1
|
Alzhrani F, Aljazeeri I, Abdelsamad Y, Alsanosi A, Kim AH, Ramos-Macias A, Ramos-de-Miguel A, Kurz A, Lorens A, Gantz B, Buchman CA, Távora-Vieira D, Sprinzl G, Mertens G, Saunders JE, Kosaner J, Telmesani LM, Lassaletta L, Bance M, Yousef M, Holcomb MA, Adunka O, Thomasen PC, Skarzynski PH, Rajeswaran R, Briggs RJ, Oh SH, Plontke S, O'Leary SJ, Agrawal S, Yamasoba T, Lenarz T, Wesarg T, Kutz W, Connolly P, Anderson I, Hagr A. International Consensus Statements on Intraoperative Testing for Cochlear Implantation Surgery. Ear Hear 2024:00003446-990000000-00303. [PMID: 38915137 DOI: 10.1097/aud.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVES A wide variety of intraoperative tests are available in cochlear implantation. However, no consensus exists on which tests constitute the minimum necessary battery. We assembled an international panel of clinical experts to develop, refine, and vote upon a set of core consensus statements. DESIGN A literature review was used to identify intraoperative tests currently used in the field and draft a set of provisional statements. For statement evaluation and refinement, we used a modified Delphi consensus panel structure. Multiple interactive rounds of voting, evaluation, and feedback were conducted to achieve convergence. RESULTS Twenty-nine provisional statements were included in the original draft. In the first voting round, consensus was reached on 15 statements. Of the 14 statements that did not reach consensus, 12 were revised based on feedback provided by the expert practitioners, and 2 were eliminated. In the second voting round, 10 of the 12 revised statements reached a consensus. The two statements which did not achieve consensus were further revised and subjected to a third voting round. However, both statements failed to achieve consensus in the third round. In addition, during the final revision, one more statement was decided to be deleted due to overlap with another modified statement. CONCLUSIONS A final core set of 24 consensus statements was generated, covering wide areas of intraoperative testing during CI surgery. These statements may provide utility as evidence-based guidelines to improve quality and achieve uniformity of surgical practice.
Collapse
Affiliation(s)
- Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Isra Aljazeeri
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Aljaber Ophthalmology and Otolaryngology Specialized Hospital, Ministry of Health, Ahsa, Saudi Arabia
- Isra Aljazeeri shared first author
| | - Yassin Abdelsamad
- Research Department, Research Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | - Angel Ramos-Macias
- Department of Otolaryngology and Head and Neck Surgery, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Angel Ramos-de-Miguel
- Department of Otolaryngology and Head and Neck Surgery, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Anja Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center, Würzburg, Germany
| | - Artur Lorens
- Word Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
| | - Bruce Gantz
- Department of Otolaryngology-Head and Neck Surgery/Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa, USA
| | - Craig A Buchman
- Department of Otolaryngology-Head & Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dayse Távora-Vieira
- Division of Surgery, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Department of Audiology, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Georg Sprinzl
- Department of Otorhinolaryngology, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, St. Poelten, Austria
| | - Griet Mertens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Antwerp, Belgium
| | - James E Saunders
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, New Hampshire, USA
| | - Julie Kosaner
- Meders Speech and Hearing Clinic, Meders İşitme ve Konuşma Merkezi, İstanbul, Turkey
| | - Laila M Telmesani
- Department of Otolaryngology/Head and Neck Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Luis Lassaletta
- Department of Otorhinolaryngology, Hospital La Paz, IdiPAZ Research Institute, Madrid, Spain
- Biomedical Research Networking Centre on Rare Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
| | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Audiology Unit, ENT Department, Menoufia University, Menoufia, Egypt
| | - Meredith A Holcomb
- Hearing Implant Program, Department of Otolaryngology, University of Miami, Miami, Florida, USA
| | - Oliver Adunka
- Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Per Cayé- Thomasen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Denmark
| | - Piotr H Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Faculty of Dental Medicine, Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Nadarzyn/Kajetany, Poland
- Center of Hearing and Speech "Medincus," Nadarzyn/Kajetany, Poland
| | - Ranjith Rajeswaran
- Madras ENT Research Foundation MERF Institute of Speech and Hearing, Chennai, India
| | - Robert J Briggs
- Department of Surgery, Otolaryngology, The University of Melbourne, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Seung-Ha Oh
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Stefan Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery; Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephen J O'Leary
- Department of Surgery, Otolaryngology, The University of Melbourne, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Tatsuya Yamasoba
- Tokyo Teishin Hospital, Tokyo, Japan
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
| | - Thomas Wesarg
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Walter Kutz
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patrick Connolly
- Clinical Research Department, MED-EL GmbH, Innsbruck, Austria; and
| | - Ilona Anderson
- Clinical Research Department, MED-EL GmbH, Innsbruck, Austria; and
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
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
|
3
|
Beck R, Aschendorff A, Arndt S, Hildenbrand T, Rauch AK, Ketterer MC. Evaluation of insertion quality of a slim perimodiolar electrode array. Eur Arch Otorhinolaryngol 2024; 281:1215-1220. [PMID: 37773530 PMCID: PMC10858093 DOI: 10.1007/s00405-023-08212-5] [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: 05/30/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The influence of cochlear morphology and electrode array design on scalar position and dislocation rates is of great interest in CI surgery. The aim of this study is to evaluate scalar position and specific points of dislocation in relation to cochlear morphology in patients implanted with a new slim perimodiolar electrode array. MATERIALS AND METHODS Patients were implanted using the slim modiolar electrode array (= SMA) (= 532/632 electrode array of Cochlear™). Postoperative imaging was performed via cone beam computed tomography (CBCT) and the scans were analyzed regarding cochlear morphology (distances A and B and cochlear height), scalar location of the electrode array, basal insertion depth and apical insertion angle. Furthermore, electrode array design and surgical protocols were evaluated. RESULTS 81 ears implanted with the SMA were retrospectively included. We evaluated 3 electrode array tip fold over intraoperatively via X-ray imaging and performed revision during the same surgery. The CBCT scans showed 76 initial scala tympani (ST) insertions without dislocation. Two ears showed a dislocated array, one at 77° and the other at 163°. Three arrays were inserted into scala vestibuli (SV) via cochleostomy. These patients showed no signs of obliteration. Cochlear morphology showed no influence on angular insertion depth and scalar position. CONCLUSIONS The SMA showed a very low rate of scalar dislocations due to its slim electrode array design (2.7%). We could find a learning curve regarding the handling and the risk of dislocation and tip fold over with this electrode array. The rate of intraoperative tip fold over detection via X-ray imaging was 3.7%. Therefore, we highly recommend X-ray imaging and transimpedance matrix measurements within the surgery protocol. Scala vestibuli insertions happened in patients with cochleostomy only. We could identify two specific points of dislocation depending on electrode array design.
Collapse
Affiliation(s)
- R Beck
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Aschendorff
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - S Arndt
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - T Hildenbrand
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A K Rauch
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - M C Ketterer
- Faculty of Medicine, Department of Otorhinolaryngology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
| |
Collapse
|
4
|
Inoue T, Tona Y, Okano T, Omori K, Yamamoto N. Detection of Tip Fold-Over of the Slim Modiolar Electrode Using Intraoperative Mobile Cone-Beam Computed Tomography. Otolaryngol Head Neck Surg 2023. [PMID: 36939567 DOI: 10.1002/ohn.240] [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: 09/23/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study aimed to evaluate the importance of mobile cone-beam computed tomography in detecting tip fold-over of a slim modiolar electrode within the cochlea during surgery. STUDY DESIGN Retrospective case review. SETTING Tertiary medical center. METHODS From January 2020 to June 2022, 33 ears of 30 patients with normal cochlear morphology underwent cochlear implantation with slim modiolar electrodes and intraoperative mobile cone-beam computed tomography imaging. Furthermore, we retrospectively reviewed the medical records and images. RESULTS The tip fold-over of the electrodes was detected using mobile cone-beam computed tomography in 3 out of 33 ears (9.1%). We could not identify the tip fold-over by scouting plain X-ray images in 2 out of 3 cases before taking the cone-beam computed tomography images. Electrode removal and reinsertion were performed before wound closure and the successful reinsertion was confirmed by mobile cone-beam computed tomography. The folded electrode tips were located at 238.8°, 152°, and 185.8°. CONCLUSION Intraoperative mobile cone-beam computed tomography is useful in detecting the tip fold-over of the slim modiolar electrodes during surgery. Therefore, it was possible to reinsert the electrodes in all cases before closing the wound, eliminating the need for revision surgeries. Moreover, the analysis of mobile cone-beam computed tomography images may help to elucidate the mechanisms of electrode tip fold-over.
Collapse
Affiliation(s)
- Taishi Inoue
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yosuke Tona
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Yamamoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| |
Collapse
|
5
|
Matsumoto N, Akagi-Tsuchihashi N, Noda T, Komune N, Nakagawa T. Orientation of the Cochlea From a Surgeon's Perspective. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e017. [PMID: 38516627 PMCID: PMC10950153 DOI: 10.1097/ono.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 03/23/2024]
Abstract
Background One of the mechanisms that cause tip fold-over is a misalignment between the electrode array's coiling direction and the cochlea's curving direction. Objectives We reviewed surgical videos and computed tomography (CT) datasets of the patients who underwent cochlear implantation procedures from January 2010 to December 2021, paying particular attention to the cochlea's orientation in the surgeon's microscopic view. Methods CT dataset and video recordings were analyzed to measure the "slope angle," which is the angle between the cochlea's coiling plane and the horizontal plane. Results There were 220 cases that met the criteria and completed the analysis. The mean slope angle was 12.1° ± 9.5°, with a minimum of -9.4° and maximum of 44.6°. However, each surgeon had a favored slope angle range. Conclusion Understanding the slope angle and making an effort to reduce the chance of misalignment during electrode insertion may help prevent tip fold-over of slim perimodiolar electrode arrays.
Collapse
Affiliation(s)
- Nozomu Matsumoto
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nana Akagi-Tsuchihashi
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Teppei Noda
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|