1
|
Meuser M, Schwitzer S, Thiele M, Boyle P, Ernst A, Basta D. Intra-Cochlear Electrode Position Impacts the Preservation of Residual Hearing in an Animal Model of Cochlear Implant Surgery. Audiol Neurootol 2024:1-11. [PMID: 38981457 DOI: 10.1159/000540266] [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: 04/12/2024] [Accepted: 07/07/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Preservation of residual hearing after cochlear implantation remains challenging. There are several approaches to preserve residual hearing, but the configuration of the implant electrode array seems to play a major role. Lateral wall electrode arrays are seemingly more favorable in this context. To date, there are no experimental data available which correlate the spatial electrode position in the scala tympani with the extent of hearing preservation. METHODS Based on micro-computed tomography (µCT) imaging data, this study analyses the exact position of a pure silicone electrode array inserted into the cochlea of four guinea pigs. Array position data were correlated with the extent of hearing loss after implantation, measured using auditory brainstem measurements in the frequency range of the area occupied by the electrode array area as well as apical to the array. RESULTS The use of pure silicone arrays without electrodes resulted in artifact-free, high-resolution µCT images that allowed precise determination of the arrays' positions within the scala tympani. The electrode arrays' locations ranged from peri-modiolar to an anti-modiolar. These revealed a correlation of a lower postoperative hearing loss with a higher spatial proximity to the lateral wall. This correlation was found in the low-frequency range only. A significant correlation between the inter-individual differences in the diameter of the scala tympani and the postoperative hearing loss could not be observed. CONCLUSION This study demonstrates the importance of the intra-cochlear electrode array's position for the preservation of residual hearing. The advantage of such an electrode array's position approximated to the lateral wall suggests, at least for this type of electrode array applied in the guinea pig, it would be advantageous in the preservation of residual hearing for the apical part of the cochlea, beyond the area occupied by the electrode array.
Collapse
Affiliation(s)
- Max Meuser
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Susanne Schwitzer
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Mario Thiele
- Julius Wolff Institute, Center for Musculoskeletal Biomechanics and Regeneration, Charité Medical School, University of Berlin, Berlin, Germany
| | - Patrick Boyle
- Advanced Bionics GmbH, European Research Centre, Hanover, Germany
| | - Arne Ernst
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| | - Dietmar Basta
- Department of Otolaryngology at ukb, Charité Medical School, University of Berlin, Berlin, Germany
| |
Collapse
|
2
|
Gerbert M, Ernst A, Seidl R, Decker L, Scholz S, Lauer G, Mittmann P. Preservation of Residual Hearing: Long-Term Results With a Mid-Scala Electrode. J Otolaryngol Head Neck Surg 2024; 53:19160216241250351. [PMID: 38888946 PMCID: PMC11155315 DOI: 10.1177/19160216241250351] [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: 02/29/2024] [Accepted: 03/30/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE The long-term preservation of residual hearing after cochlear implantation has become a major goal over the past few years. The aim of the present study was to evaluate residual hearing in the long-term follow-up using mid-scala electrodes. METHODS In this retrospective, single-center study, we collected data from 27 patients who were implanted between 2014 and 2015 with residual hearing in the low-frequency range using a mid-scala electrode. Measurements of the hearing thresholds were carried out directly postoperatively (day 1 after surgery) and in the long-term follow-up 43.7 ± 6.9 months. The calculation of the extent of audiological hearing preservation was determined using the HEARRING group formula by Skarsynski. RESULTS Postoperative preservation of residual hearing was achieved in 69.2% of the cases in the low-frequency range between 250 Hz and 1 kHz, of which 89.5% of the patients had frequencies that suggested using electroacoustic stimulation (EAS). In the long-term follow-up, 30.8% of the patients showed residual hearing; however, 57.1% had apparently benefited from EAS. CONCLUSION Preservation of residual hearing is feasible in the long term using mid-scala electrodes. Postoperatively, there is over the half of patients who benefit from an EAS strategy. The long-term follow-up shows a certain decrease in residual hearing. However, these results are comparable to studies relating to other types of electrodes. Further research should be conducted in future to better evaluate hearing loss in long-term follow-up, compared to direct postoperative audiological results.
Collapse
Affiliation(s)
- Martin Gerbert
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Arne Ernst
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Rainer Seidl
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lars Decker
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Sandra Scholz
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Gina Lauer
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| |
Collapse
|
3
|
Ucta C, Mittmann P, Ernst A, Seidl R, Lauer G. Minimizing Intracochlear Pressure: Influence of the Insertion Sheath. Audiol Neurootol 2021; 26:281-286. [PMID: 33647910 DOI: 10.1159/000512466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Atraumatic cochlear implantation (CI) and insertion of the electrode in particular are major goals of recent CI surgery. Perimodiolar electrode arrays need a stylet or exosheath for insertion. The sheath can influence the intracochlear pressure changes during insertion of the electrode. The aim of this study was to modify the insertion sheath to optimize intracochlear pressure changes. METHODS In an artifical cochlear model, 7 different modified insertion sheaths were used. The intracochlear pressure was measured with a micro-optical sensor in the apical part of the model cochlea. RESULTS Significant lower intracochlear pressure changes were observed when the apical part of the insertion sheath was either shortened or tapered. Modification of the stopper does influence the intracochlear pressure significantly. CONCLUSION Modification of the insertion sheath leads to lower intracochlear pressure gain. The differences and impact on intracochlear pressure changes found in this study underline the importance of even subtle modifications of the electrode insertion technique.
Collapse
Affiliation(s)
- Ceyhun Ucta
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Arneborg Ernst
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Rainer Seidl
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany
| | - Gina Lauer
- Department of Otolaryngology at ukb, Charité Med School Berlin, Hospital of the University of Berlin, Berlin, Germany,
| |
Collapse
|
4
|
Riemann C, Sudhoff H, Todt I. Effect of Underwater Insertion on Intracochlear Pressure. Front Surg 2020; 7:546779. [PMID: 33425980 PMCID: PMC7793869 DOI: 10.3389/fsurg.2020.546779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The importance of intracochlear pressure during cochlear electrode insertion for the preservation of residual hearing has been widely discussed. Various aspects of pre-insertional, intra-insertional, and post-insertional relevant conditions affect intracochlear pressure. The fluid situation at the round window during electrode insertion has been shown to be an influential factor. Aims/Objectives: The aim of the study was to compare various insertion techniques in terms of the fluid situation at the round window. Material and Methods: We performed insertion of cochlear implant electrodes in a curled artificial cochlear model. We placed and fixed the pressure sensor at the tip of the cochlea. In parallel to the insertions, we evaluated the maximum amplitude of intracochlear pressure under four different fluid conditions at the round window: (1) hyaluronic acid; (2) moisturized electrode, dry middle ear; (3) middle ear filled with fluid (underwater); and (4) moisturized electrode, wet middle ear, indirectly inserted. Results: We observed that the insertional intracochlear pressure is dependent on the fluid situation in front of the round window. The lowest amplitude changes were observed for the moisturized electrode indirectly inserted in a wet middle ear (0.13 mmHg ± 0.07), and the highest values were observed for insertion through hyaluronic acid in front of the round window (0.64 mmHg ± 0.31). Conclusions: The fluid state in front of the round window influences the intracochlear pressure value during cochlear implant electrode insertion in our model. Indirect insertion of a moisturized electrode through a wet middle ear experimentally generated the lowest pressure values. Hyaluronic acid in front of the round window leads to high intracochlear pressure in our non-validated artificial model.
Collapse
Affiliation(s)
- Conrad Riemann
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
| | - Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
| |
Collapse
|
5
|
Gotamco GL, Sun CH, Chou YF, Hsu CJ, Wu HP. Effect of Round Window Opening Size on Residual Hearing Preservation in Cochlear Implantation. Otolaryngol Head Neck Surg 2020; 163:375-381. [PMID: 32204664 DOI: 10.1177/0194599820912032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to compare the hearing preservation outcomes in cochlear implant surgery following slit versus full opening of the round window membrane. SETTING Tertiary referral center. STUDY DESIGN Comparative study. SUBJECTS AND METHODS Seventy patients (mean, 26.3 years; range, 2-69 years) who underwent cochlear implantation via the round window approach were included in the study. Thirty-five subjects were prospectively enrolled for cochlear implantation via the open round window technique between August 2018 and January 2019. Thirty-five patients who underwent cochlear implantation from January 2017 to July 2018 via the slit round window opening, frequency matched by sex and age, were retrospectively enrolled. Pre- and postoperative thresholds were obtained. The percentage of hearing preservation was computed with the HEARRING Network formula and classified into complete, partial, and minimal hearing preservation. The results between the groups were compared and analyzed at 6 months postoperatively. RESULTS The rate of complete hearing preservation in the open group was statistically significant (P = .030) at 71.4% (n = 25) as compared with 45.7% (n = 16) in the slit group. CONCLUSIONS The widely opened round window may be an optional technique that surgeons can utilize to improve hearing preservation outcomes.
Collapse
Affiliation(s)
- Giselle L Gotamco
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Chuan-Hung Sun
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Fan Chou
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chuan-Jen Hsu
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
6
|
Ordonez F, Riemann C, Mueller S, Sudhoff H, Todt I. Dynamic intracochlear pressure measurement during cochlear implant electrode insertion. Acta Otolaryngol 2019; 139:860-865. [PMID: 31298591 DOI: 10.1080/00016489.2019.1640391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Electrode insertion into the cochlea can cause significant pressure changes inside the cochlea with assumed effects on the cochlea's functionality regarding residual hearing. Model-based intracochlear pressure (ICP) changes were performed statically at the cochlear helix. Aims/objectives: The aim of this study was to observe dynamic pressure measurements during electrode insertion directly at the cochlear implant electrode. Material and methods: The experiments were performed in an uncurled cochlear model that contained a volume value equivalent to a full cochlea. A microfibre pressure sensor was attached at one of two positions on a cochlear implant electrode and inserted under different insertional conditions. Results: We observed the ICP increase depending on the insertional depth. A sensor-position-specific pressure change is insertional-depth dependent. Interval insertion did not lead to a lower peak insertional ICP. Conclusions and significance: In contrast to the static pressure-sensor measurement in the artificial model's helix, a dynamic measurement directly at the electrode shows the pressure profile to increase based on the insertional depth. A mechanical traumatic relevance of the observed pressure values cannot be fully excluded.
Collapse
Affiliation(s)
- F. Ordonez
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - C. Riemann
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - S. Mueller
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - H. Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - I. Todt
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| |
Collapse
|
7
|
Banakis Hartl RM, Kaufmann C, Hansen MR, Tollin DJ. Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion: Effect of Micro-mechanical Control on Limiting Pressure Trauma. Otol Neurotol 2019; 40:736-744. [PMID: 31192901 PMCID: PMC6578873 DOI: 10.1097/mao.0000000000002164] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Use of micro-mechanical control during cochlear implant (CI) electrode insertion will result in reduced number and magnitude of pressure transients when compared with standard insertion by hand. INTRODUCTION With increasing focus on hearing preservation during CI surgery, atraumatic electrode insertion is of the utmost importance. It has been established that large intracochlear pressure spikes can be generated during the insertion of implant electrodes. Here, we examine the effect of using a micro-mechanical insertion control tool on pressure trauma exposures during implantation. METHODS Human cadaveric heads were surgically prepared with an extended facial recess. Electrodes from three manufacturers were placed both by using a micro-mechanical control tool and by hand. Insertions were performed at three different rates: 0.2 mm/s, 1.2 mm/s, and 2 mm/s (n = 20 each). Fiber-optic sensors measured pressures in scala vestibuli and tympani. RESULTS Electrode insertion produced pressure transients up to 174 dB SPL. ANOVA revealed that pressures were significantly lower when using the micro-mechanical control device compared with insertion by hand (p << 0.001). No difference was noted across electrode type or speed. Chi-square analysis showed a significantly lower proportion of insertions contained pressure spikes when the control system was used (p << 0.001). CONCLUSION Results confirm previous data that suggest CI electrode insertion can cause pressure transients with intensities similar to those elicited by high-level sounds. Results suggest that the use of a micro-mechanical insertion control system may mitigate trauma from pressure events, both by reducing the amplitude and the number of pressure spikes resulting from CI electrode insertion.
Collapse
Affiliation(s)
- Renee M Banakis Hartl
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Christopher Kaufmann
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Marlan R Hansen
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel J Tollin
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
8
|
|
9
|
Todt I, Utca J, Karimi D, Ernst A, Mittmann P. Cochlear implant electrode sealing techniques and related intracochlear pressure changes. J Otolaryngol Head Neck Surg 2017; 46:40. [PMID: 28490377 PMCID: PMC5426068 DOI: 10.1186/s40463-017-0218-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/05/2017] [Indexed: 12/01/2022] Open
Abstract
Background The inserted cochlear implanted electrode is covered at the site of the round window or cochleostomy to prevent infections and leakage. In a surgically hearing preservational concept, low intracochlear pressure changes are of high importance. The aim of this study was to observe intracochlear pressure changes due to different sealing techniques in a cochlear model. Methods Cochlear implant electrode insertions were performed in an artifical cochlear model and the intracochlear pressure changes were recorded in parallel with a micro-pressure sensor positioned in the apical region of the cochlea model to follow the maximum amplitude of intracochlear pressure. Four different sealing conditions were compared: 1) overlay, 2) overlay with fascia pushed in, 3) donut-like fascia ring, 4) donut-like fascia ring pushed in. Results We found statistically significant differences in the occurrence of maximum amplitude of intracochlear pressure peak changes related to sealing procedure comparing the different techniques. While the lowest amplitude changes could be observed for the overlay technique (0.14 mmHg ± 0.06) the highest values could be observed for the donut-like pushed in technique (1.79 mmHg ± 0.69). Conclusion Sealing the electrode inserted cochlea can lead to significant intracochlear pressure changes. Pushing in of the sealing tissue cannot be recommended.
Collapse
Affiliation(s)
- Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Warenerstr.7, 12683, Berlin, Germany.
| | - Julica Utca
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Warenerstr.7, 12683, Berlin, Germany
| | - Dania Karimi
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Warenerstr.7, 12683, Berlin, Germany
| | - Arne Ernst
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Warenerstr.7, 12683, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Warenerstr.7, 12683, Berlin, Germany
| |
Collapse
|
10
|
Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3937196. [PMID: 27900329 PMCID: PMC5120182 DOI: 10.1155/2016/3937196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/17/2016] [Indexed: 11/23/2022]
Abstract
Introduction. To achieve a functional atraumatic cochlear implantation, intracochlear pressure changes during the procedure should be minimized. Postinsertional cable movements are assumed to induce intracochlear pressure changes. The aim of this study was to observe intracochlear pressure changes due to postinsertional cable movements. Materials and Methods. Intracochlear pressure changes were recorded in a cochlear model with a micro-pressure sensor positioned in the apical region of the cochlea model to follow the maximum amplitude and pressure gain velocity in intracochlear pressure. A temporal bone mastoid cavity was attached to the model to simulate cable positioning. The compared conditions were (1) touching the unsealed electrode, (2) touching the sealed electrode, (3) cable storage with an unfixed cable, and (4) cable storage with a fixed cable. Results. We found statistically significant differences in the occurrence of maximum amplitude and pressure gain velocity in intracochlear pressure changes under the compared conditions. Comparing the cable storage conditions, a cable fixed mode offers significantly lower maximum pressure amplitude and pressure gain velocity than the nonfixed mode. Conclusion. Postinsertional cable movement led to a significant pressure transfer into the cochlea. Before positioning the electrode cable in the mastoid cavity, fixation of the cable is recommended.
Collapse
|