients. After receiving triamcinolone injections at the CI receiver site, six out of seven patients (seven out of eight CI sites) were able to use their processor again without the need for a headband for an average of 9.55 hours/day. The average number of injections required for each patient was 2.57 (SD = 2.18), median (range) = 1 (1-7). One patient required a flap thinning surgery but showed no improvement even after flap thinning. None of the patients showed skin irritation, breakdown, ulceration, necrosis, or magnet exposure during follow-up period. CONCLUSIONS The significant improvement in CI retention shows that triamcinolone injections are effective in making the subcutaneous tissue thinner and allowing magnet retention.
Collapse
Affiliation(s)
- Karen Tawk
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Madelyn Frank
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Elaine C. Martin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
| |
Collapse
|
7
|
Smetak MR, Riojas KE, Whittenbarger N, Noble JH, Labadie RF. Dynamic Behavior and Insertional Forces of a Precurved Electrode Using the Pull-Back Technique in a Fresh Microdissected Cochlea. Otol Neurotol 2023; 44:324-330. [PMID: 36728107 PMCID: PMC10038836 DOI: 10.1097/mao.0000000000003812] [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: 02/03/2023]
Abstract
HYPOTHESIS This study evaluated the utility of the pull-back technique in improving perimodiolar positioning of a precurved cochlear implant (CI) electrode array (EA) with simultaneous insertion force profile measurement and direct observation of dynamic EA behavior. BACKGROUND Precurved EAs with perimodiolar positioning have improved outcomes compared with straight EAs because of lowered charge requirements for stimulation and decreased spread of excitation. The safety and efficacy of the pull-back technique in further improving perimodiolar positioning and its associated force profile have not been adequately demonstrated. METHODS The bone overlying the scala vestibuli was removed in 15 fresh cadaveric temporal bones, leaving the scala tympani unviolated. Robotic insertions of EAs were performed with simultaneous force measurement and video recording. Force profiles were obtained during standard insertion, overinsertion, and pull-back. Postinsertion CT scans were obtained during each of the three conditions, enabling automatic segmentation and calculation of angular insertion depth, mean perimodiolar distance ( Mavg ), and cochlear duct length. RESULTS Overinsertion did not result in significantly higher peak forces than standard insertion (mean [SD], 0.18 [0.06] and 0.14 [0.08] N; p = 0.18). Six temporal bones (40%) demonstrated visibly improved perimodiolar positioning after the protocol, whereas none worsened. Mavg significantly improved after the pull-back technique compared with standard insertion (mean [SD], 0.34 [0.07] and 0.41 [0.10] mm; p < 0.01). CONCLUSIONS The pull-back technique was not associated with significantly higher insertional forces compared with standard insertion. This technique was associated with significant improvement in perimodiolar positioning, both visually and quantitatively, independent of cochlear size.
Collapse
Affiliation(s)
- Miriam R. Smetak
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Noah Whittenbarger
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jack H. Noble
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN
| | - Robert F. Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
8
|
Williams CYK, Li RX, Luo MY, Bance M. Exploring patient experiences and concerns in the online Cochlear implant community: A cross-sectional study and validation of automated topic modelling. Clin Otolaryngol 2023; 48:442-450. [PMID: 36645237 DOI: 10.1111/coa.14037] [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: 05/18/2022] [Revised: 12/20/2022] [Accepted: 01/07/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE There is a paucity of research examining patient experiences of cochlear implants. We sought to use natural language processing methods to explore patient experiences and concerns in the online cochlear implant (CI) community. MATERIALS AND METHODS Cross-sectional study of posts on the online Reddit r/CochlearImplants forum from 1 March 2015 to 11 November 2021. Natural language processing using the BERTopic automated topic modelling technique was employed to cluster posts into semantically similar topics. Topic categorisation was manually validated by two independent reviewers and Cohen's kappa calculated to determine inter-rater reliability between machine vs human and human vs human categorisation. RESULTS We retrieved 987 posts from 588 unique Reddit users on the r/CochlearImplants forum. Posts were initially categorised by BERTopic into 16 different Topics, which were increased to 23 Topics following manual inspection. The most popular topics related to CI connectivity (n = 112), adults considering getting a CI (n = 107), surgery-related posts (n = 89) and day-to-day living with a CI (n = 85). Cohen's kappa among all posts was 0.62 (machine vs. human) and 0.72 (human vs. human), and among categorised posts was 0.85 (machine vs. human) and 0.84 (human vs. human). CONCLUSIONS This cross-sectional study of social media discussions among the online cochlear implant community identified common attitudes, experiences and concerns of patients living with, or seeking, a cochlear implant. Our validation of natural language processing methods to categorise topics shows that automated analysis of similar Otolaryngology-related content is a viable and accurate alternative to manual qualitative approaches.
Collapse
Affiliation(s)
- Christopher Y K Williams
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rosia X Li
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael Y Luo
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
9
|
Riepl R, Wigand MCC, Halbig AS, Werz J, Emmanuel B, Stupp F, Hoffmann TK, Goldberg-Bockhorn E. [Emphysema after cochlear implantation - risk factors and therapeutic options]. Laryngorhinootologie 2023; 102:16-26. [PMID: 36395786 DOI: 10.1055/a-1896-1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In case of cochlear implantation seroma, hematoma, local wound infections or vertigo are rare but typical complications. In contrast, emphysema is seldom reported. They can occur after cochlear implantation both in the postoperative healing phase and years later. A therapeutic algorithm does not yet exist. METHODS We report on 3 patients with subcutaneous emphysema in the area of the receiver-stimulator. An unsystematic review of the literature of cases with emphysema after cochlear implantation highlights possible risk factors and the therapeutic options. RESULTS The 3 cases developed subcutaneous emphysema 2-11 month after cochlear implantation due to nose blowing or CPAP therapy in obstructive sleep apnea. The current literature reports another 35 cases of emphysema after cochlear implantation. Air insufflation via the Eustachian tube is the most frequently described cause. Diseases of the nose and sinuses, tube dysfunction and obstructive sleep apnea are potential risk factors. Pressure bandage, puncture, tympanic tubes, and surgical revision are common treatments. CONCLUSIONS Most emphysema can be controlled by conservative methods such as pressure bandaging and behavioral instruction. Punctures should be avoided due to the risk of upcoming infections. The prophylactic use of antibiotics seems dispensable. Surgical revision should be considered especially in cases of pneumocephalus with suspected leakage in the dura. The coverage of the mastoidectomy by a bony cap can be precautious and beneficial in cases with risk factors.
Collapse
Affiliation(s)
- Ricarda Riepl
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Marlene Corinna Cosima Wigand
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Anna-Sophia Halbig
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Julia Werz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Benjamin Emmanuel
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Franziska Stupp
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Thomas Karl Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| | - Eva Goldberg-Bockhorn
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Frauensteige 12, 89075 Ulm, Universitätsklinikum, Germany
| |
Collapse
|
10
|
Smetak MR, Riojas KE, Sharma RK, Labadie RF. Beyond the phantom: Unroofing the scala vestibuli in a fresh temporal bone as a model for cochlear implant insertion experiments. J Neurosci Methods 2022; 382:109710. [PMID: 36207005 DOI: 10.1016/j.jneumeth.2022.109710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Miriam R Smetak
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States.
| | - Katherine E Riojas
- Department of Mechanical Engineering, Vanderbilt University, 2301 Vanderbilt Place PMB 401592, Nashville, TN 37240-1592, United States
| | - Rahul K Sharma
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States
| | - Robert F Labadie
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN 37232, United States; Department of Mechanical Engineering, Vanderbilt University, 2301 Vanderbilt Place PMB 401592, Nashville, TN 37240-1592, United States
| |
Collapse
|
11
|
Mallegni N, Molinari G, Ricci C, Lazzeri A, La Rosa D, Crivello A, Milazzo M. Sensing Devices for Detecting and Processing Acoustic Signals in Healthcare. BIOSENSORS 2022; 12:835. [PMID: 36290973 PMCID: PMC9599683 DOI: 10.3390/bios12100835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Acoustic signals are important markers to monitor physiological and pathological conditions, e.g., heart and respiratory sounds. The employment of traditional devices, such as stethoscopes, has been progressively superseded by new miniaturized devices, usually identified as microelectromechanical systems (MEMS). These tools are able to better detect the vibrational content of acoustic signals in order to provide a more reliable description of their features (e.g., amplitude, frequency bandwidth). Starting from the description of the structure and working principles of MEMS, we provide a review of their emerging applications in the healthcare field, discussing the advantages and limitations of each framework. Finally, we deliver a discussion on the lessons learned from the literature, and the open questions and challenges in the field that the scientific community must address in the near future.
Collapse
Affiliation(s)
- Norma Mallegni
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Giovanna Molinari
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Claudio Ricci
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Andrea Lazzeri
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Davide La Rosa
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Antonino Crivello
- ISTI-CNR, Institute of Information Science and Technologies, 56124 Pisa, Italy
| | - Mario Milazzo
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| |
Collapse
|
12
|
The remaining obstacles for a totally implantable cochlear implant. Curr Opin Otolaryngol Head Neck Surg 2022; 30:298-302. [PMID: 36004785 DOI: 10.1097/moo.0000000000000840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW For years, the development of a totally implantable cochlear implant (TICI) has faced several technical challenges hindering any prototypes from reaching full commercialization. This article aims to review the necessary specifications for a viable TICI. An overview of the remaining challenges when designing TICIs will be provided, focusing on energy supply and implantable microphones. RECENT FINDINGS The literature review highlights how research efforts to generate sufficient power to supply a fully implantable CI could take advantage of microelectromechanical systems (MEMS)-based energy harvesters incorporating piezoelectric materials. Using one of the various energy sources in the vicinity of the temporal bone would allow the development of a self-sufficient implant, overcoming the limitations of electrochemical batteries. Middle ear implantable microphones could also use similar fabrication techniques and transduction mechanisms to meet the sensor requirements for a TICI. SUMMARY Recent breakthroughs in power supply using MEMS-based energy harvesting technologies and piezoelectric implantable microphones may make TICIs become a more practical reality in the foreseeable future. Once available, TICIs will have major impact on our patients' quality of life and may help to make hearing rehabilitation a more appealing option to a greater proportion of those who fulfill our candidacy criteria.
Collapse
|
13
|
Battery Lifespan of an Implantable Middle Ear Device. Audiol Res 2022; 12:485-492. [PMID: 36136856 PMCID: PMC9498673 DOI: 10.3390/audiolres12050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The Carina system (Cochlear Ltd., Sydney, Australia) is a totally implantable device providing acoustic amplification in adult patients with moderate-to-severe sensorineural or mixed hearing loss. One of the main concerns about such a totally implantable device has been represented by the subcutaneous battery lifespan. The aim of this article is to report the analysis of battery performances in a series of Carina-implanted patients after a long follow up. Methods: In this retrospective study, the technical data of a series of patients implanted with the Carina middle ear implant in our clinic have been analysed, extracting the data from the log of telemetric measures. Results: The mean lifespan cutback was 0.43 h/years (from 0 to 0.71 h/year), with a strong negative significant correlation between the follow-up period and the percentage of battery residual lifespan. Conclusion: The lifespan of the Carina’s battery seems consistent with the manufacturer statement of a pluri-decennial lifespan, avoiding the need of an early surgical substitution and providing a full day of use of the system even after up to 12 years from the implantation.
Collapse
|
14
|
Amini S, Seche W, May N, Choi H, Tavousi P, Shahbazmohamadi S. Femtosecond laser hierarchical surface restructuring for next generation neural interfacing electrodes and microelectrode arrays. Sci Rep 2022; 12:13966. [PMID: 35978090 PMCID: PMC9385846 DOI: 10.1038/s41598-022-18161-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
Long-term implantable neural interfacing devices are able to diagnose, monitor, and treat many cardiac, neurological, retinal and hearing disorders through nerve stimulation, as well as sensing and recording electrical signals to and from neural tissue. To improve specificity, functionality, and performance of these devices, the electrodes and microelectrode arrays-that are the basis of most emerging devices-must be further miniaturized and must possess exceptional electrochemical performance and charge exchange characteristics with neural tissue. In this report, we show for the first time that the electrochemical performance of femtosecond-laser hierarchically-restructured electrodes can be tuned to yield unprecedented performance values that significantly exceed those reported in the literature, e.g. charge storage capacity and specific capacitance were shown to have improved by two orders of magnitude and over 700-fold, respectively, compared to un-restructured electrodes. Additionally, correlation amongst laser parameters, electrochemical performance and surface parameters of the electrodes was established, and while performance metrics exhibit a relatively consistent increasing behavior with laser parameters, surface parameters tend to follow a less predictable trend negating a direct relationship between these surface parameters and performance. To answer the question of what drives such performance and tunability, and whether the widely adopted reasoning of increased surface area and roughening of the electrodes are the key contributors to the observed increase in performance, cross-sectional analysis of the electrodes using focused ion beam shows, for the first time, the existence of subsurface features that may have contributed to the observed electrochemical performance enhancements. This report is the first time that such performance enhancement and tunability are reported for femtosecond-laser hierarchically-restructured electrodes for neural interfacing applications.
Collapse
Affiliation(s)
- Shahram Amini
- Research and Development, Pulse Technologies Inc., Quakertown, PA, 18951, USA.
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA.
| | - Wesley Seche
- Research and Development, Pulse Technologies Inc., Quakertown, PA, 18951, USA
| | - Nicholas May
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| | - Hongbin Choi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| | - Pouya Tavousi
- UConn Tech Park, University of Connecticut, Storrs, CT, 06269, USA
| | - Sina Shahbazmohamadi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| |
Collapse
|
15
|
Wichova H, Shew M, Nelson-Brantley J, Warnecke A, Prentiss S, Staecker H. MicroRNA Profiling in the Perilymph of Cochlear Implant Patients: Identifying Markers that Correlate to Audiological Outcomes. J Am Acad Audiol 2022; 32:627-635. [PMID: 35609590 DOI: 10.1055/s-0041-1742234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HYPOTHESIS MicroRNA (miRNA) expression profiles from human perilymph correlate to post cochlear implantation (CI) hearing outcomes. BACKGROUND The high inter-individual variability in speech perception among cochlear implant recipients is still poorly understood. MiRNA expression in perilymph can be used to characterize the molecular processes underlying inner ear disease and to predict performance with a cochlear implant. METHODS Perilymph collected during CI from 17 patients was analyzed using microarrays. MiRNAs were identified and multivariable analysis using consonant-nucleus-consonant testing at 6 and 18 months post implant activation was performed. Variables analyzed included age, gender, preoperative pure tone average (PTA), and preoperative speech discrimination (word recognition [WR]). Gene ontology analysis was performed to identify potential functional implications of changes in the identified miRNAs. RESULTS Distinct miRNA profiles correlated to preoperative PTA and WR. Patients classified as poor performers showed downregulation of six miRNAs that potentially regulate pathways related to neuronal function and cell survival. CONCLUSION Individual miRNA profiles can be identified in microvolumes of perilymph. Distinct non-coding RNA expression profiles correlate to preoperative hearing and postoperative cochlear implant outcomes.
Collapse
Affiliation(s)
| | - Matthew Shew
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jennifer Nelson-Brantley
- Department of Anatomy and Cell Biology, School of Medicine, University of Kanas, Kansas City, Kansas
| | - Athanasia Warnecke
- Department of Otolaryngology Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Sandra Prentiss
- Department of Otolaryngology Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida
| | - Hinrich Staecker
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City Kansas
| |
Collapse
|
16
|
Markodimitraki LM, Stegeman I, Thomeer HGXM. Cochlear Implant Awareness: Development and Validation of a Patient Reported Outcome Measure. Front Neurosci 2022; 16:830768. [PMID: 35573281 PMCID: PMC9100413 DOI: 10.3389/fnins.2022.830768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Surgical success of cochlear implantation is usually measured through speech perception and quality of life questionnaires. Although these questionnaires cover a broad spectrum of domains, they do not evaluate the consciousness of wearing a cochlear implant (CI) and how this impacts the daily life of patients. To evaluate this concept we aimed to develop and validate a standardized patient reported outcome measure (PROM) for use in cochlear implant users. Methods Development and evaluation of the COchlear iMPlant AwareneSS (COMPASS) questionnaire was realized following the COSMIN guidelines in three phases: (1) item generation, (2) qualitative pilot study to ensure relevance, comprehensiveness, comprehensibility, and face validity, and (3) quantitative survey study for the assessment of reliability (test-retest) with 54 participants. Results Nine domains of CI awareness were identified through literature research and interviews with experts and patients. These resulted in the formulation of 18 items which were tested with a pilot study, after which 3 items were deleted. The final 15-item COMPASS questionnaire proved to have good validity and satisfactory reliability. The intraclass correlation coefficient calculated for items with continuous variables ranged from 0.66 to 0.89 with seven out of eight items scoring above the acceptable level of 0.7. The Cohen’s kappa calculated for items with nominal variables ranged from −0.4 to 0.78 with 11 (sub)items out of 15 scoring above fair to good agreement. Measurement error analysis for items with continuous variables showed a mean difference of −2.18 to 0.22. The calculated 95% limits of agreement for these items revealed no statistically significant difference between the two administered questionnaires. For items with nominal variables, the percentages of agreement calculated, ranged between 0 and 95%, and 83.3 and 96.6% for positive and negative agreement, respectively. Conclusion The COMPASS questionnaire is a valid and reliable PROM for evaluating the cochlear implant awareness, and it can be easily used in routine clinical practice.
Collapse
Affiliation(s)
- Laura M. Markodimitraki
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Laura M. Markodimitraki,
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
17
|
Cochlear Implantation Improves Both Speech Perception and Patient-Reported Outcomes: A Prospective Follow-Up Study of Treatment Benefits among Adult Cochlear Implant Recipients. J Clin Med 2022; 11:jcm11082257. [PMID: 35456353 PMCID: PMC9032498 DOI: 10.3390/jcm11082257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cochlear implantation is considered the best treatment option for patients with severe-to-profound sensorineural hearing loss for whom conventional hearing aids are insufficient. We used a repeated measures longitudinal approach to evaluate speech recognition and patient-reported outcomes after cochlear implantation in an unbiased cohort of Danish adult patients in a prospective cohort study. We assessed 39 recipients before and two times after implantation using a battery of tests that included Dantale I, the Danish Hearing in Noise Test, the Nijmegen Cochlear Implant Questionnaire, and the Speech, Spatial, and Qualities of Hearing Scale. The study group improved significantly on all outcome measures following implantation. On average, Dantale I scores improved by 29 percentage points and Hearing in Noise Test scores improved by 22 percentage points. Most notably, the average Dantale score improved from 26 to 70% in the CI in quiet condition and from 12 to 42% in the cochlear implantation in noise condition when tested monaurally. Dantale demonstrated a significant positive correlation with Nijmegen Cochlear Implant Questionnaire and Speech, Spatial, and Qualities of Hearing Scale scores, while Hearing in Noise Test had no significant correlation with the patient-reported outcome measures. Patients improved significantly at 4 months and marginally improved further at 14 months, indicating that they were approaching a plateau. Our study’s use of audiometric and patient-reported outcome measures provides evidence of the treatment benefits of cochlear implantation in adults, which may help physicians advise patients on treatment decisions and align treatment benefit expectations, as well as serve as a foundation for the development of new cochlear implantation selection criteria.
Collapse
|
18
|
Methods for measuring pre-, intra-, and postoperative skin thickness for cochlear implants. J Otol 2022; 17:72-77. [PMID: 35949548 PMCID: PMC9349019 DOI: 10.1016/j.joto.2021.12.001] [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: 11/15/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective This study was conducted to determine whether there is a reliable method for measuring the thickness of the retroauricular skin before, during, and after cochlear implantation, which allows the assessment of the optimal force of the external magnet of the cochlear implant (CI). Methods The retroauricular skin thickness of 83 patients who received a CI was measured using three different methods. The thickness was measured on pre- and postoperative CT images, as well as intraoperatively. The magnet category chosen by the surgeon was recorded when the implant was switched on and during the first follow-up visit. Correlation analyses were performed on the different skin thickness measurements and between the skin thickness and magnet strength categories. Results Only six patients required an exchange of the magnet until the follow-up. Although the median absolute thickness differed significantly between the three measures (p < 0.0001), their thickness values showed highly significant correlations (Pearson's r = 0.457–0.585; p < 0.01). In addition, magnet strength, was significantly correlated with the flap thickness determined pre-, post-, and during surgery. The lowest correlation with magnet strength was found in the intraoperative needle method. Conclusion All three measurements methods provided a suitable base for determining the ideal magnetic force. However, of particular interest were the pre- and postoperative CT measurements. The first enabled the early assessment of the required magnetic strength and thus a timely postoperative supply, whereas the latter helped to estimate the need for magnetic strength reduction during follow-up care and the feasibility of an early swith-on.
Collapse
|
19
|
Kant E, Markodimitraki LM, Stegeman I, Thomeer HGXM. Variability in surgical techniques for cochlear implantation: an international survey study. Cochlear Implants Int 2022; 23:195-202. [PMID: 35317714 DOI: 10.1080/14670100.2022.2051242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to gain insight into current practices regarding the surgical techniques used for positioning and fixation of internal components of the cochlear implant. METHODS A questionnaire focused on surgical techniques used for cochlear implantation was distributed among 441 cochlear implant surgeons. Descriptive statistics were reported. RESULTS The questionnaire was completed by 59 surgeons working in 13 different countries. The most preferred incision shapes were the S-shape (41%) and the C-shape (36%). The preferred implantation angle for the receiver/stimulator device was either 45° (64%) or 60° (30%), relative to the Frankfurter Horizontal Plane. Most respondents used a drilled bony well with (42%) or without a subperiosteal pocket (31%) to fixate the receiver/stimulator device. All respondents used the facial recess approach. Most used the round window insertion technique to enter the scala tympani (73%). Approximately half of the respondents preferred the lateral wall electrode array, whereas the other half preferred the perimodiolar electrode array. During their career, most (86%) changed their technique towards structure preservation and minimizing trauma. CONCLUSION This study indicates variability in the surgical techniques used to position and fixate the internal components of the cochlear implant. Additionally, surgical preference transits towards structure preservation and minimal invasiveness.
Collapse
Affiliation(s)
- Ellen Kant
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura M Markodimitraki
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.,Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
20
|
Durisin M, Krüger C, Pich A, Warnecke A, Steffens M, Zeilinger C, Lenarz T, Prenzler N, Schmitt H. Proteome profile of patients with excellent and poor speech intelligibility after cochlear implantation: Can perilymph proteins predict performance? PLoS One 2022; 17:e0263765. [PMID: 35239655 PMCID: PMC8893673 DOI: 10.1371/journal.pone.0263765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022] Open
Abstract
Modern proteomic analysis and reliable surgical access to gain liquid inner ear biopsies have enabled in depth molecular characterization of the cochlea microenvironment. In order to clarify whether the protein composition of the perilymph can provide new insights into individual hearing performance after cochlear implantation (CI), computational analysis in correlation to clinical performance after CI were performed based on the proteome profile derived from perilymph samples (liquid biopsies). Perilymph samples from cochlear implant recipients have been analyzed by mass spectrometry (MS). The proteins were identified using the shot-gun proteomics method and quantified and analyzed using Max Quant, Perseus and IPA software. A total of 75 perilymph samples from 68 (adults and children) patients were included in the analysis. Speech perception data one year after implantation were available for 45 patients and these were used for subsequent analysis. According to their hearing performance, patients with excellent (n = 22) and poor (n = 14) performance one year after CI were identified and used for further analysis. The protein composition and statistically significant differences in the two groups were detected by relative quantification of the perilymph proteins. With this procedure, a selection of 287 proteins were identified in at least eight samples in both groups. In the perilymph of the patients with excellent and poor performance, five and six significantly elevated proteins were identified respectively. These proteins seem to be involved in different immunological processes in excellent and poor performer. Further analysis on the role of specific proteins as predictors for poor or excellent performance among CI recipients are mandatory. Combinatory analysis of molecular inner ear profiles and clinical performance data using bioinformatics analysis may open up new possibilities for patient stratification. The impact of such prediction algorithms on diagnosis and treatment needs to be established in further studies.
Collapse
Affiliation(s)
- Martin Durisin
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Caroline Krüger
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andreas Pich
- Core Facility Proteomics, Hannover Medical School, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence of the German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”) “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Melanie Steffens
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Carsten Zeilinger
- BMWZ (Zentrum für Biomolekulare Wirkstoffe), Gottfried-Wilhelm-Leibniz University, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence of the German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”) “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Nils Prenzler
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Heike Schmitt
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence of the German Research Foundation (DFG; “Deutsche Forschungsgemeinschaft”) “Hearing4all”, Hannover Medical School, Hannover, Germany
| |
Collapse
|
21
|
Rees J, Abrar R, Stapleton E. A comparison of imaging techniques to measure skin flap thickness in cochlear implant patients to enable pre-operative device selection. Cochlear Implants Int 2022; 23:179-188. [PMID: 35236259 DOI: 10.1080/14670100.2022.2045074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI)-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditionally measured with a needle in the operating theatre. We aimed to establish the accuracy of imaging modalities to measure skin flap thickness pre-operatively, with the goal of streamlining device selection and simplifying the consent process. METHODS Skin flap measurements were taken using ultrasound (US), computed tomography (CT) and MRI and compared for agreement with intra-operative needle measurement. RESULTS Twenty-seven skin flaps were included. Absolute agreement between needle and imaging methods was low: needle/US: 44.4% (95% confidence interval [CI]: 27.7-62.7), needle/CT: 39.1% (95% CI: 22.2-59.2), needle/MRI: 20.8% (95% CI: 9.2-40.5). However, US and CT showed 95.7% agreement (95% CI: 76.0-99.8) with intraclass correlation of 0.996 (95% CI: 0.991-0.998) and narrow Bland-Altman limits of agreement (-0.37, 0.45 mm). BMI and skin flap thickness showed a significant positive correlation (rs = 0.664, P = 0.002) but no significant correlation was observed for age (P = 0.659). DISCUSSION The high level of agreement between US and CT suggests that there are more accurate measurements of skin flap thickness compared with needle or MRI. Needle measurements are consistently smaller. CONCLUSION The use of CT or US should be considered when making pre-operative device choices.
Collapse
Affiliation(s)
- Jacob Rees
- Manchester Academic Health Science Centre, The Richard Ramsden Centre for Hearing Implants, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rohma Abrar
- Manchester Academic Health Science Centre, The Richard Ramsden Centre for Hearing Implants, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emma Stapleton
- Manchester Academic Health Science Centre, The Richard Ramsden Centre for Hearing Implants, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
22
|
Taylor G, Paladines R, Marti A, Jacobs D, Tint S, Fones A, Hamilton H, Yu L, Amini S, Hettinger J. Electrochemical enhancement of reactively sputtered rhodium, ruthenium, and iridium oxide thin films for neural modulation, sensing, and recording applications. Electrochim Acta 2021. [DOI: 10.1016/j.electacta.2021.139118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
23
|
Shew M, Wichova H, Warnecke A, Lenarz T, Staecker H. Evaluating Neurotrophin Signaling Using MicroRNA Perilymph Profiling in Cochlear Implant Patients With and Without Residual Hearing. Otol Neurotol 2021; 42:e1125-e1133. [PMID: 33973949 DOI: 10.1097/mao.0000000000003182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
HYPOTHESIS MicroRNAs predicted to regulate neurotrophin signaling can be found in human perilymph. BACKGROUND Animal and human temporal bone studies suggest that spiral ganglion health can affect cochlear implant (CI) outcomes. Neurotrophins have been identified as a key factor in the maintenance of spiral ganglion health. Changes in miRNAs may regulate neurotrophin signaling and may reflect neurotrophin expression levels. METHODS Perilymph sampling was carried out in 18 patients undergoing cochlear implantation or stapedotomy. Expression of miRNAs in perilymph was evaluated using an Agilent miRNA gene chip. Using ingenuity pathway analysis (IPA) software, miRNAs targeting neurotrophin signaling pathway genes present in a cochlear cDNA library were annotated. Expression levels of miRNAs in perilymph were correlated to the patients' preoperative pure-tone average. RESULTS Expression of mRNAs coding for neurotrophins and their receptors were identified in tissue obtained from normal human cochlea during skull base surgery. We identified miRNAs predicted to regulate these signaling cascades, including miR-1207-5p, miR-4651, miR-103-3p, miR-100-5p, miR-221-3p, miR-200-3p. There was a correlation between poor preoperative hearing and lower expression of miR-1207 (predicted to regulate NTR3) and miR-4651 (predicted to regulate NTR2). Additionally, miR-3960, miR-4481, and miR-675 showed significant differences in expression level when comparing mild and profound hearing loss patients. CONCLUSIONS Expression of some miRNAs that are predicted to regulate neurotrophin signaling in the perilymph of cochlear implant patients vary with the patient's level of residual hearing. These miRNAs may serve as biomarkers for changes in neurotrophin signaling.
Collapse
Affiliation(s)
- Matthew Shew
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Helena Wichova
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Athanasia Warnecke
- Department of Otolaryngology, Medizinische Hochschule Hannover, Hannover
- Cluster of Excellence "Hearing4all" of the German Research Foundation (EXC 1077), Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Medizinische Hochschule Hannover, Hannover
- Cluster of Excellence "Hearing4all" of the German Research Foundation (EXC 1077), Germany
| | - Hinrich Staecker
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| |
Collapse
|
24
|
Affiliation(s)
- Matthew L Carlson
- From the Department of Otolaryngology-Head and Neck Surgery and the Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
25
|
Rochford AE, Carnicer-Lombarte A, Curto VF, Malliaras GG, Barone DG. When Bio Meets Technology: Biohybrid Neural Interfaces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1903182. [PMID: 31517403 DOI: 10.1002/adma.201903182] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/06/2019] [Indexed: 06/10/2023]
Abstract
The development of electronics capable of interfacing with the nervous system is a rapidly advancing field with applications in basic science and clinical translation. Devices containing arrays of electrodes can be used in the study of cells grown in culture or can be implanted into damaged or dysfunctional tissue to restore normal function. While devices are typically designed and used exclusively for one of these two purposes, there have been increasing efforts in developing implantable electrode arrays capable of housing cultured cells, referred to as biohybrid implants. Once implanted, the cells within these implants integrate into the tissue, serving as a mediator of the electrode-tissue interface. This biological component offers unique advantages to these implant designs, providing better tissue integration and potentially long-term stability. Herein, an overview of current research into biohybrid devices, as well as the historical background that led to their development are provided, based on the host anatomical location for which they are designed (CNS, PNS, or special senses). Finally, a summary of the key challenges of this technology and potential future research directions are presented.
Collapse
Affiliation(s)
- Amy E Rochford
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | | | - Vincenzo F Curto
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | - George G Malliaras
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | - Damiano G Barone
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| |
Collapse
|
26
|
Kirchhoff L, Arweiler-Harbeck D, Arnolds J, Hussain T, Hansen S, Bertram R, Buer J, Lang S, Steinmann J, Höing B. Imaging studies of bacterial biofilms on cochlear implants-Bioactive glass (BAG) inhibits mature biofilm. PLoS One 2020; 15:e0229198. [PMID: 32084198 PMCID: PMC7034800 DOI: 10.1371/journal.pone.0229198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
The capability of Pseudomonas aeruginosa and Staphylococcus aureus to form biofilm on varying CI component materials differs in the presence and absence of bioactive glass (BAG). The application of BAG induces significant changes in biofilm morphology which can be visualized via scanning electron microscopy (SEM). Bacterial biofilm formation on medical devices, such as cochlear implants (CI), can lead to chronic infections. Interestingly, BAG of type S53P4 seems to be a promising tool for use in the reduction of biofilm development. Primarily, four bacterial species known to cause implant-related infections, P.aeruginosa (ATCC9027), S. aureus (ATCC6538), Staphylococcus epidermidis (ATCC12228) and Streptococcus pyogenes (ATCC19615) were analyzed regarding their capacity to form biofilm on CI components manufactured from three kinds of material: silicone, platinum and titanium. Subsequently, P. aeruginosa and S. aureus biofilms were visualized using scanning electron microscopy, comparing BAG-treated biofilm with non-treated biofilm. The four bacterial species presented biofilm-forming capabilities in a species and surface dependent manner. Metal CI components allowed for the greatest proliferation of biofilm. S. aureus and P. aeruginosa showed the highest rate of biofilm formation on polystyrene surfaces. For both species, SEM revealed altered biofilm morphology after treatment of S53P4 BAG. This study indicates that bacterial biofilm formation and structure on CI components is dependent on the surface composition, altering between metal and silicone surfaces. After application of BAG, changes in biofilm morphology on CI components were observed. These data highlight the impact of BAG on bacterial biofilm morphology.
Collapse
Affiliation(s)
- Lisa Kirchhoff
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Judith Arnolds
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ralph Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuernberg, Nuremberg, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Klinikum Nuernberg, Nuremberg, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
27
|
Bioactive Glass Granules Inhibit Mature Bacterial Biofilms on the Surfaces of Cochlear Implants. Otol Neurotol 2019; 39:e985-e991. [PMID: 30334871 DOI: 10.1097/mao.0000000000002021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
HYPOTHESIS Biofilm formation on cochlear implant (CI) surfaces differs between bacterial species and can be reduced by the application of S53P4 bioactive glass. BACKGROUND The formation of bacterial biofilms on medical devices, such as cochlear implants, can lead to chronic infections resulting in the need for implant removal. In this study, various surfaces of three CI implant kits from different manufacturers were examined for bacterial biofilm formation and reduction of a pre-existing biofilm by the application of bioactive glass. METHODS Biofilm formations of 4 bacterial species causing implant-related infections were tested on 17 different surfaces: Pseudomonas aeruginosa (ATCC9027), Staphylococcus aureus (ATCC6538), Staphylococcus epidermidis (ATCC12228), and Streptococcus pyogenes (ATCC19615). For P. aeruginosa and S. aureus biofilm reduction after application of S53P4 bioactive glass was evaluated. RESULTS All tested microbial species formed biofilms on the examined CI surfaces in a strain-dependent manner. For S. aureus, a significantly higher biofilm formation on metal components compared with silicone was found whereas the other strains did not show a material specific biofilm formation. Application of S53P4 bioactive glass resulted in a significant reduction of P. aeruginosa and S. aureus mature biofilm. CONCLUSION The four bacteria species displayed biofilm formation on the CI surfaces in a species- and material-specific manner. The results show that bioactive glass can reduce biofilm formation on CI materials in vitro. Future studies are necessary to confirm the results in vivo.
Collapse
|
28
|
Abstract
OBJECTIVES/HYPOTHESIS Cochlear implantation (CI) is a well-accepted surgical option for the treatment of moderate to profound deafness. The purpose of this study was to evaluate the temporal and geographic trends of this procedure nationwide in the Medicare population in an attempt to explore the impact of evolving technologies and changes in healthcare policy. METHODS Medicare Part B national summary procedural datasets from 2007 to 2016 were obtained. Current Procedural Terminology codes for CI as well as auditory osseointegrated implantation were obtained. Centers for Medicare and Medicaid Services (CMS) datasets were evaluated to determine temporal trends. For geographic trends, specific carrier datasets from 2007 and 2016 were used. RESULTS From 2007 through 2016, the number of CI procedures increased annually from 1603 to 3600 (124.6%). Other procedures to treat hearing loss including bone-anchored implantation exhibited comparatively modest increases (23%, 90%). CI procedures increased every year in contrast to bone-anchored implants. Controlling for Medicare population, the greatest number of CI procedures performed per capita in the United States was in the West North Central, with an average 1.05 CIs per 10,000 beneficiaries. CONCLUSION The number of CI procedures performed in the elderly population has increased markedly over the past 10 years, far outpacing growth in other hearing surgeries. Potential reasons may relate to changes in criteria for CI candidacy over the past decade, although significant regional variability demonstrated suggests a lack of consensus. Further studies would be necessary to ascertain the true reason for geographic disparities.
Collapse
|
29
|
Sirirattawan J, Khuancharee K. Measures of Comparative Behavior in Hearing Loss Patients with Cochlear Implant: Caretaker Assessment. Indian J Otolaryngol Head Neck Surg 2019; 71:1147-1152. [DOI: 10.1007/s12070-018-01574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/24/2018] [Indexed: 11/24/2022] Open
|
30
|
An In-Vitro Insertion-Force Study of Magnetically Guided Lateral-Wall Cochlear-Implant Electrode Arrays. Otol Neurotol 2019; 39:e63-e73. [PMID: 29315180 PMCID: PMC5763516 DOI: 10.1097/mao.0000000000001647] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hypothesis: Insertion forces can be reduced by magnetically guiding the tip of lateral-wall cochlear-implant electrode arrays during insertion via both cochleostomy and the round window. Background: Steerable electrode arrays have the potential to minimize intracochlear trauma by reducing the severity of contact between the electrode-array tip and the cochlear wall. However, steerable electrode arrays typically have increased stiffness associated with the steering mechanism. In addition, steerable electrode arrays are typically designed to curve in the direction of the basal turn, which is not ideal for round-window insertions, as the cochlear hook's curvature is in the opposite direction. Lateral-wall electrode arrays can be modified to include magnets at their tips, augmenting their superior flexibility with a steering mechanism. By applying magnetic torque to the tip, an electrode array can be navigated through the cochlear hook and the basal turn. Methods: Automated insertions of candidate electrode arrays are conducted into a scala-tympani phantom with either a cochleostomy or round-window opening. The phantom is mounted on a multi-degree-of-freedom force sensor. An external magnet applies the necessary magnetic bending torque to the magnetic tip of a modified clinical electrode array, coordinated with the insertion, with the goal of directing the tip down the lumen. Steering of the electrode array is verified through a camera. Results: Statistical t-test results indicate that magnetic guidance does reduce insertion forces by as much as 50% with certain electrode-array models. Direct tip contact with the medial wall through the cochlear hook and the lateral wall of the basal turn is completely eliminated. The magnetic field required to accomplish these insertions varied from 77 to 225 mT based on the volume of the magnet at the tip of the electrode array. Alteration of the tip to accommodate a tiny magnet is minimal and does not change the insertion characteristic of the electrode array unless the tip shape is altered. Conclusion: Magnetic guidance can eliminate direct tip contact with the medial walls through the cochlear hook and the lateral walls of the basal turn. Insertion-force reduction will vary based on the electrode-array model, but is statistically significant for all models tested. Successful steering of lateral-wall electrode arrays is accomplished while maintaining its superior flexibility.
Collapse
|
31
|
Zhang F, Underwood G, McGuire K, Liang C, Moore DR, Fu QJ. Frequency change detection and speech perception in cochlear implant users. Hear Res 2019; 379:12-20. [PMID: 31035223 PMCID: PMC6571168 DOI: 10.1016/j.heares.2019.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes.
Collapse
Affiliation(s)
- Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA.
| | - Gabrielle Underwood
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Chun Liang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA; Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, University of Cincinnati, Ohio, USA
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
32
|
de Vries I, Schmitt H, Lenarz T, Prenzler N, Alvi S, Staecker H, Durisin M, Warnecke A. Detection of BDNF-Related Proteins in Human Perilymph in Patients With Hearing Loss. Front Neurosci 2019; 13:214. [PMID: 30971872 PMCID: PMC6445295 DOI: 10.3389/fnins.2019.00214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/25/2019] [Indexed: 12/05/2022] Open
Abstract
The outcome of cochlear implantation depends on multiple variables including the underlying health of the cochlea. Brain derived neurotrophic factor (BDNF) has been shown to support spiral ganglion neurons and to improve implant function in animal models. Whether endogenous BDNF or BDNF-regulated proteins can be used as biomarkers to predict cochlear health and implant outcome has not been investigated yet. Gene expression of BDNF and downstream signaling molecules were identified in tissue of human cochleae obtained from normal hearing patients (n = 3) during skull base surgeries. Based on the gene expression data, bioinformatic analysis was utilized to predict the regulation of proteins by BDNF. The presence of proteins corresponding to these genes was investigated in perilymph (n = 41) obtained from hearing-impaired patients (n = 38) during cochlear implantation or skull base surgery for removal of vestibular schwannoma by nanoscale liquid chromatography coupled to tandem mass spectrometry (nano LC-MS/MS). Analyzed by mass spectrometry were 41 perilymph samples despite three patients undergoing bilateral cochlear implantation. These particular BDNF regulated proteins were not detectable in any of the perilymph samples. Subsequently, targeted analysis of the perilymph proteome data with Ingenuity Pathway Analysis (IPA) identified further proteins in human perilymph that could be regulated by BDNF. These BDNF regulated proteins were correlated to the presence of residual hearing (RH) prior to implantation and to the performance data with the cochlear implant after 1 year. There was overall a decreased level of expression of BDNF-regulated proteins in profoundly hearing-impaired patients compared to patients with some RH. Phospholipid transfer protein was positively correlated to the preoperative hearing level of the patients. Our data show that combination of gene expression arrays and bioinformatic analysis can aid in the prediction of downstream signaling proteins related to the BDNF pathway. Proteomic analysis of perilymph may help to identify the presence or absence of these molecules in the diseased organ. The impact of such prediction algorithms on diagnosis and treatment needs to be established in further studies.
Collapse
Affiliation(s)
- Ines de Vries
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Heike Schmitt
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence Hearing4all, German Research Foundation, Hannover Medical School, Hanover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence Hearing4all, German Research Foundation, Hannover Medical School, Hanover, Germany
| | - Nils Prenzler
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Sameer Alvi
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Hinrich Staecker
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, MO, United States
| | - Martin Durisin
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Athanasia Warnecke
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany.,Cluster of Excellence Hearing4all, German Research Foundation, Hannover Medical School, Hanover, Germany
| |
Collapse
|
33
|
Carlson ML. The History of Otologic Surgery at Mayo Clinic, 1883 to Present. Mayo Clin Proc 2019; 94:e19-e33. [PMID: 30711141 DOI: 10.1016/j.mayocp.2018.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/23/2018] [Accepted: 10/03/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew L Carlson
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
34
|
Palmer JC, Green RA, Boscher F, Poole-Warren LA, Carter PM, Enke YL, Lovell NH, Lord MS. Development and performance of a biomimetic artificial perilymph for in vitro testing of medical devices. J Neural Eng 2019; 16:026006. [DOI: 10.1088/1741-2552/aaf482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
35
|
Survey of the American Neurotology Society on Cochlear Implantation: Part 1, Candidacy Assessment and Expanding Indications. Otol Neurotol 2018; 39:e12-e19. [PMID: 29210952 DOI: 10.1097/mao.0000000000001632] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine practice variance of cochlear implant candidacy assessment and off-label indications across centers in the United States. METHODS Cross-sectional survey of the American Neurotology Society (ANS). RESULTS A total of 81 surveys were returned from ANS members who report regular involvement in cochlear implant care. Overall there was a broad distribution in age and clinical experience, with most respondents reporting ACGME accreditation in neurotology and employment at an academic center. The annual volume of cochlear implant surgeries varied considerably across centers.Seventy-eight percent of respondents performed cochlear implantation for at least one of the following indications within the last 2 years: profound hearing loss in children less than 12 months of age (35, 43%), children with asymmetrical hearing loss where at least one ear was better than performance cutoff for age (25, 31%), adults with asymmetrical hearing where at least one ear was better than the performance cutoff for adult criteria (49, 61%), single-sided deafness (37, 46%), and ipsilateral vestibular schwannoma (28, 35%). Centers with a higher annual implant volume more frequently performed off-label implantation in all queried populations (all, p≤0.001), and performed surgery on infants with congenital deafness at a younger age (p = 0.013), compared with centers with lower surgical volume.When surveyed regarding speech perception testing practices for adult candidacy assessment, 75 (100%) respondents who answered this question reported routine use of AzBio sentences, 42 (56%) CNC word scores, and 26 (35%) HINT testing; only 7 (9%) reported using BKB-SIN testing and 6 (8%) reported using CUNY scores. Fifty-one (68%) reported routine use of speech-in-noise testing to determine adult cochlear implant candidacy, 21 (28%) reported selective use only when patient scores were borderline in quiet, and 3 (4%) reported that their center does not currently use testing in noise for candidacy determination. Nineteen (26%) solely used +10 dB signal-to-noise ratio (SNR), 12 (16%) solely used +5 dB SNR, and 41 (55%) used both +10 and +5 dB SNR. Overall, 19% (N = 14) only perform unilateral implantation in the Medicare population, while 81% (N = 58) consider bilateral implantation. CONCLUSION Significant variation in cochlear implant candidacy assessment and off-label implantation exists across centers and providers in the United States resulting in healthcare inequities. The high percentage of surgeons performing implantations for off-label or nontraditional indications reflects the overly restrictive and dated status of current implant guidelines. With greater adoption of more difficult speech perception testing in noise, careful clinical judgment is needed to maintain a favorable risk-benefit balance for prospective implant candidates.
Collapse
|
36
|
Qing KY, Wasilczuk KM, Ward MP, Phillips EH, Vlachos PP, Goergen CJ, Irazoqui PP. B fibers are the best predictors of cardiac activity during Vagus nerve stimulation: Qing, vagal B fiber activation and cardiac effects. Bioelectron Med 2018; 4:5. [PMID: 32232081 PMCID: PMC7098216 DOI: 10.1186/s42234-018-0005-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background Vagus nerve stimulation (VNS) is a promising therapy for many neurologic and psychiatric conditions. However, determining stimulus parameters for individual patients is a major challenge. The traditional method of titrating stimulus intensity based on patient perception produces highly variable responses. This study explores using the vagal response to measure stimulation dose and predict physiological effect. Clinicians are investigating the use of VNS for heart failure management, and this work aims to correlate cardiac measures with vagal fiber activity. Results By recording vagal activity during VNS in rats and using regression analysis, we found that cardiac activity across all animals was best correlated to the activation of a specific vagal fiber group. With conduction velocities ranging from 5 to 10 m/s, these fibers are classified as B fibers (using the Erlanger-Gasser system) and correspond to vagal parasympathetic efferents. Conclusions B fiber activation can serve as a standardized, objective measure of stimulus dose across all subjects. Tracking fiber activation provides a more systematic way to study the effects of VNS and in the future, may lead to a more consistent method of therapy delivery.
Collapse
Affiliation(s)
- Kurt Y Qing
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA.,2Indiana University School of Medicine, Indianapolis, IN USA
| | | | - Matthew P Ward
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Evan H Phillips
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Pavlos P Vlachos
- 3Mechanical Engineering, Purdue University, West Lafayette, IN USA
| | - Craig J Goergen
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Pedro P Irazoqui
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| |
Collapse
|
37
|
On the design of a MEMS piezoelectric accelerometer coupled to the middle ear as an implantable sensor for hearing devices. Sci Rep 2018; 8:3920. [PMID: 29500435 PMCID: PMC5834511 DOI: 10.1038/s41598-018-22219-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/19/2018] [Indexed: 11/08/2022] Open
Abstract
The presence of external elements is a major limitation of current hearing aids and cochlear implants, as they lead to discomfort and inconvenience. Totally implantable hearing devices have been proposed as a solution to mitigate these constraints, which has led to challenges in designing implantable sensors. This work presents a feasibility analysis of a MEMS piezoelectric accelerometer coupled to the ossicular chain as an alternative sensor. The main requirements of the sensor include small size, low internal noise, low power consumption, and large bandwidth. Different designs of MEMS piezoelectric accelerometers were modeled using Finite Element (FE) method, as well as optimized for high net charge sensitivity. The best design, a 2 × 2 mm2 annular configuration with a 500 nm thick Aluminum Nitride (AlN) layer was selected for fabrication. The prototype was characterized, and its charge sensitivity and spectral acceleration noise were found to be with good agreement to the FE model predictions. Weak coupling between a middle ear FE model and the prototype was considered, resulting in equivalent input noise (EIN) lower than 60 dB sound pressure level between 600 Hz and 10 kHz. These results are an encouraging proof of concept for the development of MEMS piezoelectric accelerometers as implantable sensors for hearing devices.
Collapse
|
38
|
Intraoperative Cochlear Implant Device Testing Utilizing an Automated Remote System: A Prospective Pilot Study. Otol Neurotol 2018; 39:313-317. [DOI: 10.1097/mao.0000000000001719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Calero D, Paul S, Gesing A, Alves F, Cordioli JA. A technical review and evaluation of implantable sensors for hearing devices. Biomed Eng Online 2018; 17:23. [PMID: 29433516 PMCID: PMC5810055 DOI: 10.1186/s12938-018-0454-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
Most commercially available cochlear implants and hearing aids use microphones as sensors for capturing the external sound field. These microphones are in general located in an external element, which is also responsible for processing the sound signal. However, the presence of the external element is the cause of several problems such as discomfort, impossibility of being used during physical activities and sleeping, and social stigma. These limitations have driven studies with the goal of developing totally implantable hearing devices, and the design of an implantable sensor has been one of the main challenges to be overcome. Different designs of implantable sensors can be found in the literature and in some commercial implantable hearing aids, including different transduction mechanisms (capacitive, piezoelectric, electromagnetic, etc), configurations microphones, accelerometers, force sensor, etc) and locations (subcutaneous or middle ear). In this work, a detailed technical review of such designs is presented and a general classification is proposed. The technical characteristics of each sensors are presented and discussed in view of the main requirements for an implantable sensor for hearing devices, including sensitivity, internal noise, frequency bandwidth and energy consumption. The feasibility of implantation of each sensor is also evaluated and compared.
Collapse
Affiliation(s)
- Diego Calero
- Laboratory of Vibration and Acoustics, Florianópolis, Brazil
| | - Stephan Paul
- Laboratory of Vibration and Acoustics, Florianópolis, Brazil
| | - André Gesing
- Laboratory of Vibration and Acoustics, Florianópolis, Brazil
| | | | | |
Collapse
|
40
|
Leon L, Warren FM, Abbott JJ. Optimizing the Magnetic Dipole-Field Source for Magnetically Guided Cochlear-Implant Electrode-Array Insertions. ACTA ACUST UNITED AC 2018; 3. [PMID: 30009274 DOI: 10.1142/s2424905x18500046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Magnetic guidance of cochlear-implant electrode arrays during insertion has been demonstrated in vitro to reduce insertion forces, which is believed to be correlated to a reduction in trauma. In those prior studies, the magnetic dipole-field source (MDS) was configured to travel on a path that would be coincident with the cochlea's modiolar axis, which was an unnecessary constraint that was useful to demonstrate feasibility. In this paper, we determine the optimal configuration (size and location) of a spherical-permanent-magnet MDS needed to accomplish guided insertions with a 100 mT field strength required at the cochlea, and we provide a methodology to perform such an optimization more generally. Based on computed-tomography scans of 30 human subjects, the MDS should be lateral-to and slightly anterior-to the cochlea with an approximate radius (mean and standard deviation across subjects) of 64 mm and 4.5 mm, respectively. We compare these results to the modiolar configuration and find that the volume of the MDS can be reduced by a factor of five with a 43% reduction in its radius by moving it to the optimal location. We conservatively estimate that the magnetic forces generated by the optimal configuration are two orders of magnitude below the threshold needed to puncture the basilar membrane. Although subject-specific optimal configurations are computed in this paper, a one-size-fits-all version with a radius of approximately 75 mm is more robust to registration error and likely more practical. Finally, we explain how to translate the results obtained to an electromagnetic MDS.
Collapse
Affiliation(s)
- Lisandro Leon
- Department of Mechanical Engineering and the Robotics Center, University of Utah, Salt Lake City, UT, USA.,Sarcos Robotics, Salt Lake City, UT, USA
| | | | - Jake J Abbott
- Department of Mechanical Engineering and the Robotics Center, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
41
|
Survey of the American Neurotology Society on Cochlear Implantation: Part 2, Surgical and Device-Related Practice Patterns. Otol Neurotol 2018; 39:e20-e27. [DOI: 10.1097/mao.0000000000001631] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Cochlear Implant Electrode Localization Using an Ultra-High Resolution Scan Mode on Conventional 64-Slice and New Generation 192-Slice Multi-Detector Computed Tomography. Otol Neurotol 2017; 38:978-984. [DOI: 10.1097/mao.0000000000001463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
|
44
|
Palmer JC, Lord MS, Pinyon JL, Wise AK, Lovell NH, Carter PM, Enke YL, Housley GD, Green RA. Understanding the cochlear implant environment by mapping perilymph proteomes from different species. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5237-5240. [PMID: 28269445 DOI: 10.1109/embc.2016.7591908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cochlear implants operate within a bony channel of the cochlea, bathed in a fluid known as the perilymph. The perilymph is a complex fluid containing ions and proteins, which are known to actively interact with metallic electrodes. To improve our understanding of how cochlear implant performance varies in preclinical in vivo studies in comparison to human trials and patient outcomes, the protein composition (or perilymph proteome) is needed. Samples of perilymph were gathered from feline and guinea pig subjects and analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS) to produce proteomes and compare against the recently published human proteome. Over 64% of the proteins in the guinea pig proteome were found to be common to the human proteome. The proportions of apolipoproteins, enzymes and immunoglobulins showed little variation between the two proteomes, with other classes showing similarity. This establishes a good basis for comparison of results. The results for the feline profile showed less similarity with the human proteome and would not provide a quality comparison. This work highlights the suitability of the guinea pig to model the biological environment of the human cochlear and the need to carefully select models of the biological environment of a cochlear implant to more adequately translate in vitro and in vivo studies to the clinic.
Collapse
|
45
|
Roemer A, Köhl U, Majdani O, Klöß S, Falk C, Haumann S, Lenarz T, Kral A, Warnecke A. Biohybrid cochlear implants in human neurosensory restoration. Stem Cell Res Ther 2016; 7:148. [PMID: 27717379 PMCID: PMC5055669 DOI: 10.1186/s13287-016-0408-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The success of cochlear implantation may be further improved by minimizing implantation trauma. The physical trauma of implantation and subsequent immunological sequelae can affect residual hearing and the viability of the spiral ganglion. An ideal electrode should therefore decrease post-implantation trauma and provide support to the residual spiral ganglion population. Combining a flexible electrode with cells producing and releasing protective factors could present a potential means to achieve this. Mononuclear cells obtained from bone marrow (BM-MNC) consist of mesenchymal and hematopoietic progenitor cells. They possess the innate capacity to induce repair of traumatized tissue and to modulate immunological reactions. METHODS Human bone marrow was obtained from the patients that received treatment with biohybrid electrodes. Autologous mononuclear cells were isolated from bone marrow (BM-MNC) by centrifugation using the Regenlab™ THT-centrifugation tubes. Isolated BM-MNC were characterised using flow cytometry. In addition, the release of cytokines was analysed and their biological effect tested on spiral ganglion neurons isolated from neonatal rats. Fibrin adhesive (Tisseal™) was used for the coating of silicone-based cochlear implant electrode arrays for human use in order to generate biohybrid electrodes. Toxicity of the fibrin adhesive and influence on insertion, as well on the cell coating, was investigated. Furthermore, biohybrid electrodes were implanted in three patients. RESULTS Human BM-MNC release cytokines, chemokines, and growth factors that exert anti-inflammatory and neuroprotective effects. Using fibrin adhesive as a carrier for BM-MNC, a simple and effective cell coating procedure for cochlear implant electrodes was developed that can be utilised on-site in the operating room for the generation of biohybrid electrodes for intracochlear cell-based drug delivery. A safety study demonstrated the feasibility of autologous progenitor cell transplantation in humans as an adjuvant to cochlear implantation for neurosensory restoration. CONCLUSION This is the first report of the use of autologous cell transplantation to the human inner ear. Due to the simplicity of this procedure, we hope to initiate its widespread utilization in various fields.
Collapse
Affiliation(s)
- Ariane Roemer
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ulrike Köhl
- Institute for Cellular Therapeutics, IFB-Tx, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Omid Majdani
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Stephan Klöß
- Institute for Cellular Therapeutics, IFB-Tx, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christine Falk
- Institute of Transplant Immunology, IFB-Tx, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sabine Haumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andrej Kral
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| |
Collapse
|
46
|
Sharpe RA, Camposeo EL, Muzaffar WK, Holcomb MA, Dubno JR, Meyer TA. Effects of Age and Implanted Ear on Speech Recognition in Adults with Unilateral Cochlear Implants. Audiol Neurootol 2016; 21:223-230. [PMID: 27450677 DOI: 10.1159/000446390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to examine how age and implanted ear contribute to functional outcomes with cochlear implantation (CI). A retrospective review was performed on 96 adults who underwent unilateral CI. Older adults with right-ear implants had higher Hearing in Noise Test (HINT) scores at 1 year by 10.3% (p = 0.06). When adjusted to rationalized arcsine units (rau), right-ear HINT scores in older adults were higher by 12.1 rau (p = 0.04). Older adults had an 8.9% advantage on the right side compared to the left in post- versus preimplant scores for consonant-vowel nucleus-consonant words (p = 0.05). No significant differences were observed for younger adults. In conclusion, although adults of all ages experience improvements in speech perception following CI, there might be a subtle but consistent right-ear advantage in older adults.
Collapse
Affiliation(s)
- Robert Allan Sharpe
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C., USA
| | | | | | | | | | | |
Collapse
|
47
|
Landegger LD, Psaltis D, Stankovic KM. Human audiometric thresholds do not predict specific cellular damage in the inner ear. Hear Res 2016; 335:83-93. [PMID: 26924453 PMCID: PMC5970796 DOI: 10.1016/j.heares.2016.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/23/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION As otology enters the field of gene therapy and human studies commence, the question arises whether audiograms - the current gold standard for the evaluation of hearing function - can consistently predict cellular damage within the human inner ear and thus should be used to define inclusion criteria for trials. Current assumptions rely on the analysis of small groups of human temporal bones post mortem or from psychophysical identification of cochlear "dead regions" in vivo, but a comprehensive study assessing the correlation between audiometric thresholds and cellular damage within the cochlea is lacking. METHODS A total of 131 human temporal bones from 85 adult individuals (ages 19-92 years, median 69 years) with sensorineural hearing loss due to various etiologies were analyzed. Cytocochleograms - which quantify loss of hair cells, neurons, and strial atrophy along the length of the cochlea - were compared with subjects' latest available audiometric tests prior to death (time range 5 h-22 years, median 24 months). The Greenwood function and the equivalent rectangular bandwidth were used to infer, from cytocochleograms, cochlear locations corresponding to frequencies tested in clinical audiograms. Correlation between audiometric thresholds at clinically tested frequencies and cell type-specific damage in those frequency regions was examined by calculating Spearman's correlation coefficients. RESULTS Similar audiometric profiles reflected widely different cellular damage in the cochlea. In our diverse group of patients, audiometric thresholds tended to be more influenced by hair cell loss than by neuronal loss or strial atrophy. Spearman's correlation coefficient across frequencies was at most 0.7 and often below 0.5, with 1.0 indicating perfect correlation. CONCLUSIONS Audiometric thresholds do not predict specific cellular damage in the human inner ear. Our study highlights the need for better non- or minimally-invasive tools, such as cochlear endoscopy, to establish cellular-level diagnosis and thereby guide therapy and monitor response to treatment.
Collapse
Affiliation(s)
- Lukas D Landegger
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02141, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Demetri Psaltis
- Optics Laboratory, School of Engineering, Swiss Federal Institute of Technology Lausanne (EPFL), BM 4102 (Bâtiment BM), Station 17, 1015 Lausanne, Switzerland.
| | - Konstantina M Stankovic
- Eaton Peabody Laboratories, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02141, United States; Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Harvard Program in Speech and Hearing Bioscience and Technology, 260 Longwood Avenue, Boston, MA 02115, United States.
| |
Collapse
|
48
|
Intra-operative skull X-ray for misdirection of the cochlear implant array into the vestibular labyrinth. The Journal of Laryngology & Otology 2016; 129:923-7. [PMID: 26314324 DOI: 10.1017/s0022215115001966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray. METHODS The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging. RESULTS There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray. CONCLUSION These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.
Collapse
|
49
|
Lorens A, Skarzynski H, Rivas A, Rivas JA, Zimmermann K, Parnes L, Lassaletta L, Gavilán J, Bodt MD, van de Heyning P, Martin J, Raine CH, Rajeswaran R, Kameswaran M, Manoj M, Pulibalathingal S. Patient management for cochlear implant recipients in audiology departments: A practice review. Cochlear Implants Int 2016; 17:123-8. [PMID: 27078519 DOI: 10.1080/14670100.2015.1115188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine and evaluate the time clinics needed to complete the sub-processes involved in the first-fitting and follow-up fitting of people with a cochlear implant. METHODS Eight HEARRING clinics completed a questionnaire recording how long it took to complete the sub-processes involved in first-fitting and follow-up fitting cochlear implant recipients. The mean times of clinics and procedures were then compared. RESULTS Questionnaires on 77 patients were completed. Clinics varied widely on time spent on each sub-process in both first- and follow-up fittings. Total first-fitting times were similar across clinics. Follow-up fitting times varied more across clinics although this may have been due to differences in questionnaire interpretation. DISCUSSION If a patient management plan can help increasingly busy cochlear implant clinics provide high-quality care more efficiently, essential first steps are determining which procedures are generally performed and how long their performance takes. Until reliable data are gathered, constructing a patient management plan or reaping the potential benefits of its use will remain elusive; clinics will have to find what solutions they can to meet rising workload demands. CONCLUSION The variation in time spent on each sub-process may suggest that some clinics have more efficient workflow procedures. Compiling a best practice for each process could be instrumental in creating a professional process management plan that would increase efficiency without sacrificing quality of care.
Collapse
Affiliation(s)
- Artur Lorens
- a Institute of Physiology and Pathology of Hearing , Kajetany , Poland
| | - Henryk Skarzynski
- a Institute of Physiology and Pathology of Hearing , Kajetany , Poland
| | | | | | | | - Lorne Parnes
- c London Health Science Centre , London , Canada
| | | | | | | | | | | | | | | | | | - Manikoth Manoj
- h ENT Super Specialty Institute and Research Center , Calicut , India
| | | |
Collapse
|
50
|
Sweeney AD, Hunter JB, Carlson ML, Rivas A, Bennett ML, Gifford RH, Noble JH, Haynes DS, Labadie RF, Wanna GB. Durability of Hearing Preservation after Cochlear Implantation with Conventional-Length Electrodes and Scala Tympani Insertion. Otolaryngol Head Neck Surg 2016; 154:907-13. [PMID: 26908553 DOI: 10.1177/0194599816630545] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To analyze factors that influence hearing preservation over time in cochlear implant recipients with conventional-length electrode arrays located entirely within the scala tympani. STUDY DESIGN Case series with planned chart review. SETTING Single tertiary academic referral center. SUBJECTS AND METHODS A retrospective review was performed to analyze a subgroup of cochlear implant recipients with residual acoustic hearing. Patients were included in the study only if their electrode arrays remained fully in the scala tympani after insertion and serviceable acoustic hearing (≤80 dB at 250 Hz) was preserved. Electrode array location was verified through a validated radiographic assessment tool. Patients with <6 months of audiologic follow-up were excluded. The main outcome measure was change in acoustic hearing thresholds from implant activation to the last available follow-up. RESULTS A total of 16 cases met inclusion criteria (median age, 70.6 years; range, 29.4-82.2; 50% female). The average follow-up was 18.0 months (median, 16.1; range, 6.2-36.4). Patients with a lateral wall electrode array were more likely to have stable acoustic thresholds over time (P < .05). Positive correlations were seen between continued hearing loss following activation and larger initial postoperative acoustic threshold shifts, though statistical significance was not achieved. Age, sex, and noise exposure had no significant influence on continued hearing preservation over time. CONCLUSIONS To control for hearing loss associated with interscalar excursion during cochlear implantation, the present study evaluated patients only with conventional electrode arrays located entirely within the scala tympani. In this group, the style of electrode array may influence residual hearing preservation over time.
Collapse
Affiliation(s)
- Alex D Sweeney
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Alejandro Rivas
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rene H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|