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Berry JM, Tansey JB, Wu L, Choudhri A, Yawn RJ, MacDonald CB, Richard C. A Systematic Review of Cochlear Implant-Related Magnetic Resonance Imaging Artifact: Implications for Clinical Imaging. Otol Neurotol 2024; 45:204-214. [PMID: 38260952 DOI: 10.1097/mao.0000000000004095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To conduct a systematic review of the existing literature with the aim of evaluating and consolidating the present understanding of strategies for mitigating magnetic resonance imaging (MRI) artifacts related to cochlear implants in adult and pediatric patients, covering both in-vivo and ex-vivo investigations. DATA SOURCES A systematic review of MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus was performed from inception through April 2022. The protocol was registered with PROSPERO before commencement of data collection (CRD CRD42022319651). REVIEW METHODS The data were screened and collected by two authors independently, and eligibility was assessed according to Cochrane Handbook and Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations, whereas the quality of the articles was evaluated using the NIH Study Quality Assessment. RESULTS The search yielded 2,354 potentially relevant articles, of which 27 studies were included in the final review. Twelve studies looked at 1.5-T MRI, four studies looked at 3-T MRI, eight studies looked at both 1.5 and 3 T, one study looked at 0.2 and 1.5 T, and one study looked at 3- and 7.0-T MRI. Nineteen studies focused on MRI sequences as a means of artifact reduction, nine studies focused on implant magnet positioning, two studies focused on head positioning, and one study focused on both magnet and head positioning. In terms of MRI sequences, diffusion-weighted imaging produced larger artifacts compared with other sequences, whereas fast spin echo/turbo spin echo sequences and fat suppression techniques produced smaller artifacts. The position of the magnet was also found to be important, with a magnet position more than 6.5 cm posterior to the external auditory canal producing the best images with the least distortion. The angle at which the magnet is placed also affects visibility of different brain structures. CONCLUSION Proper head positioning, magnet placement at a distance of over 6.5 cm from the external auditory canal, use of spin echo sequences, and fat suppression techniques reduce the size and shape of MRI artifacts.
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Affiliation(s)
| | | | - Lin Wu
- Research and Learning Services, University of Tennessee Health Science Center Library
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Zhang L, Qi Q, Li Q, Ren S, Liu S, Mao B, Li X, Wu Y, Yang L, Liu L, Li Y, Duan S, Zhang L. Ultrasomics prediction for cytokeratin 19 expression in hepatocellular carcinoma: A multicenter study. Front Oncol 2022; 12:994456. [PMID: 36119507 PMCID: PMC9478580 DOI: 10.3389/fonc.2022.994456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to investigate the preoperative prediction of Cytokeratin (CK) 19 expression in patients with hepatocellular carcinoma (HCC) by machine learning-based ultrasomics. Methods We retrospectively analyzed 214 patients with pathologically confirmed HCC who received CK19 immunohistochemical staining. Through random stratified sampling (ratio, 8:2), patients from institutions I and II were divided into training dataset (n = 143) and test dataset (n = 36), and patients from institution III served as external validation dataset (n = 35). All gray-scale ultrasound images were preprocessed, and then the regions of interest were then manually segmented by two sonographers. A total of 1409 ultrasomics features were extracted from the original and derived images. Next, the intraclass correlation coefficient, variance threshold, mutual information, and embedded method were applied to feature dimension reduction. Finally, the clinical model, ultrasonics model, and combined model were constructed by eXtreme Gradient Boosting algorithm. Model performance was assessed by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Results A total of 12 ultrasomics signatures were used to construct the ultrasomics models. In addition, 21 clinical features were used to construct the clinical model, including gender, age, Child-Pugh classification, hepatitis B surface antigen/hepatitis C virus antibody (positive/negative), cirrhosis (yes/no), splenomegaly (yes/no), tumor location, tumor maximum diameter, tumor number, alpha-fetoprotein, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl-transpeptidase, albumin, total bilirubin, conjugated bilirubin, creatinine, prothrombin time, fibrinogen, and international normalized ratio. The AUC of the ultrasomics model was 0.789 (0.621 – 0.907) and 0.787 (0.616 – 0.907) in the test and validation datasets, respectively. However, the performance of the combined model covering clinical features and ultrasomics signatures improved significantly. Additionally, the AUC (95% CI), sensitivity, specificity, and accuracy were 0.867 (0.712 – 0.957), 0.750, 0.875, 0.861, and 0.862 (0.703 – 0.955), 0.833, 0.862, and 0.857 in the test dataset and external validation dataset, respectively. Conclusion Ultrasomics signatures could be used to predict the expression of CK19 in HCC patients. The combination of clinical features and ultrasomics signatures showed excellent effects, which significantly improved prediction accuracy and robustness.
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Affiliation(s)
- Linlin Zhang
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qinghua Qi
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Li
- Department of Ultrasound, Henan Provincial Cancer Hospital, Zhengzhou, China
| | - Shanshan Ren
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shunhua Liu
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bing Mao
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xin Li
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuejin Wu
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lanling Yang
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Luwen Liu
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yaqiong Li
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shaobo Duan
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Health Management, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- *Correspondence: Lianzhong Zhang, ; Shaobo Duan,
| | - Lianzhong Zhang
- Department of Ultrasound, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, China
- Henan Engineering Technology Research Center of Ultrasonic Molecular Imaging and Nanotechnology, Henan Provincial People's Hospital, Zhengzhou, China
- *Correspondence: Lianzhong Zhang, ; Shaobo Duan,
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Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG. Should patients with brain implants undergo MRI? J Neural Eng 2018. [DOI: 10.1088/1741-2552/aab4e4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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In vivo experiences with magnetic resonance imaging scans in Vibrant Soundbridge type 503 implantees. The Journal of Laryngology & Otology 2018; 132:401-403. [PMID: 29683103 DOI: 10.1017/s0022215118000518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To observe the effects of magnetic resonance imaging scans in Vibrant Soundbridge 503 implantees at 1.5T in vivo. METHODS In a prospective case study of five Vibrant Soundbridge 503 implantees, 1.5T magnetic resonance imaging scans were performed with and without a headband. The degree of pain was evaluated using a visual analogue scale. Scan-related pure tone audiogram and audio processor fitting changes were assessed. RESULTS In all patients, magnetic resonance imaging scans were performed without any degree of pain or change in pure tone audiogram or audio processor fitting, even without a headband. CONCLUSION In this series, 1.5T magnetic resonance imaging scans were performed with the Vibrant Soundbridge 503 without complications. Limitations persist in terms of magnetic artefacts.
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Pelosi S, Carlson ML, Glasscock ME. Implantable hearing devices: the Ototronix MAXUM system. Otolaryngol Clin North Am 2014; 47:953-65. [PMID: 25293787 DOI: 10.1016/j.otc.2014.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For many hearing-impaired individuals, the benefits of conventional amplification may be limited by acoustic feedback, occlusion effect, and/or ear discomfort. The MAXUM system and other implantable hearing devices have been developed as an option for patients who derive inadequate assistance from traditional HAs, but who are not yet candidates for cochlear implants. The MAXUM system is based on the SOUNDTEC Direct System technology, which has been shown to provide improved functional gain as well as reduced feedback and occlusion effect compared to hearing aids. This and other implantable hearing devices may have increasing importance as future aural rehabilitation options.
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Affiliation(s)
- Stanley Pelosi
- Department of Otolaryngology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA.
| | - Matthew L Carlson
- Department of Otolaryngology, Vanderbilt University Medical Center, 7209 Medical Center East-South Tower, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Michael E Glasscock
- Department of Otolaryngology, Vanderbilt University Medical Center, 7209 Medical Center East-South Tower, 1215 21st Avenue South, Nashville, TN 37232, USA
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Bittencourt AG, Burke PR, Jardim IDS, Brito RD, Tsuji RK, Fonseca ACDO, Bento RF. Implantable and semi-implantable hearing AIDS: a review of history, indications, and surgery. Int Arch Otorhinolaryngol 2014; 18:303-10. [PMID: 25992110 PMCID: PMC4297020 DOI: 10.1055/s-0033-1363463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 10/28/2022] Open
Abstract
Introduction The complaints associated with the use of conventional amplifying hearing aids prompted research at several centers worldwide that ultimately led to the development of implantable devices for aural rehabilitation. Objectives To review the history, indications, and surgical aspects of the implantable middle ear hearing devices. Data Synthesis Implantable hearing aids, such as the Vibrant Soundbridge system (Med-El Corporation, Innsbruck, Austria), the Maxum system (Ototronix LLC, Houston, Texas, United States), the fourth-generation of Carina prosthesis (Otologics LLC, Boulder, Colorado, United States), and the Esteem device (Envoy Medical Corporation - Minnesota, United States), have their own peculiarities on candidacy and surgical procedure. Conclusion Implantable hearing aids, which are currently in the early stages of development, will unquestionably be the major drivers of advancement in otologic practice in the 21st century, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.
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Affiliation(s)
| | | | | | - Rubens de Brito
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Robinson Koji Tsuji
- Department of Otolaryngology, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Piesnack S, Frame ME, Oechtering G, Ludewig E. Functionality of veterinary identification microchips following low- (0.5 tesla) and high-field (3 tesla) magnetic resonance imaging. Vet Radiol Ultrasound 2013; 54:618-22. [PMID: 23763334 DOI: 10.1111/vru.12057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/04/2013] [Indexed: 11/27/2022] Open
Abstract
The ability to read patient identification microchips relies on the use of radiofrequency pulses. Since radiofrequency pulses also form an integral part of the magnetic resonance imaging (MRI) process, the possibility of loss of microchip function during MRI scanning is of concern. Previous clinical trials have shown microchip function to be unaffected by MR imaging using a field strength of 1 Tesla and 1.5. As veterinary MRI scanners range widely in field strength, this study was devised to determine whether exposure to lower or higher field strengths than 1 Tesla would affect the function of different types of microchip. In a phantom study, a total of 300 International Standards Organisation (ISO)-approved microchips (100 each of three different types: ISO FDX-B 1.4 × 9 mm, ISO FDX-B 2.12 × 12 mm, ISO HDX 3.8 × 23 mm) were tested in a low field (0.5) and a high field scanner (3.0 Tesla). A total of 50 microchips of each type were tested in each scanner. The phantom was composed of a fluid-filled freezer pack onto which a plastic pillow and a cardboard strip with affixed microchips were positioned. Following an MRI scan protocol simulating a head study, all of the microchips were accurately readable. Neither 0.5 nor 3 Tesla imaging affected microchip function in this study.
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Affiliation(s)
- Susann Piesnack
- Department of Small Animals, Faculty of Veterinary Medicine, University of Leipzig, Germany
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Todt I, Rademacher G, Wagner F, Schedlbauer E, Wagner J, Basta D, Ernst A. MRI safety of the floating mass transducer. Cochlear Implants Int 2011; 12 Suppl 1:S133-5. [PMID: 21756497 DOI: 10.1179/146701011x13001036693395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus, Berlin, Germany.
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Baker MA, MacDonald I. Evaluation of magnetic resonance safety of veterinary radiofrequency identification devices at 1 T. Vet Radiol Ultrasound 2011; 52:161-7. [PMID: 21388467 DOI: 10.1111/j.1740-8261.2010.01762.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Implants containing metallic components have the potential to become heated or move within the patient while in the magnetic resonance (MR) environment. Despite containing a ferromagnetic core and having been in use for over 20 years, no information is available on the safety of veterinary radiofrequency identification devices during MR examinations. These devices are the most commonly encountered metallic implants in dogs and cats undergoing MR imaging. Three commercial veterinary microchips were evaluated for safety in the MR environment at 1 T. Parameters tested were translational force, torque, heating, artifact production, and function. Translation and torque were larger than that expected from normal activity under normal gravity. No significant heating was observed. Signal void artifacts may affect diagnosis if they are too close to the area of clinical importance. Microchip function was unaffected by routine clinical MR imaging. Capsule formation around devices is a major factor in counteracting translation and torque. Our findings support that is acceptable for patients to undergo MR imaging with this 1 T system following an interval of 3 months postimplantation to allow capsule growth. Because of the complex interactions involved, these observations may not be translatable to MR scanners of different field strength and/or manufacturer. Further safety testing of these and other radiofrequency identification devices is therefore recommended at different field strengths and equipment specifications.
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Affiliation(s)
- Martin A Baker
- Department of Veterinary Clinical Science, University of Liverpool, Wirral CH64 7TE, UK School of Medical Imaging Sciences, University of Cumbria, Carlisle, Cumbria CA12HH, UK.
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Wang Z, Mills R, Luo H, Zheng X, Hou W, Wang L, Brown SI, Cuschieri A. A micropower miniature piezoelectric actuator for implantable middle ear hearing device. IEEE Trans Biomed Eng 2010; 58:452-8. [PMID: 21041151 DOI: 10.1109/tbme.2010.2090150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper describes the design and development of a small actuator using a miniature piezoelectric stack and a flextensional mechanical amplification structure for an implantable middle ear hearing device (IMEHD). A finite-element method was used in the actuator design. Actuator vibration displacement was measured using a laser vibrometer. Preliminary evaluation of the actuator for an IMEHD was conducted using a temporal bone model. Initial results from one temporal bone study indicated that the actuator was small enough to be implanted within the middle ear cavity, and sufficient stapes displacement can be generated for patients with mild to moderate hearing losses, especially at higher frequency range, by the actuator suspended onto the stapes. There was an insignificant mass-loading effect on normal sound transmission (<3 dB) when the actuator was attached to the stapes and switched off. Improved vibration performance is predicted by more firm attachment. The actuator power consumption and its generated equivalent sound pressure level are also discussed. In conclusion, the actuator has advantages of small size, lightweight, and micropower consumption for potential use as IMHEDs.
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Majdani O, Leinung M, Rau T, Akbarian A, Zimmerling M, Lenarz M, Lenarz T, Labadie R. Demagnetization of Cochlear Implants and Temperature Changes in 3.0T MRI Environment. Otolaryngol Head Neck Surg 2008; 139:833-9. [DOI: 10.1016/j.otohns.2008.07.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 07/21/2008] [Accepted: 07/21/2008] [Indexed: 11/28/2022]
Abstract
Objective To investigate the level of demagnetization of the magnets and temperature changes in cochlear implants (Cis) in a 3.0 tesla (3.0T) MRI. Study Design Experimental. Subjects and Methods Demagnetization and remagnetization measurements were done on magnets for different types of CIs. Temperature of different body and electrode sides was measured in the MRI environment. Results Demagnetization of the magnets of the CI is dependent on the angle between the magnetic field of the CI magnet and the MRI. When this angle was greater than 80 degrees, relevant demagnetization occurred and sufficient remagnetization was not possible with the 3.0T MRI magnet. Maximum temperature rise was 0.5°C. Conclusions Patients carrying CIs with non-removable magnets should not enter a 3.0T MRI device in a routine clinical setup. Under special conditions (angle between the two magnets less than 80 degrees) imaging in a 3.0T MRI may be possible without harming the patient or the implant.
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Affiliation(s)
- Omid Majdani
- Medical University of Hannover, Clinic for Otolaryngology, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | - Martin Leinung
- Medical University of Hannover, Clinic for Otolaryngology, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | - Thomas Rau
- Medical University of Hannover, Clinic for Otolaryngology, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | - Arash Akbarian
- International Neuroscience Institute, Department of Neurosurgery, Hannover, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | - Martin Zimmerling
- R&D Department, MED-EL Elektromedizinische Geraete GmbH, Innsbruck, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | | | - Thomas Lenarz
- Medical University of Hannover, Clinic for Otolaryngology, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
| | - Robert Labadie
- Vanderbilt University Medical Center, Clinic for Otolaryngology, Nashville, Hannover, Germany; Innsbruck, Austria; and Nashville, TN
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Abstract
The aim of this article is to give readers a general overview of the concepts involved in the latest generation of implantable hearing aids. A section on ear biomechanics has also been included to familiarize readers with the basic concepts involved. These devices have been developed over the last 20 years, driven by problems with conventional hearing aids and by advances in the understanding of middle-ear mechanics. The use of technology borrowed from cochlear implants has enabled the first generation of fully implantable aids to be trialled. The author examines the theoretical advantages and disadvantages of implantable hearing aids over conventional aids and then reviews the technology and clinical results of a range of devices that have been trialled.
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Affiliation(s)
- P Counter
- School of Surgical and Reproductive Sciences, Newcastle University, Newcastle, UK,
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Abstract
PURPOSE OF REVIEW The increasing magnet strengths used for MRI scanning combined with a greater number and variety of otologic prostheses can lead to possible safety issues. This review examines the specific issues and the conclusions of 33 referenced studies examining those issues. RECENT FINDINGS Variability of interactions between otologic implants and MRI scanners requires specific considerations for individual prostheses and magnet strengths. Recommendations are proposed in the referenced studies. SUMMARY When a patient with an otologic prosthesis requires an MRI scan, options exist to help assure patient safety.
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Affiliation(s)
- Michael H Fritsch
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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