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Eitutis ST, Tam YC, Roberts I, Swords C, Tysome JR, Donnelly NP, Axon PR, Bance ML. Detecting and managing partial shorts in Cochlear implants: A validation of scalp surface potential testing. Clin Otolaryngol 2022; 47:641-649. [PMID: 35833359 DOI: 10.1111/coa.13963] [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: 10/04/2021] [Revised: 05/18/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate the value of scalp surface potentials to identify and manage partial short circuits to ground in cochlear implant electrodes. DESIGN A retrospective review of patients with suspected partial short circuits. MAIN OUTCOME MEASURE Electrical output of individual electrodes was measured using scalp surface potentials for patients reporting a change in hearing function. Electrical output was compared to functional performance and impedance measurements to determine if devices with suspected partial short circuits were experiencing a decrease in performance as a result of reduced electrical output. Electrical output was checked in an artificial cochlea for two implants following explant surgery to confirm scalp surface potential results. RESULTS All patients with suspected partial short circuits (n = 49) had reduced electrical output, a drop in impedances to approximately ½ of previously stable measurements or to below 2 kΩ, an atypical electrical field measurement (EFI) and a decline in hearing function. Only devices with an atypical EFI showed reduced electrical output. Results of scalp based surface potentials could be replicated in an artificial cochlea following explantation of the device. All explant reports received to date (n = 42) have confirmed partial short circuits, with an additional four devices failing integrity tests. CONCLUSION Surface potential measurements can detect partial shorts and had 100% correlation with atypical EFI measurements, which are characteristic of a partial short to ground in this device. Surface potentials can help determine the degree to which the electrode array is affected, particularly when behavioural testing is limited or not possible.
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Affiliation(s)
- Susan T Eitutis
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Yu Chuen Tam
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Iwan Roberts
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Chloe Swords
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James R Tysome
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil P Donnelly
- Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick R Axon
- Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Manohar L Bance
- Cambridge Hearing Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Benoiton LA, MacLachlan AL, Mustard J, Jayawardana J, Bird P. Classification of cochlear implant complications using a modified Clavien-Dindo classification. Cochlear Implants Int 2022; 23:317-325. [PMID: 35818635 DOI: 10.1080/14670100.2022.2096193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications. METHODS Complications were classified as: I - Self-limiting complications requiring no treatment or simple pharmacological therapies; II - Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa - Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb - Complications necessitating implant explantation and/or reimplantation. RESULTS 1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb. DISCUSSION We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.
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Affiliation(s)
- Lara Angele Benoiton
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | | | - Jill Mustard
- Southern Cochlear Implant Programme, Christchurch, New Zealand
| | - Janitha Jayawardana
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Philip Bird
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand.,Southern Cochlear Implant Programme, Christchurch, New Zealand
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The Importance of a Preinsertion Integrity Device Test of Cochlear Implants. Otol Neurotol 2022; 43:e641-e644. [PMID: 35709419 DOI: 10.1097/mao.0000000000003548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The surgery of a cochlear implant is a complex interdisciplinary procedure with high quality standards to ensure patients safety and implant durability. An integrity test of the device prior to insertion is an additional tool to improve quality standards by detecting potentially malfunctioning implants without burdening the patient. METHODS At the Department of Otorhinolaryngology, University Hospital Frankfurt a. M. (Germany) since 2010 an integrity device test ("pre-insertion telemetry") has been performed prior to the implantation of a cochlear implant. The preinsertion telemetry measures the electrical impedances of the implant electrode contacts in conductive saline solution and thereby confirms regular bidirectional data transmission and electrode integrity. In the case of irregular results with suspected implant malfunction, the device was discarded during surgery and returned to the manufacturer for further technical review. Data and test results of the preinsertion telemetry and from rejected implants (manufacturers' reports) between January 2010 and December 2020 were analyzed. RESULTS From 2010 to 2020, 1,926 cochlear implants from three manufacturers were implanted at our institution. All implants had fully functioning bidirectional data transmission. 15 implants had irregular preinsertion telemetry results (electrode circuit failures) and were rejected during surgery. In 13 cases, the manufacturer confirmed implant malfunction. In the last 5 years, only one implant with irregular preinsertion telemetry was detected. CONCLUSION Preinsertion telemetry is strongly recommended as a quick and reliable integrity test of the device to confirm the functionality of a cochlear implant.
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Topsakal V, Heuninck E, Matulic M, Tekin AM, Mertens G, Van Rompaey V, Galeazzi P, Zoka-Assadi M, van de Heyning P. First Study in Men Evaluating a Surgical Robotic Tool Providing Autonomous Inner Ear Access for Cochlear Implantation. Front Neurol 2022; 13:804507. [PMID: 35386404 PMCID: PMC8979022 DOI: 10.3389/fneur.2022.804507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Image-guided and robot-assisted surgeries have found their applications in skullbase surgery. Technological improvements in terms of accuracy also opened new opportunities for robotically-assisted cochlear implantation surgery (RACIS). The HEARO® robotic system is an otological next-generation surgical robot to assist the surgeon. It first provides software-defined spatial boundaries for orientation and reference information to anatomical structures during otological and neurosurgical procedures. Second, it executes a preplanned drill trajectory through the temporal bone. Here, we report how safe the HEARO procedure can provide an autonomous minimally invasive inner ear access and the efficiency of this access to subsequently insert the electrode array during cochlear implantation. In 22 out of 25 included patients, the surgeon was able to complete the HEARO® procedure. The dedicated planning software (OTOPLAN®) allowed the surgeon to reconstruct a three-dimensional representation of all the relevant anatomical structures, designate the target on the cochlea, i.e., the round window, and plan the safest trajectory to reach it. This trajectory accommodated the safety distance to the critical structures while minimizing the insertion angles. A minimal distance of 0.4 and 0.3 mm was planned to facial nerve and chorda tympani, respectively. Intraoperative cone-beam CT supported safe passage for the 22 HEARO® procedures. The intraoperative accuracy analysis reported the following mean errors: 0.182 mm to target, 0.117 mm to facial nerve, and 0.107 mm to chorda tympani. This study demonstrates that microsurgical robotic technology can be used in different anatomical variations, even including a case of inner ear anomalies, with the geometrically correct keyhole to access to the inner ear. Future perspectives in RACIS may focus on improving intraoperative imaging, automated segmentation and trajectory, robotic insertion with controlled speed, and haptic feedback. This study [Experimental Antwerp robotic research otological surgery (EAR2OS) and Antwerp Robotic cochlear implantation (25 refers to 25 cases) (ARCI25)] was registered at clinicalTrials.gov under identifier NCT03746613 and NCT04102215.
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Affiliation(s)
- Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- *Correspondence: Vedat Topsakal
| | - Emilie Heuninck
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Ahmet M. Tekin
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | | | - Paul van de Heyning
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Neuron Compatibility and Antioxidant Activity of Barium Titanate and Lithium Niobate Nanoparticles. Int J Mol Sci 2022; 23:ijms23031761. [PMID: 35163681 PMCID: PMC8836423 DOI: 10.3390/ijms23031761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
The biocompatibility and the antioxidant activity of barium titanate (BaTiO3) and lithium niobate (LiNbO3) were investigated on a neuronal cell line, the PC12, to explore the possibility of using piezoelectric nanoparticles in the treatment of inner ear diseases, avoiding damage to neurons, the most delicate and sensitive human cells. The cytocompatibility of the compounds was verified by analysing cell viability, cell morphology, apoptotic markers, oxidative stress and neurite outgrowth. The results showed that BaTiO3 and LiNbO3 nanoparticles do not affect the viability, morphological features, cytochrome c distribution and production of reactive oxygen species (ROS) by PC12 cells, and stimulate neurite branching. These data suggest the biocompatibility of BaTiO3 and LiNbO3 nanoparticles, and that they could be suitable candidates to improve the efficiency of new implantable hearing devices without damaging the neuronal cells.
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Investigation of the Effect of Abutment Angle Tolerance on the Stress Created in the Fixture and Screw in Dental Implants Using Finite Element Analysis. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2021. [DOI: 10.4028/www.scientific.net/jbbbe.51.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Today, an artificial tooth root called a dental implant is used to replace lost tooth function. Treatment with dental implants is considered an effective and safe method. However, in some cases, the use of dental implants had some failures. The success of dental implants is influenced by several biomechanical factors such as loading type, used material properties, shape and geometry of implants, quality and quantity of bone around implants, surgical method, lack of rapid and proper implant surface's integration with the jaw bone, etc. The main purpose of functional design is to investigate and control the stress distribution on dental implants to optimize their performance. Finite element analysis allows researchers to predict the stress distribution in the bone implant without the risk and cost of implant placement. In this study, the stresses created in the 3A.P.H.5 dental implant's titanium fixture and screw due to the change in abutment angles tolerance have been investigated. The results show that although the fixture and the screw's load and conditions are the same in different cases, the change of the abutment angle and the change in the stress amount also made a difference in the location of maximum stress. The 21-degree abutment puts the fixture in a more critical condition and increases the chance of early plasticization compared to other states. The results also showed that increasing the abutment angle to 24 degrees reduces the stress in the screw, but decreasing the angle to 21 degrees leads to increased screw stress and brings it closer to the fracture.
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Chen J, Chen B, Shi Y, Li Y. A retrospective review of cochlear implant revision surgery: a 24-year experience in China. Eur Arch Otorhinolaryngol 2021; 279:1211-1220. [PMID: 33813626 DOI: 10.1007/s00405-021-06745-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/09/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to analyse the reasons behind the need for cochlear implant revision surgeries, as well as the rate at which they occur, to reduce the revision surgery rate for non-device failures. We also aimed to elucidate the cumulative survival and device survival rates in different age groups. METHODS This retrospective single cohort study reviewed 4563 cochlear implant surgeries and 119 revision surgeries performed at a tertiary referral hospital in China between 1996 and 2019. Kaplan-Meier curves were used to calculate the cumulative survival and device survival rates. RESULTS The revision surgery rate was 2.61%. The reasons for revision included device (73.1%) and non-device (26.9%) failures. The most common reasons were hard device (47.1%) and non-device failure (28.6%). The 10- and 20-year cumulative survival rates were 96.8% and 96.7%, respectively. Younger children were more likely to undergo a second surgery. CONCLUSION This study is the longest study about revision surgery in China. Cochlear implantation is a reliable treatment. It has a low complication rate in patients with sensorineural hearing loss. Children have a higher revision rate than adults. Doctors should be aware of each complication and perform the appropriate procedure.
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Affiliation(s)
- Jingyuan Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Biao Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Ying Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Baumann U, Stöver T, Weißgerber T. Device profile of the MED-EL cochlear implant system for hearing loss: overview of its safety and efficacy. Expert Rev Med Devices 2020; 17:599-614. [PMID: 32552086 DOI: 10.1080/17434440.2020.1781614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients suffering from severe to profound hearing loss or even deafness can achieve a hearing improvement with a cochlear implant (CI) treatment that is significantly higher than the results achieved with conventional hearing aids. The CI system consists of an implantable stimulator, which is inserted retro-auricularly into the mastoid, and an externally worn processor unit, which provides the pickup of sound and processing of acoustic information as well as the power supply for the stimulator and internal current sources. The stimulator has an electrode array that is inserted into the cochlea. AREAS COVERED This is a descriptive overview of MED-EL's multichannel CI system (MED-EL, Innsbruck, Austria), which was introduced to the European market in 1994. The continuing development of the implant as well as the external components is outlined and various other aspects (stimulation strategy, adaptation, results, reliability) are discussed. EXPERT COMMENTARY The strength of the company is the continuous pursuit of innovative ideas. This is evidenced by numerous innovations. The reliability of the implants has been continuously improved. The current SYNCHRONY models of the manufacturer show no indication of technically caused failures over an observation period of 5 years.
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Affiliation(s)
- Uwe Baumann
- Audiological Acoustics, ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
| | - Timo Stöver
- ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
| | - Tobias Weißgerber
- Audiological Acoustics, ENT Department, University Hospital Frankfurt , Frankfurt Am Main, Germany
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