1
|
Berg KA, DeFreese AJ, Sisler-Dinwiddie AL, Labadie RF, Tawfik KO, Gifford RH. Clinical Applications for Spread of Excitation Functions Obtained Via Electrically Evoked Compound Action Potentials (eCAP). Otol Neurotol 2024; 45:790-797. [PMID: 38923968 DOI: 10.1097/mao.0000000000004242] [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: 06/28/2024]
Abstract
OBJECTIVES To assess the clinical utility of spread of excitation (SOE) functions obtained via electrically evoked compound action potentials (eCAP) to 1) identify electrode array tip fold-over, 2) predict electrode placement factors confirmed via postoperative computed tomography (CT) imaging, and 3) predict postoperative speech recognition through the first year post-activation in a large clinical sample. STUDY DESIGN Retrospective case review. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Two hundred seventy-two ears (238 patients) with Cochlear Ltd. CIs (mean age = 46 yr, range = 9 mo-93 yr, 50% female) implanted between August 2014 and December 2022 were included. MAIN OUTCOME MEASURES eCAP SOE widths (mm) (probe electrodes 5, 11, and 17), incidence of electrode tip fold-over, CT imaging data (electrode-to-modiolus distance, angular insertion depth, scalar location), and speech recognition outcomes (consonant-nucleus-consonant [CNC], AzBio quiet, and +5 dB SNR) through the first year after CI activation. RESULTS 1) eCAP SOE demonstrated a sensitivity of 85.7% for identifying tip fold-over instances that were confirmed by CT imaging. In the current dataset, the tip fold-over incidence rate was 3.1% (7 patients), with all instances involving a precurved electrode array. 2) There was a significant positive relationship between eCAP SOE and mean electrode-to-modiolus distance for precurved arrays, and a significant positive relationship between eCAP SOE and angular insertion depth for straight arrays. No relationships between eCAP SOE and scalar location or cochlea diameter were found in this sample. 3) There were no significant relationships between eCAP SOE and speech recognition outcomes for any measure or time point, except for a weak negative correlation between average eCAP SOE widths and CNC word scores at 6 months post-activation for precurved arrays. CONCLUSIONS In the absence of intraoperative CT or fluoroscopic imaging, eCAP SOE is a reasonable alternative method for identifying electrode array tip fold-over and should be routinely measured intraoperatively, especially for precurved electrode arrays with a sheath.
Collapse
Affiliation(s)
- Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
2
|
Torres R, Daoudi H, Gu W, Breil E, Ferrary E, Sterkers O, Nguyen Y, Mosnier I. Exploring Trauma Patterns and Contributing Factors With Slim Straight Electrode Array After Cochlear Implantation. Otolaryngol Head Neck Surg 2024; 171:521-529. [PMID: 38532540 DOI: 10.1002/ohn.737] [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: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To assess trauma patterns associated with the insertion of lateral wall electrode arrays. The study focused on 3 categories-scala tympani (ST), intermediate, and scala vestibuli (SV)-to identify traumatic patterns and contributing factors. STUDY DESIGN Retrospective study. SETTING Data from 106 cochlear implant recipients at a tertiary otologic center. METHODS Demographic and surgical data were collected from recipients who underwent cochlear implantation manually and with RobOtol®. Measurements included cochlear dimensions, angular depth of insertion, and position of the first electrode. Three-dimensional reconstructions were used to analyze the electrode array location relative to the basilar membrane, categorized into ST, intermediate, and SV electrodes. Nontraumatic insertion was defined as all electrodes in the ST, while traumatic insertions had 1 or more electrodes in intermediate or SV locations. RESULTS Out of 106 cases, 44% had nontraumatic and 56% had traumatic insertions. Demographic and surgical characteristics showed no association with traumatic insertions. A deeper position of the first electrode, relative to the round window, was associated with traumatic insertions (P = .03). Three trauma patterns were observed: distal (facing the apical electrodes), proximal (facing the middle electrodes around 180°), and distal/proximal. CONCLUSION This study considers the intermediate position which could be associated with basilar membrane lesions. Risk zones for intracochlear trauma with lateral wall arrays were identified distally and proximally. Traumatic insertions were independently linked to deeper array placement. Future studies should explore whether gentler insertion, without insisting on further electrode array insertion depth, could reduce the trauma during cochlear implantation.
Collapse
Affiliation(s)
- Renato Torres
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Hannah Daoudi
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Wenxi Gu
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eugénie Breil
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| |
Collapse
|
3
|
Rak K, Spahn B, Müller-Graff FT, Engert J, Voelker J, Hackenberg S, Hagen R, Petritsch B, Grunz JP, Bley T, Neun T, Huflage H. The Photon-Counting CT Enters the Field of Cochlear Implantation: Comparison to Angiography DynaCT and Conventional Multislice CT. Otol Neurotol 2024; 45:662-670. [PMID: 38865722 DOI: 10.1097/mao.0000000000004221] [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: 06/14/2024]
Abstract
INTRODUCTION Cochlear duct length (CDL) measurement plays a role in the context of individualized cochlear implant (CI) surgery regarding an individualized selection and implantation of the CI electrode carrier and an efficient postoperative anatomy-based fitting process. The level of detail of the preoperative temporal bone CT scan depends on the imaging modality with major impact on CDL measurements and CI electrode contact position determination. The aim of this study was to evaluate the accuracy of perioperative CDL measurements and electrode contact determination in photon-counting CT (PCCT). METHODS Ten human fresh-frozen petrous bone specimens were examined with a first-generation PCCT. A clinically applicable radiation dose of 27.1 mGy was used. Scans were acquired before and after CI insertion. Postoperative measurement of the CDL was conducted using an otological planning software and 3D-curved multiplanar reconstruction. Investigation of electrode contact position was performed by two respective observers. Measurements were compared with a conventional multislice CT and to a high-resolution flat-panel volume CT with secondary reconstructions. RESULTS Pre- and postoperative CDL measurements in PCCT images showed no significant difference to high-resolution flat-panel volume CT. Postoperative CI electrode contact determination was also as precise as the flat-panel CT-based assessment. PCCT and flat-panel volume CT were equivalent concerning interobserver variability. CONCLUSION CDL measurement with PCCT was equivalent to flat-panel volume CT with secondary reconstructions. PCCT enabled highly precise postoperative CI electrode contact determination with substantial advantages over conventional multislice CT scanners.
Collapse
Affiliation(s)
- Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Bjoern Spahn
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Jonas Engert
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | | | | | - Thorsten Bley
- Department of Diagnostic and Interventional Radiology
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | |
Collapse
|
4
|
Micuda A, Li H, Rask-Andersen H, Ladak HM, Agrawal SK. Morphologic Analysis of the Scala Tympani Using Synchrotron: Implications for Cochlear Implantation. Laryngoscope 2024; 134:2889-2897. [PMID: 38189807 DOI: 10.1002/lary.31263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To use synchrotron radiation phase-contrast imaging (SR-PCI) to visualize and measure the morphology of the entire cochlear scala tympani (ST) and assess cochlear implant (CI) electrode trajectories. METHODS SR-PCI images were used to obtain geometric measurements of the cochlear scalar diameter and area at 5-degree increments in 35 unimplanted and three implanted fixed human cadaveric cochleae. RESULTS The cross-sectional diameter and area of the cochlea were found to decrease from the base to the apex. This study represents a wide variability in cochlear morphology and suggests that even in the smallest cochlea, the ST can accommodate a 0.4 mm diameter electrode up to 720°. Additionally, all lateral wall array trajectories were within the anatomically accommodating insertion zone. CONCLUSION This is the first study to use SR-PCI to visualize and quantify the entire ST morphology, from the round window to the apical tip, and assess the post-operative trajectory of electrodes. These high-resolution anatomical measurements can be used to inform the angular insertion depth that can be accommodated in CI patients, accounting for anatomical variability. LEVEL OF EVIDENCE N/A. Laryngoscope, 134:2889-2897, 2024.
Collapse
Affiliation(s)
- Ashley Micuda
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Hao Li
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| |
Collapse
|
5
|
Beck RL, Aschendorff A, Arndt S, Hildenbrand T, Ketterer MC. Is the Position of the Basal-Most Electrode Depending on Electrode Array Design and Influencing Postoperative Speech Perception? A Retrospective Analysis of 495 Ears. Otol Neurotol 2024; 45:502-506. [PMID: 38509805 DOI: 10.1097/mao.0000000000004165] [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: 03/22/2024]
Abstract
OBJECTIVE The objective of this study is to examine the influence of electrode array design on the position of the basal-most electrode in cochlear implant (CI) surgery and therefore the stimulability of the basal cochlea. Specifically, we evaluated the angular insertion depth of the basal-most electrode in perimodiolar and straight electrode arrays in relation to postoperative speech perception. MATERIALS AND METHODS We conducted a retrospective analysis of 495 patients between 2013 and 2018 using the Cochlear™ Contour Advance® (CA), Cochlear™ Slim Straight® (SSA), or Cochlear™ Slim Modiolar® (SMA) electrode arrays, as well as the MED-EL Flex24 (F24), MED-EL Flex28 (F28), and MED-EL FlexSoft (F31.5) electrode arrays. Cochlear size and the position of the basal-most electrode were measured using rotational tomography or cone beam computed tomography, and the results were compared with postoperative speech perception in monosyllables and numbers. RESULTS The straight electrode arrays, specifically the F31.5 (31.5 mm length) and the F28 (28 mm length), exhibited a significantly greater angular insertion depth of the basal-most electrode. No significant correlation was found between cochlear morphology measurements and the position of the basal-most electrode artifact. Cochleostomy-inserted electrode arrays showed a significantly higher insertion depth of the basal-most electrode. Nevertheless, the position of the basal-most electrode did not have a significant impact on postoperative speech perception. CONCLUSION Straight electrode arrays with longer lengths achieved deeper angular insertion depths of the basal-most electrode. Cochlear morphology does not have a substantial influence on the position of basal-most electrode. The study confirms that the basal area of the cochlea, responsible for high-frequency range during acoustic stimulation, is not the primary region for speech understanding via electrical stimulation with CI.
Collapse
Affiliation(s)
- Rainer Linus Beck
- Department of Otorhinolaryngology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | | | | | | |
Collapse
|
6
|
de Quillettes R, Kaandorp M, Merkus P, Kramer SE, Smits C. Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied. Ear Hear 2024:00003446-990000000-00274. [PMID: 38755742 DOI: 10.1097/aud.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.
Collapse
Affiliation(s)
- Richard de Quillettes
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marre Kaandorp
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Paul Merkus
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Cas Smits
- Amsterdam UMC, Location University of Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Lee AY, Lee DY, Saunders JE. Preoperative Imaging in Cochlear Implants. Otol Neurotol 2024; 45:398-403. [PMID: 38478408 DOI: 10.1097/mao.0000000000004157] [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: 06/29/2024]
Abstract
OBJECTIVE To determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) in cochlear implant candidates. STUDY DESIGN Retrospective case review. SETTING Tertiary referral hospital. PATIENTS A total of 207 cochlear implanted patients with CT and/or MRI. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Age versus abnormal radiologic findings, imaging abnormality versus postoperative outcomes, postoperative outcomes versus electrode design, Cambridge Cochlear Implant Protocol (CCIP) status for imaging abnormalities, sensitivity and specificity of CT and MRI for round-window/cochlear occlusion, and MRI for incomplete partitions. RESULTS A total of 207 patients with CT, MRI, or both were reviewed retrospectively. Less than half (15.5%) of CT scans had findings that might affect surgical intervention compared with 5.9% of MRI. No significant difference was found between children and adults for relevant imaging abnormalities (grade 4 or higher) with either CT (p = 0.931) or MRI (p = 0.606). CCIP status correlated with cochlear abnormalities (p = 0.040); however, only 46.2% of radiographic abnormalities on CT would be identified by these criteria. For detecting cochlear occlusion requiring surgical intervention, the sensitivity and specificity for CT were 40% (4 of 10; 95% confidence interval [CI], 12.16-73.76) and 95.73% (95% CI, 91.40-98.27), respectively. For MRI, the sensitivity and specificity were 33.33% (1 of 3; 95% CI, 0.84-90.57) and 96.97% (63 of 65; 95% CI, 89.32-99.63), respectively. There was no difference for postoperative AzBio scores for higher-grade imaging abnormalities (p = 0.6012) or for electrode designs (p = 0.3699). CONCLUSIONS Significant radiographic abnormalities were relatively uncommon in cochlear implant patients on either CT or MRI at our single-center institution. If present, abnormal imaging findings rarely translated to management changes. CCIP status does not reliably predict which patients are likely to have abnormalities. Both MRI and CT have low sensitivity for round-window or cochlear occlusion, but detection likely leads to changes in surgical management.
Collapse
Affiliation(s)
- Andrew Y Lee
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Diana Y Lee
- New York University Langone Health, Towson, Maryland
| | | |
Collapse
|
8
|
Ayas M, Muzaffar J, Borsetto D, Eitutis S, Phillips V, Tam YC, Salorio-Corbetto M, Bance ML. A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices. PLoS One 2024; 19:e0299597. [PMID: 38452034 PMCID: PMC10919746 DOI: 10.1371/journal.pone.0299597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as Trans-Impedance Matrix (TIM) measurements may enable clinicians to identify electrode malposition and direct surgeons to correctly place the electrode array during surgery. OBJECTIVES To assess the current literature on the effectiveness of TIM measurements in identifying extracochlear electrodes and tip fold overs. METHODS A scoping review of studies on TIM-based measurements were carried out using the Databases-Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Eleven full texts articles met the inclusion criteria. Only human studies pertaining to TIM as a tool used in CI were included in the review. Further, patient characteristics, electrode design, and TIM measurement outcomes were reported. RESULTS TIM measurements were available for 550 implanted ears with the subjects age ranged between 9 months to 89 years. Abnormal TIM measurements were reported for 6.55% (36). Tip fold over was detected in 3.64% (20) of the cases, extracochlear electrodes in 1.45% (8), and 1.45% (8) were reported as buckling. Slim-modiolar electrode array designs were more common (54.71%) than pre-curved (23.34%) or lateral wall (21.95%) electrode array. Abnormal cochlear anatomy was reported for five ears (0.89%), with normal cochlear anatomy for all other patients. CONCLUSION TIM measurement is a promising tool for the intraoperative detection of electrode malposition. TIM measurement has a potential to replace intraoperative imaging in future. Though, TIM measurement is in its early stages of clinical utility, intuitive normative data sets coupled with standardised criteria for detection of abnormal electrode positioning would enhance its sensitivity.
Collapse
Affiliation(s)
- Muhammed Ayas
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
| | - Jameel Muzaffar
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Department of Ear, Nose and Throat Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Daniele Borsetto
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Susan Eitutis
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
| | - Veronica Phillips
- Medical Library, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Yu Chuen Tam
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
| | - Marina Salorio-Corbetto
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
| | - Manohar L. Bance
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
9
|
Quatre R, Schmerber S, Attyé A. Improving rehabilitation of deaf patients by advanced imaging before cochlear implantation. J Neuroradiol 2024; 51:145-154. [PMID: 37806523 DOI: 10.1016/j.neurad.2023.10.002] [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: 09/17/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Cochlear implants have advanced the management of severe to profound deafness. However, there is a strong disparity in hearing performance after implantation from one patient to another. Moreover, there are several advanced kinds of imaging assessment before cochlear implantation. Microstructural white fiber degeneration can be studied with Diffusion weighted MRI (DWI) or tractography of the central auditory pathways. Functional MRI (fMRI) allows us to evaluate brain function, and CT or MRI segmentation to better detect inner ear anomalies. OBJECTIVE This literature review aims to evaluate how helpful pre-implantation anatomic imaging can be to predict hearing rehabilitation outcomes in deaf patients. These techniques include DWI and fMRI of the central auditory pathways, and automated labyrinth segmentation by CT scan, cone beam CT and MRI. DESIGN This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching in PubMed and by checking the reference lists of relevant articles. Inclusion criteria were adults over 18, with unilateral or bilateral hearing loss, who had DWI acquisition or fMRI or CT/ Cone Beam CT/ MRI image segmentation. RESULTS After reviewing 172 articles, we finally included 51. Studies on DWI showed changes in the central auditory pathways affecting the white matter, extending to the primary and non-primary auditory cortices, even in sudden and mild hearing impairment. Hearing loss patients show a reorganization of brain activity in various areas, such as the auditory and visual cortices, as well as regions involved in language and emotions, according to fMRI studies. Deep Learning's automatic segmentation produces the best CT segmentation in just a few seconds. MRI segmentation is mainly used to evaluate fluid space of the inner ear and determine the presence of an endolymphatic hydrops. CONCLUSION Before cochlear implantation, a DWI with tractography can evaluate the central auditory pathways up to the primary and non-primary auditory cortices. This data is then used to generate predictions on the auditory rehabilitation of patients. A CT segmentation with systematic 3D reconstruction allow a better evaluation of cochlear malformations and predictable difficulties during surgery.
Collapse
Affiliation(s)
- Raphaële Quatre
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France; BrainTech Lab INSERM UMR 2015, Grenoble, France; GeodAIsics, Grenoble, France.
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France; BrainTech Lab INSERM UMR 2015, Grenoble, France
| | - Arnaud Attyé
- Department of Neuroradiology, University Hospital, Grenoble, France; GeodAIsics, Grenoble, France
| |
Collapse
|
10
|
Spahn B, Ilgen L, Neun T, Müller-Graff FT, Schendzielorz P, Hagen R, Althoff D, Zabler S, Rak K. Dependence of Cochlear Duct Length Measurement on the Resolution of the Imaging Dataset. Otol Neurotol 2024; 45:e234-e240. [PMID: 38238926 DOI: 10.1097/mao.0000000000004088] [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: 02/17/2024]
Abstract
HYPOTHESIS Measurements of the cochlear duct length (CDL) are dependent on the resolution of the imaging dataset. BACKGROUND Previous research has shown highly precise cochlear measurements using 3D-curved multiplanar reconstruction (MPR) and flat-panel volume computed tomography (fpVCT). Thus far, however, there has been no systematic evaluation of the imaging dataset resolution required for optimal CDL measurement. Therefore, the aim of this study was to evaluate the dependence of CDL measurement on the resolution of the imaging dataset to establish a benchmark for future CDL measurements. METHODS fpVCT scans of 10 human petrous bone specimens were performed. CDL was measured using 3D-curved MPR with secondary reconstruction of the fpVCT scans (fpVCT SECO ) and increasing resolution from 466 to 99 μm. In addition, intraobserver variability was evaluated. A best-fit function for calculation of the CDL was developed to provide a valid tool when there are no measurements done with high-resolution imaging datasets. RESULTS Comparison of different imaging resolution settings showed significant differences for CDL measurement in most of the tested groups ( p < 0.05), except for the two groups with the highest resolution. Imaging datasets with a resolution lower than 200 μm showed lower intraobserver variability than the other resolution settings, although there were no clinically unacceptable errors with respect to the Bland-Altman plots. The developed best-fit function showed high accuracy for CDL calculation using resolution imaging datasets of 300 μm or lower. CONCLUSION 3D-curved MPR in fpVCT with a resolution of the imaging dataset of 200 μm or higher revealed the most precise CDL measurement. There was no benefit of using a resolution higher than 200 μm with regard to the accuracy of the CDL measurement.
Collapse
Affiliation(s)
- Bjoern Spahn
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Lukas Ilgen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University of Wuerzburg
| | - Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Philipp Schendzielorz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| | - Daniel Althoff
- Fraunhofer Development Center for X-ray Technology, Wuerzburg
| | - Simon Zabler
- Deggendorf Institute of Technology, Faculty of Applied Computer Science, Deggendorf, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center
| |
Collapse
|
11
|
Räth M, Schurzig D, Timm ME, Lenarz T, Warnecke A. Correlation of Scalar Cochlear Volume and Hearing Preservation in Cochlear Implant Recipients with Residual Hearing. Otol Neurotol 2024; 45:256-265. [PMID: 38361293 DOI: 10.1097/mao.0000000000004122] [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: 02/17/2024]
Abstract
OBJECTIVE Preservation of residual hearing is one of the main goals in cochlear implantation. There are many factors that can influence hearing preservation after cochlear implantation. The purpose of the present study was to develop an algorithm for validated preoperative cochlear volume analysis and to elucidate the role of cochlear volume in preservation of residual hearing preservation after atraumatic cochlear implantation. STUDY DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENTS A total of 166 cochlear implant recipients were analyzed. All patients were implanted with either a MED-EL (Innsbruck, Austria) FLEXSOFT (n = 3), FLEX28 (n = 72), FLEX26 (n = 1), FLEX24 (n = 41), FLEX20 (n = 38), or FLEX16 (n = 11, custom made device) electrode array through a round window approach. Main outcome measures: Cochlear volume as assessed after manual segmentation of cochlear cross-sections in cone beam computed tomography, and preservation of residual hearing 6 months after implantation were analyzed. The association between residual hearing preservation and cochlear volume was then assessed statistically. RESULTS Rapid and valid cochlear volume analysis was possible using the individual cross-sections and a newly developed and validated algorithm. Cochlear volume had the tendency to be larger in patients with hearing preservation than in those with hearing loss. Significant correlations with hearing preservation could be observed for the basal width and length of the basal turn. CONCLUSIONS Preservation of residual hearing after cochlear implantation may depend on cochlear volume but appears to be influenced more strongly by other cochlear dimensions.
Collapse
|
12
|
Concheri S, Brotto D, Ariano M, Daloiso A, Di Pasquale Fiasca VM, Sorrentino F, Coppadoro B, Trevisi P, Zanoletti E, Franchella S. Intraoperative Measurement of Insertion Speed in Cochlear Implant Surgery: A Preliminary Experience with Cochlear SmartNav. Audiol Res 2024; 14:227-238. [PMID: 38525682 PMCID: PMC10961689 DOI: 10.3390/audiolres14020021] [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: 12/05/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES The objectives were to present the real-time estimated values of cochlear implant (CI) electrode insertion speed (IS) during intraoperative sessions using the Cochlear Nucleus SmartNav System to assess whether this measure affected CI outcomes and to determine whether real-time feedback assists expert surgeons in achieving slow insertion. METHODS The IS was measured in 52 consecutive patients (65 implanted ears) using the CI632 electrode. The IS values were analyzed in relation to procedure repetition over time, NRT ratio, and CI audiological outcomes. RESULTS The average IS was 0.64 mm/s (SD = 0.24); minimum and maximum values were 0.23 and 1.24 mm/s, respectively. The IS significantly decreased with each array insertion by the operator (p = 0.006), and the mean decreased by 24% between the first and last third of procedures; however, this reduction fell within the error range of SmartNav for IS (+/-0.48 mm/s). No correlation was found between IS and the NRT ratio (p = 0.51), pure-tone audiometry (PTA) at CI activation (p = 0.506), and PTA (p = 0.94) or word recognition score (p = 0.231) at last evaluation. CONCLUSIONS The estimated IS reported by SmartNav did not result in a clinically significant reduction in insertion speed or an improvement in CI hearing outcomes. Real-time feedback of IS could potentially be used for training, but its effectiveness requires confirmation through additional studies and more accurate tools. Implementation of IS assessment in clinical practice will enable comparisons between measurement techniques and between manual and robot-assisted insertions. This will help define the optimal IS range to achieve better cochlear implant (CI) outcomes.
Collapse
Affiliation(s)
- Stefano Concheri
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Davide Brotto
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Marzia Ariano
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Antonio Daloiso
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | | | - Flavia Sorrentino
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Beatrice Coppadoro
- Pediatric Hematology Oncology Unit, Department of Woman’s and Child’s Health, Azienda Ospedale-Università di Padova, 35122 Padua, Italy
| | - Patrizia Trevisi
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Sebastiano Franchella
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| |
Collapse
|
13
|
Vohra V, Andresen NS, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Creighton FX, Bowditch SP, Sun DQ. Cochlear Implant Electrode Array Design and Speech Understanding. Otol Neurotol 2024; 45:136-142. [PMID: 38152035 DOI: 10.1097/mao.0000000000004083] [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: 12/29/2023]
Abstract
OBJECTIVE Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations. DESIGN Retrospective cohort study. SETTING Single academic medical center. PARTICIPANTS A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017. INTERVENTIONSS PM versus LW cochlear implants. MAIN OUTCOMES AND MEASURES Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years. RESULTS Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 [interquartile range, 38-68] versus 48 [31-62], p = 0.036) and from 2 to 5 years (58 [43-72] versus 48 [33-66], p < 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w ( β = 4.4 [95% confidence interval, 0.6-8.3], p = 0.023) and HINT testing ( β = 4.5 [95% confidence interval, 0.3-8.7], p = 0.038). CONCLUSIONS This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
Collapse
Affiliation(s)
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Carver
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dunham
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dawn Marsiglia
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenifer Yeagle
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles C Della Santina
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen P Bowditch
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
14
|
Hasan Z, Key S, Lee M, Da Cruz M. Systematic Review of Intracochlear Measurements and Effect on Postoperative Auditory Outcomes after Cochlear Implant Surgery. Otol Neurotol 2024; 45:e1-e17. [PMID: 38013462 DOI: 10.1097/mao.0000000000004044] [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: 11/29/2023]
Abstract
OBJECTIVE Quality and adequacy of the electrode neuron interface (ENI) is postulated to be a determining factor in affecting auditory outcomes after cochlear implantation. This study aims to review radiological parameters affecting ENI, including angular insertion (AngI), wrapping factor (WF), scalar translocation (ScaT), and electrode-modiolar distance (EMD) and their effect on auditory outcomes. DATABASES REVIEWED PubMed, MEDLINE, Embase, Scopus, OpenGrey, and Google Scholar from inception to 01 September 2022. METHODS Inclusion criteria were (i) all humans with any cochlear implant (CI); (ii) postoperative cross-sectional imaging with electrode position factors of AngI, ScaT, EMD, and/or WF; and (iii) associated auditory outcomes. Search was restricted to English-language literature. Two independent reviewers performed title and abstract screening, data extraction, and ROBINS-I risk of bias assessment. Formal statistical analysis not performed due to data heterogeneity. PROSPERO (CRD42022359198). RESULTS Thirty-one studies (n = 2,887 patients, 3,091 electrodes) underwent qualitative synthesis. Higher AngI (n = 1921 patients) demonstrated positive correlation in 11 studies, no correlation in eight studies, and negative correlation in four studies. ScaT (n = 2,115 patients) demonstrated negative correlation in 12 studies, none in six studies, and one unclear correlation. Larger EMD (n = 240 patients) showed negative correlation in two studies, no correlation in one, and unclear correlation in one study. Smaller WF (n = 369 patients) demonstrated no correlation in three studies and positive correlation in one study. CONCLUSIONS Our study finds variable reported relationship between AngI and auditory outcomes. CI electrodes with a ScaT or larger EMD are more likely to exhibit poorer outcomes, and WF does not correlate with outcomes.
Collapse
Affiliation(s)
| | - Seraphina Key
- Faculty of Medicine and Health, University of Sydney, Australia
| | - Michael Lee
- Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | | |
Collapse
|
15
|
Weiss NM, Breitsprecher T, Wozniak M, Bächinger D, Völter C, Mlynski R, Van de Heyning P, Van Rompaey V, Dazert S. Comparing linear and non-linear models to estimate the appropriate cochlear implant electrode array length-are current methods precise enough? Eur Arch Otorhinolaryngol 2024; 281:43-49. [PMID: 37466660 PMCID: PMC10764384 DOI: 10.1007/s00405-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/09/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE In cochlear implantation with flexible lateral wall electrode arrays, a cochlear coverage (CC) range between 70% and 80% is considered ideal for optimal speech perception. To achieve this CC, the cochlear implant (CI) electrode array has to be chosen according to the individual cochlear duct length (CDL). Here, we mathematically analyzed the suitability of different flexible lateral wall electrode array lengths covering between 70% and 80% of the CDL. METHODS In a retrospective cross-sectional study preoperative high-resolution computed tomography (HRCT) from patients undergoing cochlear implantation was investigated. The CDL was estimated using an otosurgical planning software and the CI electrode array lengths covering 70-80% of the CDL was calculated using (i) linear and (ii) non-linear models. RESULTS The analysis of 120 HRCT data sets showed significantly different model-dependent CDL. Significant differences between the CC of 70% assessed from linear and non-linear models (mean difference: 2.5 mm, p < 0.001) and the CC of 80% assessed from linear and non-linear models (mean difference: 1.5 mm, p < 0.001) were found. In up to 25% of the patients none of the existing flexible lateral wall electrode arrays fit into this range. In 59 cases (49,2%) the models did not agree on the suitable electrode arrays. CONCLUSIONS The CC varies depending on the underlying CDL approximation, which critically influences electrode array choice. Based on the literature, we hypothesize that the non-linear method systematically overestimates the CC and may lead to rather too short electrode array choices. Future studies need to assess the accuracy of the individual mathematical models.
Collapse
Affiliation(s)
- Nora M Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- International Graduate School of Neuroscience (IGSN), Ruhr-University Bochum, Bochum, Germany.
| | - Tabita Breitsprecher
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Martin Wozniak
- MED-EL Elektromedizinische Geräte Deutschland GmbH, Starnberg, Deutschland
| | - David Bächinger
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner", University, Rostock, Germany
| | - Paul Van de Heyning
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| |
Collapse
|
16
|
Creff G, Lambert C, Coudert P, Pean V, Laurent S, Godey B. Comparison of Tonotopic and Default Frequency Fitting for Speech Understanding in Noise in New Cochlear Implantees: A Prospective, Randomized, Double-Blind, Cross-Over Study. Ear Hear 2024; 45:35-52. [PMID: 37823850 DOI: 10.1097/aud.0000000000001423] [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: 10/13/2023]
Abstract
OBJECTIVES While cochlear implants (CIs) have provided benefits for speech recognition in quiet for subjects with severe-to-profound hearing loss, speech recognition in noise remains challenging. A body of evidence suggests that reducing frequency-to-place mismatch may positively affect speech perception. Thus, a fitting method based on a tonotopic map may improve speech perception results in quiet and noise. The aim of our study was to assess the impact of a tonotopic map on speech perception in noise and quiet in new CI users. DESIGN A prospective, randomized, double-blind, two-period cross-over study in 26 new CI users was performed over a 6-month period. New CI users older than 18 years with bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on the Greenwood function. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Each setting was maintained for 6 weeks, at the end of which participants performed speech perception tasks. The primary outcome measure was speech recognition in noise. Participants were allocated to sequences by block randomization of size two with a ratio 1:1 (CONSORT Guidelines). Participants and those assessing the outcomes were blinded to the intervention. RESULTS Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (one in each sequence) had to be excluded due to the COVID-19 pandemic. Twenty-four participants were analyzed. Speech recognition in noise was significantly better with the tonotopic fitting at all signal-to-noise ratio (SNR) levels tested [SNR = +9 dB, p = 0.002, mean effect (ME) = 12.1%, 95% confidence interval (95% CI) = 4.9 to 19.2, standardized effect size (SES) = 0.71; SNR = +6 dB, p < 0.001, ME = 16.3%, 95% CI = 9.8 to 22.7, SES = 1.07; SNR = +3 dB, p < 0.001 ME = 13.8%, 95% CI = 6.9 to 20.6, SES = 0.84; SNR = 0 dB, p = 0.003, ME = 10.8%, 95% CI = 4.1 to 17.6, SES = 0.68]. Neither period nor interaction effects were observed for any signal level. Speech recognition in quiet ( p = 0.66) and tonal audiometry ( p = 0.203) did not significantly differ between the two settings. 92% of the participants kept the tonotopy-based map after the study period. No correlation was found between speech-in-noise perception and age, duration of hearing deprivation, angular insertion depth, or position or width of the frequency filters allocated to the electrodes. CONCLUSION For new CI users, tonotopic fitting appears to be more efficient than the default frequency fitting because it allows for better speech recognition in noise without compromising understanding in quiet.
Collapse
Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
- MediCIS, LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Cassandre Lambert
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | - Paul Coudert
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | | | | | - Benoit Godey
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
- MediCIS, LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
- Hearing Aid Academy, Javene, France
| |
Collapse
|
17
|
Rader T, Schrank L, Spiegel JL, Nachtigäller P, Spiro JE, Hempel JM, Canis M, Mueller J. Comparison of speech perception in bimodal cochlear implant patients with respect to the cochlear coverage. HNO 2024; 72:17-24. [PMID: 37608133 PMCID: PMC10799137 DOI: 10.1007/s00106-023-01327-5] [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] [Accepted: 06/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The hearing success of patients with bimodal fitting, utilizing both a cochlear implant (CI) and a hearing aid (HA), varies considerably: While some patients benefit from bimodal CI and HA, others do not. OBJECTIVES This retrospective study aimed to investigate speech perception in bimodally fitted patients and compare it with the cochlear coverage (CC). METHODS The CC was calculated with the OTOPLAN software, measuring the cochlear duct length on temporal bone CT scans of 39 patients retrospectively. The patients were categorized into two groups: CC ≤ 65% (CC500) and CC > 65% (CC600). Monaural speech intelligibility for monosyllables at a sound pressure level (SPL) of 65 dB in a free-field setting was assessed before and after CI at various time points. The two groups, one with preoperative HA and one with postoperative CI, were compared. Additionally, speech intelligibility was correlated with CC in the entire cohort before CI and at the last available follow-up (last observation time, LOT). RESULTS Overall, there was no significant difference in speech intelligibility between CC500 and CC600 patients, with both groups demonstrating a consistent improvement after implantation. While CC600 patients tended to exhibit earlier improvement in speech intelligibility, CC500 patients showed a slower initial improvement within the first 3 months but demonstrated a steeper learning curve thereafter. At LOT, the two patient groups converged, with no significant differences in expected speech intelligibility. There was no significant relationship between unimodal/unilateral free-field speech intelligibility and CC. Interestingly, patients with a CC of 70-75% achieved the highest speech intelligibility. CONCLUSION Despite of the lack of a significant correlation between CC and speech perception, patients appeared to reach their maximum in unimodal/unilateral speech perception primarily at a coverage level of 70-75%. Nevertheless, further investigation is warranted, as CC500 was associated with shorter cochlear duct length, and different types of electrodes were used in both groups.
Collapse
Affiliation(s)
- Tobias Rader
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Leonhard Schrank
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pascal Nachtigäller
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Judith E Spiro
- Department for Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - John-Martin Hempel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joachim Mueller
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
18
|
Gu W, Daoudi H, Lahlou G, Sterkers O, Ferrary E, Nguyen Y, Mosnier I, Torres R. Auditory outcomes after scala vestibuli array insertion are similar to those after scala tympani insertion 1 year after cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:155-162. [PMID: 37516989 DOI: 10.1007/s00405-023-08107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE In cochlear implantation, a scala vestibuli (SV) insertion of an electrode array is a rare occurrence and is reported to be linked to poor hearing outcomes. Using the same electrode array, the auditory performance of patients with a complete SV location was compared with that of patients having a complete scala tympani (ST) location 1 year after implantation. METHODS Thirty-three patients were included in this retrospective case-control study (SV, n = 12; ST, n = 21). The matching criteria were electrode array type, age at implantation, and duration of severe or profound deafness. The array location was analyzed using 3D reconstruction of postoperative CT scans. Postoperative audiological evaluation of the implanted ear was performed using pure-tone audiometry, speech recognition of monosyllabic words in quiet, and words and sentences in noise. RESULTS On the preoperative CT scan, six patients in the SV group presented with both round window (RW) and ST ossification, three with RW ossification alone, and three with no RW ossification. Auditory performance did not differ between SV and ST groups 1 year after cochlear implantation. Speech recognition of words was 49 ± 7.6% and 56 ± 5.0% in quiet and 75 ± 9.5% and 66 ± 6.0% in noise in SV and ST groups, respectively. CONCLUSION ST insertion is the gold standard that allows the three cochlear scalae to preserve scalar cochlear integrity. However, 1 year after implantation, a planned or unexpected SV insertion is not detrimental to hearing outcomes, providing similar auditory performance in quiet and noise to ST insertion.
Collapse
Affiliation(s)
- Wenxi Gu
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases (14DZ2260300), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hannah Daoudi
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Ghizlene Lahlou
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Olivier Sterkers
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Evelyne Ferrary
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Yann Nguyen
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Isabelle Mosnier
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France
| | - Renato Torres
- APHP/Sorbonne Université, GHU Pitié-Salpêtrière, Service ORL, Unité Fonctionnelle Implants Auditifs Et Explorations Fonctionnelles, 50-52 Boulevard Vincent Auriol, 75013, Paris, France.
- Institut Pasteur/Université Paris Cité/Inserm, Institut de L'Audition, Technologie Et Thérapie Génique Pour La Surdité, 63 Rue de Charenton, 75012, Paris, France.
- Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru.
| |
Collapse
|
19
|
Breitsprecher TM, Baumgartner WD, Brown K, Dazert S, Doyle U, Dhanasingh A, Großmann W, Hagen R, Van de Heyning P, Mlynski R, Neudert M, Rajan G, Rak K, Van Rompaey V, Schmutzhard J, Volkenstein S, Völter C, Wimmer W, Zernotti M, Weiss NM. Effect of Cochlear Implant Electrode Insertion Depth on Speech Perception Outcomes: A Systematic Review. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e045. [PMID: 38516541 PMCID: PMC10950166 DOI: 10.1097/ono.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/29/2023] [Indexed: 03/23/2024]
Abstract
Objective The suitable electrode array choice is broadly discussed in cochlear implantation surgery. Whether to use a shorter electrode length under the aim of structure preservation versus choosing a longer array to achieve a greater cochlear coverage is a matter of debate. The aim of this review is to identify the impact of the insertion depth of a cochlear implant (CI) electrode array on CI users' speech perception outcomes. Databases Reviewed PubMed was searched for English-language articles that were published in a peer-reviewed journal from 1997 to 2022. Methods A systematic electronic search of the literature was carried out using PubMed to find relevant literature on the impact of insertion depth on speech perception. The review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines of reporting. Studies in both, children and adults with pre- or postlingual hearing loss, implanted with a CI were included in this study. Articles written in languages other than English, literature reviews, meta-analyses, animal studies, histopathological studies, or studies pertaining exclusively to imaging modalities without reporting correlations between insertion depth and speech outcomes were excluded. The risk of bias was determined using the "Risk of Bias in Nonrandomized Studies of Interventions" tool. Articles were extracted by 2 authors independently using predefined search terms. The titles and abstracts were screened manually to identify studies that potentially meet the inclusion criteria. The extracted information included: the study population, type of hearing loss, outcomes reported, devices used, speech perception outcomes, insertion depth (linear insertion depth and/or the angular insertion depth), and correlation between insertion depth and the speech perception outcomes. Results A total of 215 relevant studies were assessed for eligibility. Twenty-three studies met the inclusion criteria and were analyzed further. Seven studies found no significant correlation between insertion depth and speech perception outcomes. Fifteen found either a significant positive correlation or a positive effect between insertion depth and speech perception. Only 1 study found a significant negative correlation between insertion depth and speech perception outcomes. Conclusion Although most studies reported a positive effect of insertion depth on speech perception outcomes, one-third of the identified studies reported no correlation. Thus, the insertion depth must be considered as a contributing factor to speech perception rather than as a major decisive criterion. Registration This review has been registered in PROSPERO, the international prospective register of systematic reviews (CRD42021257547), available at https://www.crd.york.ac.uk/PROSPERO/.
Collapse
Affiliation(s)
- Tabita M. Breitsprecher
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Wolf-Dieter Baumgartner
- Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Medizinische Universität Wien, Wien, Austria
| | - Kevin Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Una Doyle
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
| | - Anandhan Dhanasingh
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner,” Rostock University Medical Center, Rostock, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Paul Van de Heyning
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner,” Rostock University Medical Center, Rostock, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology Head and Neck Surgery, Technische Universität Dresden (oder TU Dresden), Faculty of Medicine (and University Hospital) Carl Gustav Carus, Dresden, Germany
| | - Gunesh Rajan
- Otolaryngology, Head and Neck Surgery, Medical School, University of Western Australia, Perth, Australia
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Volkenstein
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, Johannes Wesling Klinikum Minden, Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Mario Zernotti
- Division of Otolaryngology and Head and Neck Surgery, Sanatorio Allende, Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum, Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Technical University of Munich (TUM), Munich, Germany
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Munich, Germany
- International Graduate School of Neuroscience, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
20
|
Ding L, Zhang L, Li J, Lin T. Electrode-Modiolus Distance Affects Speech Perception for Lateral Wall Electrodes. Otol Neurotol 2023; 44:e702-e709. [PMID: 37939358 DOI: 10.1097/mao.0000000000004019] [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: 11/10/2023]
Abstract
OBJECTIVES The goal of this study was to use cone-beam computed tomography to locate the electrode-modiolus distance (EMD) and correlate this with speech perception in cochlear implant (CI) recipients of the 31.5-mm lateral wall (LW) electrode arrays. STUDY DESIGN Retrospective review. PATIENTS Forty-five child CI recipients with prelingual profound sensorineural hearing loss of inserted 31.5-mm LW arrays listening with a CI-alone device. INTERVENTIONS Stepwise forward multiple linear regression was performed to control and reduce the variability in implant performance to determine whether EMD affects speech perception. MAIN OUTCOME MEASURES Electrode location (angular insertion depth [AID], EMD), together with the electrode impedance (EI), surgical approach, sex, CI age, and preimplant hearing aid usage were estimated as independent variables. The dependent variables were the Meaningful Use of Speech Scale (MUSS) and parents' evaluation of children's aural/oral performance (PEACH) assessed with the CI alone at 12 months postactivation. RESULTS EMD and CI age were predictive variables for PEACH/MUSS. A negative correlation was found between AID and EMD (r = -0.56, p < 0.01), whereas EMD had a moderately positive correlation with EI (r = 0.32, p < 0.01). CONCLUSIONS The best "location-related" predictor of postoperative speech perception was EMD with a 31.5-mm array among CI-alone users.
Collapse
Affiliation(s)
- Ling Ding
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Luguang Zhang
- Department of Medical Imaging, The Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tao Lin
- Department of Neurosurgery, Shandong Second Provincial General Hospital, Jinan, Shandong, 250022, China
| |
Collapse
|
21
|
Stebani J, Blaimer M, Zabler S, Neun T, Pelt DM, Rak K. Towards fully automated inner ear analysis with deep-learning-based joint segmentation and landmark detection framework. Sci Rep 2023; 13:19057. [PMID: 37925540 PMCID: PMC10625555 DOI: 10.1038/s41598-023-45466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
Automated analysis of the inner ear anatomy in radiological data instead of time-consuming manual assessment is a worthwhile goal that could facilitate preoperative planning and clinical research. We propose a framework encompassing joint semantic segmentation of the inner ear and anatomical landmark detection of helicotrema, oval and round window. A fully automated pipeline with a single, dual-headed volumetric 3D U-Net was implemented, trained and evaluated using manually labeled in-house datasets from cadaveric specimen ([Formula: see text]) and clinical practice ([Formula: see text]). The model robustness was further evaluated on three independent open-source datasets ([Formula: see text] scans) consisting of cadaveric specimen scans. For the in-house datasets, Dice scores of [Formula: see text], intersection-over-union scores of [Formula: see text] and average Hausdorff distances of [Formula: see text] and [Formula: see text] voxel units were achieved. The landmark localization task was performed automatically with an average localization error of [Formula: see text] voxel units. A robust, albeit reduced performance could be attained for the catalogue of three open-source datasets. Results of the ablation studies with 43 mono-parametric variations of the basal architecture and training protocol provided task-optimal parameters for both categories. Ablation studies against single-task variants of the basal architecture showed a clear performance benefit of coupling landmark localization with segmentation and a dataset-dependent performance impact on segmentation ability.
Collapse
Affiliation(s)
- Jannik Stebani
- Magnetic Resonance and X-Ray Imaging Department, Fraunhofer Institute for Integrated Circuits IIS, 97074, Würzburg, Germany.
- Universität Würzburg, Experimentelle Physik V, 97074, Würzburg, Germany.
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, Universitätsklinikum Würzburg, 97080, Würzburg, Germany.
| | - Martin Blaimer
- Magnetic Resonance and X-Ray Imaging Department, Fraunhofer Institute for Integrated Circuits IIS, 97074, Würzburg, Germany
| | - Simon Zabler
- Magnetic Resonance and X-Ray Imaging Department, Fraunhofer Institute for Integrated Circuits IIS, 97074, Würzburg, Germany
- Faculty of Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, Universitätsklinikum Würzburg, 97080, Würzburg, Germany
| | - Daniël M Pelt
- Leiden Institute of Advanced Computer Science (LIACS), Universiteit Leiden, Leiden, CA, 2333, The Netherlands
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, Universitätsklinikum Würzburg, 97080, Würzburg, Germany
| |
Collapse
|
22
|
Aksoy DÖ, Meltem E, Karagöz Y, Yildirim G, Mahmutoğlu Ö, Mahmutoğlu AS. Comprehension of Cochlear Duct Length for Incomplete Partition Types. J Comput Assist Tomogr 2023; 47:982-988. [PMID: 37948375 DOI: 10.1097/rct.0000000000001488] [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: 06/03/2023]
Abstract
OBJECTIVE Preoperative assessment of the cochlear duct length (CDL) and cochlear dimensions allows the selection of optimized implants. We aimed to evaluate the CDL measurements in incomplete partition (IP) defect patients and to create a reference to the literature. METHODS Forty-one patients with IP (13 IP I, 23 IP II, and 5 IP III) and 30 controls were included in the study. The standardized cochlear image showing the basal turn in the most expansive plane was reconstructed from temporal high-resolution computed tomography images. Cochlear duct length measured manually (CDL-M) was measured by points placed consecutively on the lateral wall of the cochlea. The defined equations for estimating CDL (CDL measured according to Schurzig et al formula [CDL-Ɵ], CDL measured according to Escudé et al formula [CDL-E], CDL measured according to Alexiades et al formula [CDL-A]) were calculated from the same images. Cochlear duct length mean values obtained by each method were compared for each IP type. RESULTS The longest CDL value was found in the control group, irrespective of the calculation method. Incomplete partition II cases had the most extended mean CDL among IP types. Incomplete partition III had the shortest CDL among all groups' CDL-M values. However, the mean CDL-M values of IP types I and III showed close results. There was no significant difference between the CDL-E and CDL-M values of the control group. Similarly, no significant difference was found between CDL-Ɵ and CDL-M values in IP type III cases. However, the results of other estimating formulations of all groups differed significantly from CDL-M values. CONCLUSION Cochlear duct length differences were detected between the control group and IP subtypes. These differences should be considered when choosing the appropriate electrode length. Because the results of formulas estimating CDL may differ from CDL-M in both control and IP cases, it would be more appropriate to use manual measurements in clinical practice.
Collapse
Affiliation(s)
- Direnç Özlem Aksoy
- From the Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Emine Meltem
- From the Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Yeşim Karagöz
- From the Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gülşah Yildirim
- From the Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Özdeş Mahmutoğlu
- Department of Radiology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Soydan Mahmutoğlu
- From the Department of Radiology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
23
|
Schraivogel S, Aebischer P, Wagner F, Weder S, Mantokoudis G, Caversaccio M, Wimmer W. Postoperative Impedance-Based Estimation of Cochlear Implant Electrode Insertion Depth. Ear Hear 2023; 44:1379-1388. [PMID: 37157125 PMCID: PMC10583924 DOI: 10.1097/aud.0000000000001379] [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: 01/06/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Reliable determination of cochlear implant electrode positions shows promise for clinical applications, including anatomy-based fitting of audio processors or monitoring of electrode migration during follow-up. Currently, electrode positioning is measured using radiography. The primary objective of this study is to extend and validate an impedance-based method for estimating electrode insertion depths, which could serve as a radiation-free and cost-effective alternative to radiography. The secondary objective is to evaluate the reliability of the estimation method in the postoperative follow-up over several months. DESIGN The ground truth insertion depths were measured from postoperative computed tomography scans obtained from the records of 56 cases with an identical lateral wall electrode array. For each of these cases, impedance telemetry records were retrieved starting from the day of implantation up to a maximum observation period of 60 mo. Based on these recordings, the linear and angular electrode insertion depths were estimated using a phenomenological model. The estimates obtained were compared with the ground truth values to calculate the accuracy of the model. RESULTS Analysis of the long-term recordings using a linear mixed-effects model showed that postoperative tissue resistances remained stable throughout the follow-up period, except for the two most basal electrodes, which increased significantly over time (electrode 11: ~10 Ω/year, electrode 12: ~30 Ω/year). Inferred phenomenological models from early and late impedance telemetry recordings were not different. The insertion depth of all electrodes was estimated with an absolute error of 0.9 mm ± 0.6 mm or 22° ± 18° angle (mean ± SD). CONCLUSIONS Insertion depth estimations of the model were reliable over time when comparing two postoperative computed tomography scans of the same ear. Our results confirm that the impedance-based position estimation method can be applied to postoperative impedance telemetry recordings. Future work needs to address extracochlear electrode detection to increase the performance of the method.
Collapse
Affiliation(s)
- Stephan Schraivogel
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Aebischer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Technical University of Munich, Germany; TUM School of Medicine, Klinikum rechts der Isar, Department of Otorhinolaryngology
| |
Collapse
|
24
|
Atak HBO, Sennaroglu G, Sennaroglu L. Speech recognition and quality of life outcomes of adults with cochlear implants following a quarter-century of deafness: what should be the maximum duration? Eur Arch Otorhinolaryngol 2023; 280:4903-4913. [PMID: 37672104 DOI: 10.1007/s00405-023-08214-3] [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: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE This study was aimed at examining the pre- and post-cochlear implant (CI) speech recognition and quality of life results of postlingually deaf adult CI users with a duration of deafness (DoD) > 25 years and determining the maximum DoD limit. METHODS We enrolled 54 postlingually deaf CI users and divided them into ages ≤ 60 and > 60 years and DoDs ≤ 25 and > 25 years. All participants were evaluated using multisensory measures (auditory and auditory + visual) and open-set Speech Recognition Test (SRT) before CI and 3 years postoperatively. They were administered with The Hearing Handicap Inventory for the Elderly (HHIE) to determine the effects of hearing impairment on daily life. RESULTS DoD and open-set SRT for auditory and auditory + visual stimuli showed a strong negative linear relationship (r = - 0.506, p < 0.01). Open-set SRT scores of patients with DoD aged ≤ 25 and > 25 years (p < 0.01) differed significantly. The chronological age and HHIE scores in social and emotional subfactors showed a strong negative linear relationship (r = - 0.519, p < 0.01). CONCLUSIONS The present study showed that the number of years was a major factor determining that postlingual adults with profound hearing loss had hearing loss. The results support CI use as soon as possible in adults to prevent degeneration of the auditory pathways and possible central remodeling. However, auditory rehabilitation outcomes in adults using CI vary widely. Investigating the causes of this variability contributes to audiology.
Collapse
Affiliation(s)
- Hilal Burcu Ozkan Atak
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey.
| | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
25
|
Sieber D, Timm ME, Weller T, Suhling M, Lenarz T, Schurzig D. The Dependency of Cochlear Lateral Wall Measurements on Observer and Imaging Type. Otol Neurotol 2023; 44:873-880. [PMID: 37641206 DOI: 10.1097/mao.0000000000003991] [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: 08/31/2023]
Abstract
HYPOTHESIS Assessment techniques for the cochlear spatial lateral wall are associated with inter-rater variability, but derived clinical recommendations nonetheless offer value for individualized electrode selection. BACKGROUND Anatomical variations influence the location of cochlear implant electrodes inside the cochlea. Preoperative planning allows individualization of the electrode based on characterization of the bony lateral wall. METHODS The study used publicly available digitized temporal bones based on microslicing and computed tomography. Four experienced observers assessed the lateral wall applying manual tracing, linear regression scaling and elliptic-circular approximation methods in all modalities. Radial and height differences were computed in 90-degree steps from the round window center to the apex. Total length, total angular length, and tonotopic frequencies were computed for each reconstruction. RESULTS Differences were found most pronounced between assessment methods in vertical direction across observers and imaging modalities. One of the five anatomies was consistently found to be of shorter cochlear duct length with estimation techniques yielding more conservative results compared with manual tracings. CONCLUSIONS Assessment techniques for the bony lateral wall yield method, observer, and image modality related deviations. Automation of the anatomical characterization may offer potential in minimizing inaccuracies. Nonetheless, observers were consistently able to detect a smaller inner ear demonstrating the ability of current methods to contribute to an optimized choice of electrodes based on individual patient anatomy.
Collapse
Affiliation(s)
- Daniel Sieber
- Department of Medical and Health Technologies, MCI The Entrepreneurial School, Innsbruck, Austria
| | - Max E Timm
- Department of Otolaryngology, Hannover Medical School
| | - Tobias Weller
- Department of Otolaryngology, Hannover Medical School
| | - Marie Suhling
- Department of Otolaryngology, Hannover Medical School
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School
| | | |
Collapse
|
26
|
Swords C, Geerardyn A, Zhu M, O'Malley JT, Wu P, Arenberg JG, Podury A, Brassett C, Bance M, Quesnel AM. Incomplete Partition Type II Cochlear Malformations: Delineating the Three-Dimensional Structure from Digitized Human Histopathological Specimens. Otol Neurotol 2023; 44:881-889. [PMID: 37621122 PMCID: PMC10803064 DOI: 10.1097/mao.0000000000003999] [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: 08/26/2023]
Abstract
HYPOTHESIS There are clinically relevant differences in scalae anatomy and spiral ganglion neuron (SGN) quantity between incomplete partition type II (IP-II) and normal cochleae. BACKGROUND IP-II is a commonly implanted cochlear malformation. Detailed knowledge of intracochlear three-dimensional (3D) morphology may assist with cochlear implant (CI) electrode selection/design and enable optimization of audiologic programming based on SGN maps. METHODS IP-II (n = 11) human temporal bone histological specimens were identified from the National Institute on Deafness and Other Communication Disorders National Temporal Bone Registry and digitized. The cochlear duct, scalae, and surgically relevant anatomy were reconstructed in 3D. A machine learning algorithm was applied to map the location and number of SGNs. RESULTS 3D scalae morphology of the basal turn was normal. Scala tympani (ST) remained isolated for 540 degrees before fusing with scala vestibuli. Mean ST volume reduced below 1 mm 2 after the first 340 degrees. Scala media was a distinct endolymphatic compartment throughout; mean ± standard deviation cochlear duct length was 28 ± 3 mm. SGNs were reduced compared with age-matched norms (mean, 48%; range, 5-90%). In some cases, SGNs failed to ascend Rosenthal's canal, remaining in an abnormal basalward modiolar location. Two forms of IP-II were seen: type A and type B. A majority (98-100%) of SGNs were located in the basal modiolus in type B IP-II, compared with 76 to 85% in type A. CONCLUSION Hallmark features of IP-II cochleae include the following: 1) fusion of the ST and scala vestibuli at a mean of 540 degrees, 2) highly variable and overall reduced SGN quantity compared with normative controls, and 3) abnormal SGN distribution with cell bodies failing to ascend Rosenthal's canal.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Manohar Bance
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
27
|
Mewes A, Bennett C, Dambon J, Brademann G, Hey M. Evaluation of CI electrode position from imaging: comparison of an automated technique with the established manual method. BMC Med Imaging 2023; 23:143. [PMID: 37773060 PMCID: PMC10543862 DOI: 10.1186/s12880-023-01102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND A manual evaluation of the CI electrode position from CT and DVT scans may be affected by diagnostic errors due to cognitive biases. The aim of this study was to compare the CI electrode localization using an automated method (image-guided cochlear implant programming, IGCIP) with the clinically established manual method. METHODS This prospective experimental study was conducted on a dataset comprising N=50 subjects undergoing cochlear implantation with a Nucleus® CI532 or CI632 Slim Modiolar electrode. Scalar localization, electrode-to-modiolar axis distances (EMD) and angular insertion depth (aDOI) were compared between the automated IGCIP tool and the manual method. Two raters made the manual measurements, and the interrater reliability (±1.96·SD) was determined as the reference for the method comparison. The method comparison was performed using a correlation analysis and a Bland-Altman analysis. RESULTS Concerning the scalar localization, all electrodes were localized both manually and automatically in the scala tympani. The interrater differences ranged between ±0.2 mm (EMD) and ±10° (aDOI). There was a bias between the automatic and manual method in measuring both localization parameters, which on the one hand was smaller than the interrater variations. On the other hand, this bias depended on the magnitude of the EMD respectively aDOI. A post-hoc analysis revealed that the deviations between the methods were likely due to a different selection of mid-modiolar axis. CONCLUSIONS The IGCIP is a promising tool for automated processing of CT and DVT scans and has useful functionality such as being able to segment the cochlear using post-operative scans. When measuring EMD, the IGCIP tool is superior to the manual method because the smallest possible distance to the axis is determined depending on the cochlear turn, whereas the manual method selects the helicotrema as the reference point rigidly. Functionality to deal with motion artifacts and measurements of aDOI according to the consensus approach are necessary, otherwise the IGCIP is not unrestrictedly ready for clinical use.
Collapse
Affiliation(s)
- Alexander Mewes
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | | | - Jan Dambon
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Goetz Brademann
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
28
|
Jia G, Song Z, Wu L, Sun Q, Sheng Y, Ni Y, Li H, Li W. An Accurate and Individualized Preoperative Estimation Method for the Linear Insertion Depth of Cochlear Implant Electrode Arrays Based on Computed Tomography. Ear Hear 2023; 44:1036-1042. [PMID: 36864593 DOI: 10.1097/aud.0000000000001346] [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: 03/04/2023]
Abstract
OBJECTIVES Cochlear implantation or auditory brainstem implantation is currently the only accepted method for improving severe or profound sensorineural hearing loss. The length of the electrodes implanted during cochlear implantation is closely related to the degree of hearing improvement of hearing after the surgery. We aimed to explore new methods to accurately estimate the electrode array (EA) linear insertion depth based on computed tomography (CT) images prior surgery, which could help surgeons select the appropriate EA length for each patient. DESIGN Previous studies estimated the linear insertion depth by measuring the length of the lateral wall of the cochlea rather than the electrode's path in the cochlea duct. Here, we determined the actual position of the EA on the CT image after cochlear surgery in order to predict the path of the EA, and the length of the predicted EA path was measured by the contouring technique (CoT) to estimate the linear insertion depth of the EA. Because CoT can only measure the length of the estimated EA path on a two-dimensional plane, we further modified the measurement by weighting the height of the cochlea and the length of the EA tail (the length of the last stimulating electrode to the end, which cannot be displayed on the CT image), which we termed the modified CoT + height + tail (MCHT) measurement. RESULTS Based on our established method, MCHT could reduce the error to the submillimeter range (0.67 ± 0.37 mm) when estimating the linear insertion depth of various kinds of EAs compared with the actual implant length. The correlation coefficient between the linear insertion depth as predicted by MCHT and the actual was 0.958. The linear insertion depth estimated by this method was more accurate than that estimated using the classical CoT technique ( R = 0.442) and using the modified Escudé's method ( R = 0.585). CONCLUSIONS MCHT is a method based on CT images that can accurately predict the linear insertion depth of cochlear implants preoperatively. This is the first report that we are aware of a method for predicting linear insertion depth before cochlear implantation with only submillimeter errors and that is tailored to different types of EAs.
Collapse
Affiliation(s)
- Gaogan Jia
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- These authors contributed equally to this work
| | - Zijun Song
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- These authors contributed equally to this work
| | - Lingjie Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
| | - Qiushi Sun
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Yaru Sheng
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yusu Ni
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
| | - Huawei Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, People's Republic of China
| | - Wenyan Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, People's Republic of China
| |
Collapse
|
29
|
Breitsprecher T, Mlynski R, Völter C, Van de Heyning P, Van Rompaey V, Dazert S, Weiss NM. Accuracy of Preoperative Cochlear Duct Length Estimation and Angular Insertion Depth Prediction. Otol Neurotol 2023; 44:e566-e571. [PMID: 37550888 DOI: 10.1097/mao.0000000000003956] [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: 08/09/2023]
Abstract
OBJECTIVE In cochlear implantation with flexible lateral wall electrodes, a cochlear coverage of 70% to 80% is assumed to yield an optimal speech perception. Therefore, fitting the cochlear implant (CI) to the patient's individual anatomy has gained importance in recent years. For these reasons, the optimal angular insertion depth (AID) has to be calculated before cochlear implantation. One CI manufacturer offers a software that allows to visualize the AID of different electrode arrays. Here, it is hypothesized that these preoperative AID models overestimate the postoperatively measured insertion angle. This study aims to investigate the agreement between preoperatively estimated and postoperatively measured AID. STUDY DESIGN Retrospective cross-sectional study. SETTING Single-center tertiary referral center. PATIENTS Patients undergoing cochlear implantation. INTERVENTION Preoperative and postoperative high-resolution computed tomography (HRCT). MAIN OUTCOME MEASURES The cochlear duct length was estimated by determining cochlear parameters ( A value and B value), and the AID for the chosen electrode was (i) estimated by elliptic circular approximation by the software and (ii) measured manually postoperatively by detecting the electrode contacts after insertion. RESULTS A total of 80 HRCT imaging data sets from 69 patients were analyzed. The mean preoperative AID estimation was 662.0° (standard deviation [SD], 61.5°), and the mean postoperatively measured AID was 583.9° (SD, 73.6°). In all cases (100%), preoperative AID estimation significantly overestimated the postoperative determined insertion angle (mean difference, 38.1°). A correcting factor of 5% on preoperative AID estimation dissolves these differences. CONCLUSIONS The use of an electrode visualization tool may lead to shorter electrode array choices because of an overestimation of the insertion angle. Applying a correction factor of 0.95 on preoperative AID estimation is recommended.
Collapse
Affiliation(s)
- Tabita Breitsprecher
- Department of Otorhinolaryngology–Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum,
Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner,” University Rostock, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology–Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum,
Germany
| | - Paul Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan Dazert
- Department of Otorhinolaryngology–Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum,
Germany
| | - Nora M Weiss
- Department of Otorhinolaryngology–Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital Bochum, Bochum,
Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- International Graduate School of Neuroscience (IGSN), Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
30
|
Yoshimura H, Watanabe K, Nishio SY, Takumi Y, Usami SI. Determining optimal cochlear implant electrode array with OTOPLAN. Acta Otolaryngol 2023; 143:748-752. [PMID: 37737708 DOI: 10.1080/00016489.2023.2256790] [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: 07/21/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND To achieve better speech performance following cochlear implantation (CI), measuring the patient's cochlear duct length (CDL) and determining the appropriate length of the CI array are important. OBJECTIVE To investigate the CDL in CI patients after using the OTOPLAN software preoperatively and compare the results of angular insertion depth (AID) estimation by OTOPLAN and postoperative radiography. MATERIALS AND METHODS The study included 105 Japanese CI patients with normal cochleae. We measured the CDL using OTOPLAN and the position of the tip channel of the electrode for each selected electrode array, and estimated the AID using the software. RESULTS The mean CDL was 35.1 ± 1.6 mm. Preoperatively, the mean estimated AID was 580.3 ± 57.8°. Postoperative radiography revealed a mean AID of 583.0 ± 56.7°, demonstrating a strong linear correlation between the two measurements (R2 = 0.635). CONCLUSION AND SIGNIFICANCE Our findings revealed that CDL varies widely, which is consistent with previous studies. To achieve better speech perception, surgeons should select the appropriate length of CI electrode array based on the individual's CDL. Preoperative measurement of each CDL by OTOPLAN, which is clinically feasible and comparable to postoperative evaluation, can be used to ensure selection of the appropriate electrode array length.
Collapse
Affiliation(s)
- Hidekane Yoshimura
- Department of Otorhinolaryngology - Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kizuki Watanabe
- Department of Otorhinolaryngology - Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ya Nishio
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yutaka Takumi
- Department of Otorhinolaryngology - Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
31
|
Távora-Vieira D, Voola M, Kuthubutheen J, Friedland P, Gibson D, Acharya A. Evaluation of the Performance of OTOPLAN-Based Cochlear Implant Electrode Array Selection: A Retrospective Study. J Pers Med 2023; 13:1276. [PMID: 37623526 PMCID: PMC10455663 DOI: 10.3390/jpm13081276] [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: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Otoplan is a surgical planning software designed to assist with cochlear implant surgery. One of its outputs is a recommendation of electrode array type based on imaging parameters. In this retrospective study, we evaluated the differences in auditory outcomes between patients who were implanted with arrays corresponding to those recommended by the Otoplan software versus those in which the array selection differed from the Otoplan recommendation. Pre-operative CT images from 114 patients were imported into the software, and array recommendations were generated. These were compared to the arrays which had actually been implanted during surgery, both in terms of array type and length. As recommended, 47% of patients received the same array, 34% received a shorter array, and 18% received a longer array. For reasons relating to structure and hearing preservation, 83% received the more flexible arrays. Those who received stiffer arrays had cochlear malformations or ossification. A negative, although non-statistically significant correlation was observed between the CNC scores at 12 months and the absolute value of the difference between recommended array and implanted array. In conclusion, clinicians may be slightly biased toward shorter electrode arrays due to their perceived greater ability to achieve full insertion. Using 3D imaging during the pre-operative planning may improve clinicians' confidence to implant longer electrode arrays, where appropriate, to achieve optimum hearing outcomes.
Collapse
Affiliation(s)
- Dayse Távora-Vieira
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Faculty of Health Sciences, School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Marcus Voola
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
| | - Jafri Kuthubutheen
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
| | - Peter Friedland
- Medical School, Division of Surgery, The University of Western Australia, Perth, WA 6010, Australia
- Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
| | - Daren Gibson
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Aanand Acharya
- Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| |
Collapse
|
32
|
Lindquist NR, Dietrich MS, Patro A, Henry MR, DeFreese AJ, Freeman MH, Perkins EL, Gifford RH, Haynes DS, Holder JT. Early Datalogging Predicts Cochlear Implant Performance: Building a Recommendation for Daily Device Usage. Otol Neurotol 2023; 44:e479-e485. [PMID: 37442607 PMCID: PMC10361622 DOI: 10.1097/mao.0000000000003917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To quantify the effect of datalogging on speech recognition scores and time to achievement for a "benchmark" level of performance within the first year, and to provide a data-driven recommendation for minimum daily cochlear implant (CI) device usage to better guide patient counseling and future outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Three hundred thirty-seven adult CI patients with data logging and speech recognition outcome data who were implanted between August 2015 and August 2020. MAIN OUTCOME MEASURES Processor datalogging, speech recognition scores, achievement of "benchmark speech recognition performance" defined as 80% of the median score for speech recognition outcomes at our institution. RESULTS The 1-month datalogging measure correlated positively with word and sentences scores at 1, 3, 6, and 12 months postactivation. Compared with age, sex, and preoperative performance, datalogging was the largest predictive factor of benchmark achievement on multivariate analysis. Each hour/day increase of device usage at 1 month resulted in a higher likelihood of achieving benchmark consonant-nucleus-consonant and AzBio scores within the first year (odds ratio = 1.21, p < 0.001) as well as earlier benchmark achievement. Receiver operating characteristic curve analysis identified the optimal data logging threshold at an average of 12 hours/day. CONCLUSIONS Early CI device usage, as measured by 1-month datalogging, predicts benchmark speech recognition achievement in adults. Datalogging is an important predictor of CI performance within the first year postimplantation. These data support the recommended daily CI processor utilization of at least 12 hours/day to achieve optimal speech recognition performance for most patients.
Collapse
Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine (Biostatistics, VICC, Psychiatry) and Nursing, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Henry
- Division of Audiology, Henry Ford Health, Dearborn, Michigan
| | - Andrea J DeFreese
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
33
|
Rader T, Schrank L, Spiegel JL, Nachtigäller P, Spiro JE, Hempel JM, Canis M, Müller J. [Speech perception as a function of cochlear coverage-comparison in bimodally hearing cochlear implant patients. German version]. HNO 2023:10.1007/s00106-023-01330-w. [PMID: 37450020 PMCID: PMC10403407 DOI: 10.1007/s00106-023-01330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Hearing success in bimodally hearing patients with a cochlear implant (CI) and a hearing aid (HA) exhibits different results: while some benefit from bimodal CI and HA, others do not. OBJECTIVE The aim of this study was to investigate hearing success in terms of speech perception in bimodally fitted patients in relation to the cochlear coverage (CC) of the CI electrodes. MATERIALS AND METHODS Using the OTOPLAN software (CAScination AG, Bern, Switzerland), CC was retrospectively measured from CT scans of the temporal bone of 39 patients, who were then categorized into two groups: CC ≤ 65% (CC500) and CC > 65% (CC600). Monaural speech intelligibility for monosyllables at a sound pressure level (SPL) of 65 dB in open field was assessed at various timepoints, preoperatively with HA and postoperatively with CI, and compared between the groups. In addition, speech intelligibility was correlated with CC in the entire cohort before surgery and during follow-up (FU). RESULTS Overall, no significant differences in speech intelligibility were found between CC500 and CC600 patients at any of the FU timepoints. However, both CC500 and CC600 patients showed a steady improvement in speech intelligibility after implantation. While CC600 patients tended to show an earlier improvement in speech intelligibility, CC500 patients tended to show a slower improvement during the first 3 months and a steeper learning curve thereafter. The two patient groups converged during FU, with no significant differences in speech intelligibility. There was no significant relationship between unimodal/unilateral free-field speech intelligibility and CC. However, patients with a CC of 70-75% achieved maximum speech intelligibility. CONCLUSION Despite a nonsignificant correlation between CC and speech discrimination, patients seem to reach their maximum in unimodal/unilateral speech understanding mainly at 70-75% coverage. However, there is room for further investigation, as CC500 was associated with a shorter cochlear duct length (CDL), and long and very long electrodes were used in both groups.
Collapse
Affiliation(s)
- Tobias Rader
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Leonhard Schrank
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Jennifer L Spiegel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Schwindel- und Gleichgewichtszentrum, LMU Klinikum der Universität München, München, Deutschland
| | - Pascal Nachtigäller
- Abteilung Audiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Judith E Spiro
- Klinik und Poliklinik für Radiologie, LMU Klinikum der Universität München, München, Deutschland
| | - John-Martin Hempel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
| | - Martin Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
| | - Joachim Müller
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum der Universität München, München, Deutschland
| |
Collapse
|
34
|
Weller T, Timm ME, Lenarz T, Büchner A. Cochlear coverage with lateral wall cochlear implant electrode arrays affects post-operative speech recognition. PLoS One 2023; 18:e0287450. [PMID: 37437046 DOI: 10.1371/journal.pone.0287450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The goal was to investigate the relationship between the insertion angle/cochlear coverage of cochlear implant electrode arrays and post-operative speech recognition scores in a large cohort of patients implanted with lateral wall electrode arrays. METHODS Pre- and post-operative cone beam computed tomography scans of 154 ears implanted with lateral wall electrode arrays were evaluated. Traces of lateral wall and electrode arrays were combined into a virtual reconstruction of the implanted cochlea. This reconstruction was used to measure insertion angles and proportional cochlear coverage. Word recognition scores and sentence recognition scores measured 12 months after implantation using electric-only stimulation were used to examine the relationship between cochlear coverage/insertion angle and implantation outcomes. RESULTS Post-operative word recognition scores and the difference between post- and pre-operative word recognition scores were positively correlated with both cochlear coverage and insertion angle, however sentence recognition scores were not. A group-wise comparison of word recognition scores revealed that patients with cochlear coverage below 70% performed significantly worse than patients with coverage between 79%-82% (p = 0.003). Performance of patients with coverage above 82% was on average poorer than between 79%-82, although this finding was not statistically significant (p = 0.84). Dividing the cohort into groups based on insertion angle quadrants revealed that word recognition scores were highest above 450° insertion angle, sentence recognition scores were highest between 450° and 630° and the difference between pre- and post-operative word recognition scores was largest between 540° and 630°, however none of these differences reached statistical significance. CONCLUSIONS The results of this study show that cochlear coverage has an effect on post-operative word recognition abilities and the benefit patients receive from their implant. Generally, higher coverage led to better outcomes, however there were results indicating that insertion past 82% cochlear coverage may not provide an additional benefit for word recognition. These findings can be useful for choosing the optimal electrode array and thereby improving cochlear implantation outcomes on a patient-individual basis.
Collapse
Affiliation(s)
- Tobias Weller
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| |
Collapse
|
35
|
Banalagay RA, Labadie RF, Noble JH. Validation of active shape model techniques for intracochlear anatomy segmentation in computed tomography images. J Med Imaging (Bellingham) 2023; 10:044003. [PMID: 37476645 PMCID: PMC10355218 DOI: 10.1117/1.jmi.10.4.044003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Purpose Cochlear implants (CIs) have been shown to be highly effective restorative devices for patients suffering from severe-to-profound hearing loss. Hearing outcomes with CIs depend on electrode positions with respect to intracochlear anatomy. Intracochlear anatomy can only be directly visualized using high-resolution modalities, such as micro-computed tomography (μ CT ), which cannot be used in vivo. However, active shape models (ASM) have been shown to be robust and effective for segmenting intracochlear anatomy in large scale datasets of patient computed tomographies (CTs). We present an extended dataset of μ CT specimens and aim to evaluate the ASM's performance more comprehensively than has been previously possible. Approach Using a dataset of 16 manually segmented cochlea specimens on μ CTs , we found parameters that optimize mean CT segmentation performance and then evaluate the effect of library size on the ASM. The optimized ASM was further evaluated on a clinical dataset of 134 CT images to assess method reliability. Results Optimized parameters lead to mean CT segmentation performance to 0.36 mm point-to-point error, 0.10 mm surface error, and 0.83 Dice score. Larger library sizes provide diminishing returns on segmentation performance and total variance captured by the ASM. We found our method to be clinically reliable with the main performance limitation that was found to be the candidate search process rather than model representation. Conclusions We have presented a comprehensive validation of the ASM for use in intracochlear anatomy segmentation. These results are critical to understand the limitations of the method for clinical use and for future development.
Collapse
Affiliation(s)
- Rueben A. Banalagay
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| | - Robert F. Labadie
- Medical University of South Carolina, Department of Otolaryngology—Head & Neck Surgery, Charleston, South Carolina, United States
| | - Jack H. Noble
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| |
Collapse
|
36
|
Berg KA, Chen C, Noble JH, Dawant BM, Dwyer RT, Labadie RF, Gifford RH. Effects of the Number of Channels and Channel Stimulation Rate on Speech Recognition and Sound Quality Using Precurved Electrode Arrays. Am J Audiol 2023; 32:403-416. [PMID: 37249492 PMCID: PMC10468116 DOI: 10.1044/2023_aja-22-00032] [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] [Received: 02/04/2022] [Revised: 06/16/2022] [Accepted: 02/05/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE This study investigated the relationship between the number of active electrodes, channel stimulation rate, and their interaction on speech recognition and sound quality measures while controlling for electrode placement. Cochlear implant (CI) recipients with precurved electrode arrays placed entirely within scala tympani and closer to the modiolus were hypothesized to be able to utilize more channels and possibly higher stimulation rates to achieve better speech recognition performance and sound quality ratings than recipients in previous studies. METHOD Participants included seven postlingually deafened adult CI recipients with Advanced Bionics Mid-Scala electrode arrays confirmed to be entirely within scala tympani using postoperative computerized tomography. Twelve conditions were tested using four, eight, 12, and 16 electrodes and channel stimulation rates of 600 pulse per second (pps), 1,200 pps, and each participant's maximum allowable rate (1,245-4,800 pps). Measures of speech recognition and sound quality were acutely assessed. RESULTS For the effect of channels, results showed no significant improvements beyond eight channels for all measures. For the effect of channel stimulation rate, results showed no significant improvements with higher rates, suggesting that 600 pps was sufficient for maximum speech recognition performance and sound quality ratings. However, across all conditions, there was a significant relationship between mean electrode-to-modiolus distance and all measures, suggesting that a lower mean electrode-to-modiolus distance was correlated with higher speech recognition scores and sound quality ratings. CONCLUSION These findings suggest that even well-placed precurved electrode array recipients may not be able to take advantage of more than eight channels or higher channel stimulation rates (> 600 pps), but that closer electrode array placement to the modiolus correlates with better outcomes for these recipients.
Collapse
Affiliation(s)
- Katelyn A. Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Chen Chen
- Research and Technology, Advanced Bionics, LLC, Valencia, CA
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN
| | - Benoit M. Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN
| | - Robert T. Dwyer
- Research and Technology, Advanced Bionics, LLC, Valencia, CA
| | - Robert F. Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - René H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
37
|
Paouris D, Kunzo S, Goljerová I. Validation of Automatic Cochlear Measurements Using OTOPLAN ® Software. J Pers Med 2023; 13:jpm13050805. [PMID: 37240975 DOI: 10.3390/jpm13050805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Electrode length selection based on case-related cochlear parameters is becoming a standard pre-operative step for cochlear implantation. The manual measurement of the parameters is often time-consuming and may lead to inconsistencies. Our work aimed to evaluate a novel, automatic measurement method. MATERIALS AND METHODS A retrospective evaluation of pre-operative HRCT images of 109 ears (56 patients) was conducted, using a development version of the OTOPLAN® software. Inter-rater (intraclass) reliability and execution time were assessed for manual (surgeons R1 and R2) vs. automatic (AUTO) results. The analysis included A-Value (Diameter), B-Value (Width), H-Value (Height), and CDLOC-length (Cochlear Duct Length at Organ of Corti/Basilar membrane). RESULTS The measurement time was reduced from approximately 7 min ± 2 (min) (manual) to 1 min (AUTO). Cochlear parameters in mm (mean ± SD) for R1, R2 and AUTO, respectively, were A-value: 9.00 ± 0.40, 8.98 ± 0.40 and 9.16 ± 0.36; B-value: 6.81 ± 0.34, 6.71 ± 0.35 and 6.70 ± 0.40; H-value: 3.98 ± 0.25, 3.85 ± 0.25 and 3.76 ± 0.22; and the mean CDLoc-length: 35.64 ± 1.70, 35.20 ± 1.71 and 35.47 ± 1.87. AUTO CDLOC measurements were not significantly different compared to R1 and R2 (H0: Rx CDLOC = AUTO CDLOC: p = 0.831, p = 0.242, respectively), and the calculated intraclass correlation coefficient (ICC) for CDLOC was 0.9 (95% CI: 0.85, 0.932) for R1 vs. AUTO; 0.90 (95% CI: 0.85, 0.932) for R2 vs. AUTO; and 0.893 (95% CI: 0.809, 0.935) for R1 vs. R2. CONCLUSIONS We observed excellent inter-rater reliability, a high agreement of outcomes, and reduced execution time using the AUTO method.
Collapse
Affiliation(s)
- Dimitrios Paouris
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
| | - Samuel Kunzo
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
| | - Irina Goljerová
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
| |
Collapse
|
38
|
Müller-Graff FT, Voelker J, Kurz A, Hagen R, Neun T, Rak K. Accuracy of radiological prediction of electrode position with otological planning software and implications of high-resolution imaging. Cochlear Implants Int 2023; 24:144-154. [PMID: 36617441 DOI: 10.1080/14670100.2022.2159128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In cochlear implantation, preoperative prediction of electrode position has recently gained increasing attention. Currently, planning is usually done by multislice CT (MSCT). However, flat-panel volume CT (fpVCT) and its secondary reconstructions (fpVCTSECO) allow for more precise visualization of the cochlea. Combined with a newly developed otological planning software, the position of every single contact can be effectively predicted. In this study it was investigated how accurately radiological prediction forecasts the postoperative electrode localization and whether higher image resolution is advantageous. METHODS Utilizing otological planning software (OTOPLAN®) and different clinical imaging modalities (MSCT, fpVCT and fpVCTSECO) the electrode localization [angular insertion depth (AID)] and respective contact frequencies were predicted preoperatively and examined postoperatively. Furthermore, inter-electrode-distance (IED) and inter-electrode-frequency difference (IEFD) were evaluated postoperatively. RESULTS Measurements revealed a preoperative overestimation of AID. Corresponding frequencies were also miscalculated. Determination of IED and IEFD revealed discrepancies at the transition from the basal to the middle turn and round window to the basal turn. All predictions and discrepancies were lowest when using fpVCTSECO. CONCLUSION The postoperative electrode position can be predicted quite accurately using otological planning software. However, because of several potential misjudgments, high-resolution imaging, such as offered by fpVCTSECO, should be used pre- and postoperatively.
Collapse
Affiliation(s)
- Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Anja Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
39
|
Castle N, Liang J, Smith M, Petersen B, Matson C, Eldridge T, Zhang K, Lee CH, Liu Y, Dai C. Finite Element Modeling of Residual Hearing after Cochlear Implant Surgery in Chinchillas. Bioengineering (Basel) 2023; 10:bioengineering10050539. [PMID: 37237608 DOI: 10.3390/bioengineering10050539] [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: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Cochlear implant (CI) surgery is one of the most utilized treatments for severe hearing loss. However, the effects of a successful scala tympani insertion on the mechanics of hearing are not yet fully understood. This paper presents a finite element (FE) model of the chinchilla inner ear for studying the interrelationship between the mechanical function and the insertion angle of a CI electrode. This FE model includes a three-chambered cochlea and full vestibular system, accomplished using µ-MRI and µ-CT scanning technologies. This model's first application found minimal loss of residual hearing due to insertion angle after CI surgery, and this indicates that it is a reliable and helpful tool for future applications in CI design, surgical planning, and stimuli setup.
Collapse
Affiliation(s)
- Nicholas Castle
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Junfeng Liang
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Matthew Smith
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Brett Petersen
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Cayman Matson
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Tara Eldridge
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Ke Zhang
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Chung-Hao Lee
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Yingtao Liu
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Chenkai Dai
- Department of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| |
Collapse
|
40
|
Kirk JR, Smyth D, Dueck WF. A new paradigm of hearing loss and preservation with cochlear implants: Learnings from fundamental studies and clinical research. Hear Res 2023; 433:108769. [PMID: 37120894 DOI: 10.1016/j.heares.2023.108769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 02/18/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
In 2010 Cochlear initiated a coordinated preclinical research program to identify the factors and underlying mechanisms of acoustic hearing loss following cochlear implantation and device use. At its inception the program was structured around several major hypotheses implicated in the loss of acoustic hearing. The understanding of causes evolved over the course of the program, leading to an increased appreciation of the role of the biological response in post-implant hearing loss. A systematic approach was developed which mapped the cochlear implant journey along a timeline that considers all events in an individual's hearing history. By evaluating the available data in this context, rather than by discrete hypothesis testing, causative and associated factors may be more readily detected. This approach presents opportunities for more effective research management and may aid in identifying new prospects for intervention. Many of the outcomes of the research program apply beyond preservation of acoustic hearing to factors important to overall cochlear health and considerations for future therapies.
Collapse
Affiliation(s)
- Jonathon R Kirk
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia.
| | - Daniel Smyth
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia
| | - Wolfram F Dueck
- Cochlear Limited, 1 University Avenue, Macquarie University, NSW 2109, Australia
| |
Collapse
|
41
|
Thomas JP, Klein H, Haubitz I, Dazert S, Völter C. Intra- and Interrater Reliability of CT- versus MRI-Based Cochlear Duct Length Measurement in Pediatric Cochlear Implant Candidates and Its Impact on Personalized Electrode Array Selection. J Pers Med 2023; 13:jpm13040633. [PMID: 37109019 PMCID: PMC10142378 DOI: 10.3390/jpm13040633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Background: Radiological high-resolution computed tomography-based evaluation of cochlear implant candidates’ cochlear duct length (CDL) has become the method of choice for electrode array selection. The aim of the present study was to evaluate if MRI-based data match CT-based data and if this impacts on electrode array choice. Methods: Participants were 39 children. CDL, length at two turns, diameters, and height of the cochlea were determined via CT and MRI by three raters using tablet-based otosurgical planning software. Personalized electrode array length, angular insertion depth (AID), intra- and interrater differences, and reliability were calculated. Results: Mean intrarater difference of CT- versus MRI-based CDL was 0.528 ± 0.483 mm without significant differences. Individual length at two turns differed between 28.0 mm and 36.6 mm. Intrarater reliability between CT versus MRI measurements was high (intra-class correlation coefficient (ICC): 0.929–0.938). Selection of the optimal electrode array based on CT and MRI matched in 90.1% of cases. Mean AID was 629.5° based on the CT and 634.6° based on the MRI; this is not a significant difference. ICC of the mean interrater reliability was 0.887 for the CT-based evaluation and 0.82 for the MRI-based evaluation. Conclusion: MRI-based CDL measurement shows a low intrarater difference and a high interrater reliability and is therefore suitable for personalized electrode array selection.
Collapse
Affiliation(s)
- Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Johannes Hospital, Cath. St. Paulus Society, Academic Teaching Hospital of the University of Münster, Johannesstr. 9-17, 44137 Dortmund, Germany
| | - Hannah Klein
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Imme Haubitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787 Bochum, Germany
| |
Collapse
|
42
|
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
|
43
|
Smetak MR, Fernando SJ, O'Malley MR, Bennett ML, Haynes DS, Wootten CT, Virgin FW, Dwyer RT, Dawant BM, Noble JH, Labadie RF. Electrode array positioning after cochlear reimplantation from single manufacturer. Cochlear Implants Int 2023. [PMID: 37489512 PMCID: PMC10372339 DOI: 10.1080/14670100.2023.2179756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To investigate whether revision surgery with the same device results in a change in three key indicators of electrode positioning: scalar location, mean modiolar distance (M¯), and angular insertion depth (AID). METHODS Retrospective analysis of a cochlear implant database at a university-based tertiary medical center. Intra-operative CT scans were obtained after initial and revision implantation. Electrode array (EA) position was calculated using auto-segmentation techniques. Initial and revision scalar location, M¯, and AID were compared. RESULTS Mean change in M¯ for all ears was -0.07 mm (SD 0.24 mm; P = 0.16). The mean change in AID for all ears was -5° (SD 67°; P = 0.72). Three initial implantations with pre-curved EAs resulted in a translocation from Scala Tympani (ST) to Scala Vestibuli (SV). Two remained translocated after revision, while one was corrected when revised with a straight EA. An additional five translocations occurred after revision. CONCLUSIONS In this study examining revision cochlear implantation from a single manufacturer, we demonstrated no significant change in key indicators of EA positioning, even when revising with a different style of electrode. However, the revision EA is not necessarily confined by the initial trajectory and there may be an increased risk of translocation.
Collapse
Affiliation(s)
- Miriam R. Smetak
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Shanik J. Fernando
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Matthew R. O'Malley
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Marc L. Bennett
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - David S. Haynes
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Christopher T. Wootten
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Frank W. Virgin
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Robert T. Dwyer
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Benoit M. Dawant
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Jack H. Noble
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Robert F. Labadie
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| |
Collapse
|
44
|
Summating Potential as Marker of Intracochlear Position in Bipolar Electrocochleography. Ear Hear 2023; 44:118-134. [PMID: 35894668 DOI: 10.1097/aud.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cochlear implantation criteria include subjects with residual low-frequency hearing. To minimize implantation trauma and to avoid unwanted interactions of electric- and acoustic stimuli, it is often recommended to stop cochlear implantation before the cochlear implant (CI) reaches the cochlear partition with residual hearing, as determined by an audiogram. For this purpose, the implant can be used to record acoustically evoked signals during implantation, including cochlear compound action potentials (CAP), cochlear microphonics (CMs), and summating potentials (SPs). The former two have previously been used to monitor residual hearing in clinical settings. DESIGN In the present study we investigated the use of intracochlear, bipolar SP recordings to determine the exact cochlear position of the contacts of implanted CIs in guinea pig cochleae (n = 13). Polarity reversals of SPs were used as a functional marker of intracochlear position. Micro computed tomography (µCT) imaging and a modified Greenwood function were used to determine the cochleotopic positions of the contacts in the cochlea. These anatomical reconstructions were used to validate the SP-based position estimates. RESULTS The precision of the SP-based position estimation was on average within ± 0.37 octaves and was not impaired by moderate hearing loss caused by noise exposure after implantation. It is important to note that acute hearing impairment did not reduce the precision of the method. The cochleotopic position of CI accounted for ~70% of the variability of SP polarity reversals. Outliers in the dataset were associated with lateral CI positions. Last, we propose a simplified method to avoid implantation in functioning parts of the cochlea by approaching a predefined frequency region using bipolar SP recordings through a CI. CONCLUSIONS Bipolar SP recordings provide reliable information on electrode position in the cochlea. The position estimate remains reliable after moderate hearing loss. The technique presented here could be applied during CI surgery to monitor the CI approach to a predefined frequency region.
Collapse
|
45
|
Dutt SN, Gaur SK, Vadlamani S, Nandikur S. Evolving a Radiological Protocol for Cochlear Duct Length Measurement: Three Audit Cycles. Indian J Otolaryngol Head Neck Surg 2022; 74:3998-4006. [PMID: 36742472 PMCID: PMC9895517 DOI: 10.1007/s12070-021-02774-8] [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: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023] Open
Abstract
To develop an accurate protocol for measuring the Cochlear Duct Length (CDL) by using Multi Detector Computerized Tomography (MDCT) imaging of the temporal bones and thereby make the appropriate choice of electrode for cochlear implantation. 79 MED-EL® Cochlear implantees were divided into three cohorts in chronological order of their implantation. CDL was calculated from MDCT images and correlated with the CDL calculated using the existing Jolly's formula. Results of the CDL measured by unfurling the cochlea correlated well with the existing formula. In addition to CDL measurement, measuring diameter of each turn, especially the apical turn, helped in choosing the appropriate electrode for complete cochlear coverage. Having dedicated radiographers and neuro-radiologists can avoid inter-observer variations in CDL measurements. Measuring the CDL and the diameter of each turn helps in choosing an appropriate electrode thus minimizing intra-operative difficulties and achieving complete safe insertion.
Collapse
Affiliation(s)
- Sunil Narayan Dutt
- Department of Otorhinolaryngology, Head and Neck Surgery, Apollo Hospitals, 154/11, Bannerghatta Road, Opposite IIM, Bangalore, 560076 India
| | - Sumit Kumar Gaur
- Department of Otorhinolaryngology, Head and Neck Surgery, Apollo Hospitals, 154/11, Bannerghatta Road, Opposite IIM, Bangalore, 560076 India
| | - Swathi Vadlamani
- Department of Otorhinolaryngology, Head and Neck Surgery, Apollo Hospitals, 154/11, Bannerghatta Road, Opposite IIM, Bangalore, 560076 India
| | | |
Collapse
|
46
|
Chen YS, Cabrera E, Tucker BJ, Shin TJ, Moawad JV, Totten DJ, Booth KT, Nelson RF. TMPRSS3 expression is limited in spiral ganglion neurons: implication for successful cochlear implantation. J Med Genet 2022; 59:1219-1226. [PMID: 35961784 DOI: 10.1136/jmg-2022-108654] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is well established that biallelic mutations in transmembrane protease, serine 3 (TMPRSS3) cause hearing loss. Currently, there is controversy regarding the audiological outcomes after cochlear implantation (CI) for TMPRSS3-associated hearing loss. This controversy creates confusion among healthcare providers regarding the best treatment options for individuals with TMPRSS3-related hearing loss. METHODS A literature review was performed to identify all published cases of patients with TMPRSS3-associated hearing loss who received a CI. CI outcomes of this cohort were compared with published adult CI cohorts using postoperative consonant-nucleus-consonant (CNC) word performance. TMPRSS3 expression in mouse cochlea and human auditory nerves (HAN) was determined by using hybridisation chain reaction and single-cell RNA-sequencing analysis. RESULTS In aggregate, 27 patients (30 total CI ears) with TMPRSS3-associated hearing loss treated with CI, and 85% of patients reported favourable outcomes. Postoperative CNC word scores in patients with TMPRSS3-associated hearing loss were not significantly different than those seen in adult CI cohorts (8 studies). Robust Tmprss3 expression occurs throughout the mouse organ of Corti, the spindle and root cells of the lateral wall and faint staining within <5% of the HAN, representing type II spiral ganglion neurons. Adult HAN express negligible levels of TMPRSS3. CONCLUSION The clinical features after CI and physiological expression of TMPRSS3 suggest against a major role of TMPRSS3 in auditory neurons.
Collapse
Affiliation(s)
- Yuan-Siao Chen
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ernesto Cabrera
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brady J Tucker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy J Shin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jasmine V Moawad
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas J Totten
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kevin T Booth
- Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
- Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
47
|
Association between lateral wall electrode array insertion parameters and audiological outcomes in bilateral cochlear implantation. Eur Arch Otorhinolaryngol 2022; 280:2707-2714. [PMID: 36436080 PMCID: PMC10175364 DOI: 10.1007/s00405-022-07756-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/15/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
The aims of this study were to compare speech recognition at different postoperative times for both ears in bilaterally implanted patients and to assess the influence of the time of deafness, frequency-to-place mismatch, angular insertion depth (AID) and angular separation between neighbouring electrode contacts on audiometric outcomes.
Methods
This study was performed at an academic tertiary referral centre. A total of 19 adult patients (6 men, 13 women), who received sequential bilateral implantation with lateral wall electrode arrays, were analysed in retrospective. Statistical analysis was performed using two-sided t test, Wilcoxon test, median test, and Spearman’s correlation.
Results
Postlingually deafened patients (deafness after the age of 10) had a significantly better speech perception (WRS65[CI]) than the perilingually deafened subjects (deafness at the age of 1–10 years) (p < 0.001). Comparison of cochlear duct length between peri- and postlingually deafened subjects showed a slightly significantly smaller cochleae in perilingual patients (p = 0.045). No association between frequency-to-place mismatch as well as angular separation and speech perception could be detected. There was even no significant difference between the both ears in the intraindividual comparison, even if insertion parameters differed.
Conclusion
The exact electrode position seems to have less influence on the speech comprehension of CI patients than already established parameters as preoperative speech recognition or duration of deafness.
Collapse
|
48
|
Bratu EL, Sunderhaus LW, Berg KA, Dwyer RT, Labadie RF, Gifford RH, Noble JH. Activation region overlap visualization for image-guided cochlear implant programming. Biomed Phys Eng Express 2022; 9:10.1088/2057-1976/ac9aba. [PMID: 36594887 PMCID: PMC10072294 DOI: 10.1088/2057-1976/ac9aba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
Objective. The cochlear implant is a neural prosthesis designed to directly stimulate auditory nerve fibers to induce the sensation of hearing in those experiencing severe-to-profound hearing loss. After surgical implantation, audiologists program the implant's external processor with settings intended to produce optimal hearing outcomes. The likelihood of achieving optimal outcomes increases when audiologists have access to tools that objectively present information related to the patient's own anatomy and surgical outcomes. This includes visualizations like the one presented here, termed the activation region overlap image, which is designed to decrease subjectivity when determining amounts of overlapping stimulation between implant electrodes.Approach. This visualization uses estimates of electric field strength to indicate spread of neural excitation due to each electrode. Unlike prior visualizations, this method explicitly defines regions of nerves receiving substantial stimulation from each electrode to help clinicians assess the presence of significant overlapping stimulation. A multi-reviewer study compared this and an existing technique on the consistency, efficiency, and optimality of plans generated from each method. Statistical significance was evaluated using the two-sided Wilcoxon rank sum test.Main results. The study showed statistically significant improvements in consistency (p < 10-12), efficiency (p < 10-15), and optimality (p < 10-5) when generating plans using the proposed method versus the existing method.Significance. This visualization addresses subjectivity in assessing overlapping stimulation between implant electrodes, which currently relies on reviewer estimates. The results of the evaluation indicate the provision of such objective information during programming sessions would likely benefit clinicians in making programming decisions.
Collapse
Affiliation(s)
- Erin L. Bratu
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, TN, USA
| | - Linsey W. Sunderhaus
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
| | - Katelyn A. Berg
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
| | - Robert T. Dwyer
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
| | - Robert F. Labadie
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
| | - René H. Gifford
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
| | - Jack H. Noble
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, TN, USA
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences, Nashville, TN, USA
- Vanderbilt University Medical Center, Department of Otolaryngology – Head & Neck Surgery, Nashville, TN, USA
| |
Collapse
|
49
|
Munhall CC, Noble JH, Dawant B, Labadie RF. Cochlear Implant Translocation: Diagnosis, Prevention, and Clinical Implications. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
50
|
Alshalan A, Abdelsamad Y, Assiri M, Alsanosi A. Cochlear Implantation: The Variation in Cochlear Height. EAR, NOSE & THROAT JOURNAL 2022:1455613221134860. [PMID: 36251258 DOI: 10.1177/01455613221134860] [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: 11/16/2022] Open
Abstract
This study aimed to identify the association between different cochlear metrics, including the basal turn diameter (A-value), the basal turn width (B-value), and the height of the cochlea (H-value). We also reported an association between H-value and hearing outcomes with cochlear implants (CI). This is a retrospective study that included all patients who underwent CI procedures between 2012 and 2018 at a tertiary center and have; preoperative high-resolution computed tomography (CT), normal cochlea, postoperative follow-up duration of at least 2 years, scores of the category auditory performance II (CAP-II), and speech intelligibility rating (SIR) scales. A total of 65 ears implanted with CI in 46 patients (24 boys and 20 girls; mean age of 7 (±10) years) fulfilled the inclusion criteria. We found significant positive correlations between A vs B, A vs H, and B vs H (P-value = 0.008, 0.018, and 0.0039, respectively). We also found a significant positive relationship between A, B, and H values and cochlear duct length (CDL) (P-value < 0.0001, 0.008, and 0.018, respectively). Finally, the H-value was significantly correlated with the SIR (P-value = 0.027). However, its correlation with the CAP score was not statistically significant (P-value = 0.62). Cochlear height significantly correlated with CDL and the other cochlear parameters. The variation in cochlear height can also affect speech outcomes in patients undergoing CI. Therefore, the H-value together with the other cochlear metrics should be adequately assessed preoperatively in CI patients.
Collapse
Affiliation(s)
- Afrah Alshalan
- Department of Otolaryngology, Neurotology & Lateral Skull Base Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | | | - Majed Assiri
- Department of Otolaryngology, Neurotology & Lateral Skull Base Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|