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Hrnčiřík F, Nagy L, Grimes HL, Iftikhar H, Muzaffar J, Bance M. Impact of Insertion Speed, Depth, and Robotic Assistance on Cochlear Implant Insertion Forces and Intracochlear Pressure: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:3307. [PMID: 38894099 PMCID: PMC11174543 DOI: 10.3390/s24113307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Cochlear implants are crucial for addressing severe-to-profound hearing loss, with the success of the procedure requiring careful electrode placement. This scoping review synthesizes the findings from 125 studies examining the factors influencing insertion forces (IFs) and intracochlear pressure (IP), which are crucial for optimizing implantation techniques and enhancing patient outcomes. The review highlights the impact of variables, including insertion depth, speed, and the use of robotic assistance on IFs and IP. Results indicate that higher insertion speeds generally increase IFs and IP in artificial models, a pattern not consistently observed in cadaveric studies due to variations in methodology and sample size. The study also explores the observed minimal impact of robotic assistance on reducing IFs compared to manual methods. Importantly, this review underscores the need for a standardized approach in cochlear implant research to address inconsistencies and improve clinical practices aimed at preserving hearing during implantation.
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Affiliation(s)
- Filip Hrnčiřík
- Cambridge Hearing Group, Cambridge CB2 7EF, UK; (F.H.)
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Leo Nagy
- Clinical School, University of Cambridge, Cambridge CB2 0QQ, UK
| | | | - Haissan Iftikhar
- Department of Otolaryngology, University Hospitals Birmingham, Birmingham B15 2TT, UK
| | - Jameel Muzaffar
- Cambridge Hearing Group, Cambridge CB2 7EF, UK; (F.H.)
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Otolaryngology, University Hospitals Birmingham, Birmingham B15 2TT, UK
| | - Manohar Bance
- Cambridge Hearing Group, Cambridge CB2 7EF, UK; (F.H.)
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
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Wang R, Xu K, Luo J, Chao X, Hu F, Zhang D, Chen Y, Li Y, Fan Z, Wang H, Xu L. Vestibular function and hearing preservation in children following a minimally invasive cochlear implantation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08504-4. [PMID: 38341823 DOI: 10.1007/s00405-024-08504-4] [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: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE This retrospective cohort study aimed to investigate the effect of minimally invasive cochlear implantation (CI) on the vestibular function (VF) and residual hearing (RH) as well as their relationship in pediatric recipients before and after surgery. METHODS Twenty-four pediatric patients with preoperative low frequency residual hearing (LFRH) (250 or 500 Hz ≤ 80 dB HL) who underwent minimally invasive CI were enrolled. Pure-tone thresholds, the cervical/ocular vestibular-evoked myogenic potential (cVEMP/oVEMP), and video head impulse test (vHIT) were all evaluated in the 24 pediatric patients with preoperative normal VF before and at 1 and 12 months after surgery. The relationship between changes in hearing and VF was analyzed preoperatively and at 1 and 12 months postoperatively. RESULTS There were no significant differences on VF preservation and hearing preservation (HP) at both 1 and 12 months post-CI (p > 0.05). At 1 month post-CI, the correlations of the variations in vestibulo-ocular reflex (VOR) gains of horizontal semicircular canal (HSC) and posterior semicircular canal (PSC) and the shift in 250 Hz threshold were negatively correlated (r = - 0.41, p = 0.04 and r = - 0.43, p = 0.04, respectively). At 12 months post-CI, the shift in 250 Hz threshold negatively correlated to the variations in VOR gain of superior semicircular canal (SSC) (r = - 0.43, p = 0.04); the HP positively correlated to the variation in oVEMP-amplitude ratio (AR) (r = 0.41, p = 0.04). CONCLUSION Our study confirmed that there were partial correlations between VF preservation and HP both in the short- and long-terms after atraumatic CI surgery, especially with the 250 Hz threshold. Regarding the variation of PSC function, the correlation with hearing status was variable with time after atraumatic CI surgery. Minimally invasive techniques for HP are successful and effective for the preservation of VF in pediatric patients both in the short- and long-terms.
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Affiliation(s)
- Ruijie Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Kaifan Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Jianfen Luo
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Xiuhua Chao
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Fangxia Hu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Daogong Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Yueling Chen
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Yuanling Li
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Lei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China.
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China.
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Kashani RG, Henslee A, Nelson RF, Hansen MR. Robotic assistance during cochlear implantation: the rationale for consistent, controlled speed of electrode array insertion. Front Neurol 2024; 15:1335994. [PMID: 38318440 PMCID: PMC10839068 DOI: 10.3389/fneur.2024.1335994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Cochlear implants (CI) have revolutionized the treatment of patients with severe to profound sensory hearing loss by providing a method of bypassing normal hearing to directly stimulate the auditory nerve. A further advance in the field has been the introduction of "hearing preservation" surgery, whereby the CI electrode array (EA) is carefully inserted to spare damage to the delicate anatomy and function of the cochlea. Preserving residual function of the inner ear allows patients to receive maximal benefit from the CI and to combine CI electric stimulation with acoustic hearing, offering improved postoperative speech, hearing, and quality of life outcomes. However, under the current paradigm of implant surgery, where EAs are inserted by hand, the cochlea cannot be reliably spared from damage. Robotics-assisted EA insertion is an emerging technology that may overcome fundamental human kinetic limitations that prevent consistency in achieving steady and slow EA insertion. This review begins by describing the relationship between EA insertion speed and generation of intracochlear forces and pressures. The various mechanisms by which these intracochlear forces can damage the cochlea and lead to worsened postoperative outcomes are discussed. The constraints of manual insertion technique are compared to robotics-assisted methods, followed by an overview of the current and future state of robotics-assisted EA insertion.
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Affiliation(s)
- Rustin G. Kashani
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | | | | | - Marlan R. Hansen
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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