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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.
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Geerardyn A, Zhu M, Verhaert N, Quesnel AM. Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes. Otol Neurotol 2024; 45:245-255. [PMID: 38270168 PMCID: PMC10922381 DOI: 10.1097/mao.0000000000004102] [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: 01/26/2024]
Abstract
HYPOTHESIS Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis. BACKGROUND The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this. METHODS Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point. RESULTS Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the -26 to -18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations. CONCLUSION OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
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Affiliation(s)
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Pai I, Connor S, Komninos C, Ourselin S, Bergeles C. The impact of the size and angle of the cochlear basal turn on translocation of a pre-curved mid-scala cochlear implant electrode. Sci Rep 2024; 14:1024. [PMID: 38200135 PMCID: PMC10781700 DOI: 10.1038/s41598-023-47133-5] [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: 06/05/2023] [Accepted: 11/09/2023] [Indexed: 01/12/2024] Open
Abstract
Scalar translocation is a severe form of intra-cochlear trauma during cochlear implant (CI) electrode insertion. This study explored the hypothesis that the dimensions of the cochlear basal turn and orientation of its inferior segment relative to surgically relevant anatomical structures influence the scalar translocation rates of a pre-curved CI electrode. In a cohort of 40 patients implanted with the Advanced Bionics Mid-Scala electrode array, the scalar translocation group (40%) had a significantly smaller mean distance A of the cochlear basal turn (p < 0.001) and wider horizontal angle between the inferior segment of the cochlear basal turn and the mastoid facial nerve (p = 0.040). A logistic regression model incorporating distance A (p = 0.003) and horizontal facial nerve angle (p = 0.017) explained 44.0-59.9% of the variance in scalar translocation and correctly classified 82.5% of cases. Every 1mm decrease in distance A was associated with a 99.2% increase in odds of translocation [95% confidence interval 80.3%, 100%], whilst every 1-degree increase in the horizontal facial nerve angle was associated with an 18.1% increase in odds of translocation [95% CI 3.0%, 35.5%]. The study findings provide an evidence-based argument for the development of a navigation system for optimal angulation of electrode insertion during CI surgery to reduce intra-cochlear trauma.
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Affiliation(s)
- Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- St. Thomas' Hearing Implant Centre, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Lambeth Wing, London, SE1 7EH, UK.
| | - Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Charalampos Komninos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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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/.
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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
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Neagoș CM, Domuța EM, Vlad AG, Neagoș A. The Role of Imaging Investigations in Evaluation of Cochlear Dimensions in Candidates for Cochlear Implantation-Our Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2086. [PMID: 38138189 PMCID: PMC10744659 DOI: 10.3390/medicina59122086] [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: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The Cochlear implant is the first approved cranial nerve stimulator that works by directly stimulating the cochlear nerve. Various attempts have been made to evaluate the dimensions of the cochlea related to cochlear implantation. The preoperative computed tomographic examination is essential not only in assessing the anatomical aspect of the cochlea, but also in determining its dimensions to choose an appropriate electrode and obtain the best possible audiological performance. Materials and Methods: In the present paper, we aimed to carry out an observational study regarding the role of cochlear measurements in the preoperative evaluation of patients proposed for cochlear implants. The purpose of the study was to measure the cochlea and establish the existence of a correlation between the size of the cochlea and the age and gender of the patients. Results: From the group of 35 examined patients, 54% (n = 19) were male and 46% (n = 16) were female. The average length of the cochlea in the age group 0-4 years is 7.82 mm in the left ear and 7.86 mm in the right ear; in the age group 4-7 years, it is 7.82 mm and 7.94 mm, respectively; for the age group 7-14 years, the dimensions increase to 8.48 mm and 8.77 mm, respectively; and after 14 years, these dimensions reach 9.12 mm and 9.18 mm, respectively. Comparative measurements of the length of the cochlea by age groups show an increase in length with the patient's age, but this increase does not exceed 1.5 mm for both the right and left ears. The measurements of the width of the cochlea, by age group, start from 6.84 mm in the left ear and 6.81 mm in the right ear at 0-4 years, 6.94 mm and 6.97 mm, respectively, in the group 4-7 years, 7.71 mm and 7.55 mm at 7-14 years, and reaching 8.19 mm and 8.12 mm at the age of 14 years and over. Conclusions: From the study carried out, it can be concluded that the evaluation of the dimensions of the cochlea is important for cochlear implantation. The size variables, although small, are still an element to be considered in correlation with the age of the patient and the implanted ear. This increase is statistically insignificant, but it still exists, even if, from a theoretical point of view, it is considered that the dimensions of the cochlea remain constant.
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Affiliation(s)
- Cristian Mircea Neagoș
- Department of Otorhinolaryngology, Emergency County Hospital of Targu Mures, George Emil Palade University of Medicine Pharmacy Science and Technology, 540067 Targu Mures, Romania;
| | - Eugenia Maria Domuța
- Department of Otorhinolaryngology, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
| | - Anca Gabriela Vlad
- Intensive Care Department, Emergency County Hospital of Targu Mures, 540136 Targu Mures, Romania
| | - Adriana Neagoș
- Department of Otorhinolaryngology, Emergency County Hospital of Targu Mures, George Emil Palade University of Medicine Pharmacy Science and Technology, 540067 Targu Mures, Romania;
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Choi G, Ha Y, Kim DH, Shin S, Hyun J, Kim S, Oh SH, Min KS. Assessing the manufacturable 32-channel cochlear electrode array: evaluation results for clinical trials. Biomed Microdevices 2023; 25:41. [PMID: 37870619 DOI: 10.1007/s10544-023-00681-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] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Reliability evaluation results of a manufacturable 32-channel cochlear electrode array are reported in this paper. Applying automated laser micro-machining process and a layer-by-layer silicone deposition scheme, authors developed the manufacturing methods of the electrode array for fine patterning and mass production. The developed electrode array has been verified through the requirements specified by the ISO Standard 14708-7. And the insertion trauma of the electrode array has been evaluated based on human temporal bone studies. According to the specified requirements, the electrode array was assessed through elongation & insulation, flexural, and fatigue tests. In addition, Temporal bone study was performed using eight fresh-frozen cadaver temporal bones with the electrode arrays inserted via the round window. Following soaking in saline condition, the impedances between conducting wires of the electrode array were measured over 100 kΩ (the pass/fail criterion). After each required test, it was shown that the electrode array maintained the electrical continuity and insulation condition. The average insertion angle of the electrode array inside the scala tympani was 399.7°. The human temporal bone studies exhibited atraumatic insertion rate of 60.3% (grade 0 or 1). The reliability of the manufacturable electrode array is successfully verified in mechanical, electrical, and histological aspects. Following the completion of a 32-channel cochlear implant system, the performance and stability of the 32-channel electrode array will be evaluated in clinical trials.
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Affiliation(s)
| | - Yoonhee Ha
- TODOC Co., Ltd., Seoul, 08394, South Korea
| | | | | | | | | | - Seung-Ha Oh
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, 03080, South Korea
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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.
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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
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Starovoyt A, Shaheen E, Putzeys T, Kerckhofs G, Politis C, Wouters J, Verhaert N. Anatomically and mechanically accurate scala tympani model for electrode insertion studies. Hear Res 2023; 430:108707. [PMID: 36773540 DOI: 10.1016/j.heares.2023.108707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/25/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
The risk of insertion trauma in cochlear implantation is determined by the interplay between individual cochlear anatomy and electrode insertion mechanics. Whereas patient anatomy cannot be changed, new surgical techniques, devices for cochlear monitoring, drugs, and electrode array designs are continuously being developed and tested, to optimize the insertion mechanics and prevent trauma. Preclinical testing of these developments is a crucial step in feasibility testing and optimization for clinical application. Human cadaveric specimens allow for the best simulation of an intraoperative setting. However, their availability is limited and it is not possible to conduct repeated, controlled experiments on the same sample. A variety of artificial cochlear models have been developed for electrode insertion studies, but none of them were both anatomically and mechanically representative for surgical insertion into an individual cochlea. In this study, we developed anatomically representative models of the scala tympani for surgical insertion through the round window, based on microCT images of individual human cochleae. The models were produced in transparent material using commonly-available 3D printing technology at a desired scale. The anatomical and mechanical accuracy of the produced models was validated by comparison with human cadaveric cochleae. Mechanical evaluation was performed by recording insertion forces, counting the number of inserted electrodes and grading tactile feedback during manual insertion of a straight electrode by experienced cochlear implant surgeons. Our results demonstrated that the developed models were highly representative for the anatomy of the original cochleae and for the insertion mechanics in human cadaveric cochleae. The individual anatomy of the produced models had a significant impact on the insertion mechanics. The described models have a promising potential to accelerate preclinical development and testing of atraumatic insertion techniques, reducing the need for human cadaveric material. In addition, realistic models of the cochlea can be used for surgical training and preoperative planning of patient-tailored cochlear implantation surgery.
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Affiliation(s)
- Anastasiya Starovoyt
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, UZ Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Tristan Putzeys
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Laboratory for Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, University of Leuven, Leuven, Belgium
| | - Greet Kerckhofs
- Biomechanics lab, Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium; Department of Materials Engineering, KU Leuven, University of Leuven, Leuven, Belgium; IREC, Institute of Experimental and Clinical Research, UCLouvain, Woluwé-Saint-Lambert, Belgium; Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, UZ Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Nicolas Verhaert
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium; Leuven Brain Institute, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, UZ Leuven, University Hospitals of Leuven, Leuven, Belgium.
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Schurzig D, Repp F, Timm ME, Batsoulis C, Lenarz T, Kral A. Virtual cochlear implantation for personalized rehabilitation of profound hearing loss. Hear Res 2023; 429:108687. [PMID: 36638762 DOI: 10.1016/j.heares.2022.108687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
In cochlear implantation, current preoperative planning procedures allow for estimating how far a specific implant will reach into the inner ear of the patient, which is important to optimize hearing preservation and speech perception outcomes. Here we report on the development of a methodology that goes beyond current planning approaches: the proposed model does not only estimate specific outcome parameters but allows for entire, three-dimensional virtual implantations of patient-specific cochlear anatomies with different types of electrode arrays. The model was trained based on imaging datasets of 186 human cochleae, which contained 171 clinical computer tomographies (CTs) of actual cochlear implant patients as well as 15 high-resolution micro-CTs of cadaver cochleae to also reconstruct the refined intracochlear structures not visible in clinical imaging. The model was validated on an independent dataset of 141 preoperative and postoperative clinical CTs of cochlear implant recipients and outperformed all currently available planning approaches, not only in terms of accuracy but also regarding the amount of information that is available prior to the actual implantation.
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Affiliation(s)
- Daniel Schurzig
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; MED-EL Research Center, Hannover, Germany.
| | | | - Max E Timm
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | | | - Thomas Lenarz
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andrej Kral
- Institute of AudioNeuroTechnology & Department of Experimental Otology, ENT Department, Hannover Medical School, Hannover, Germany; Department of Otolaryngology, Hannover Medical School, Hannover, Germany; Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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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.
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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
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11
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Human cochlear microstructures at risk of electrode insertion trauma, elucidated in 3D with contrast-enhanced microCT. Sci Rep 2023; 13:2191. [PMID: 36750646 PMCID: PMC9905077 DOI: 10.1038/s41598-023-29401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Cochlear implant restores hearing loss through electrical stimulation of the hearing nerve from within the cochlea. Unfortunately, surgical implantation of this neuroprosthesis often traumatizes delicate intracochlear structures, resulting in loss of residual hearing and compromising hearing in noisy environments and appreciation of music. To avoid cochlear trauma, insertion techniques and devices have to be adjusted to the cochlear microanatomy. However, existing techniques were unable to achieve a representative visualization of the human cochlea: classical histology damages the tissues and lacks 3D perspective; standard microCT fails to resolve the cochlear soft tissues; and previously used X-ray contrast-enhancing staining agents are destructive. In this study, we overcame these limitations by performing contrast-enhanced microCT imaging (CECT) with a novel polyoxometalate staining agent Hf-WD POM. With Hf-WD POM-based CECT, we achieved nondestructive, high-resolution, simultaneous, 3D visualization of the mineralized and soft microstructures in fresh-frozen human cochleae. This enabled quantitative analysis of the true intracochlear dimensions and led to anatomical discoveries, concerning surgically-relevant microstructures: the round window membrane, the Rosenthal's canal and the secondary spiral lamina. Furthermore, we demonstrated that Hf-WD POM-based CECT enables quantitative assessment of these structures as well as their trauma.
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12
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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.
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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
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13
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van der Jagt AMA, Briaire JJ, Boehringer S, Verbist BM, Frijns JHM. Prolonged Insertion Time Reduces Translocation Rate of a Precurved Electrode Array in Cochlear Implantation. Otol Neurotol 2022; 43:e427-e434. [PMID: 35213473 DOI: 10.1097/mao.0000000000003499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Insertion speed during cochlear implantation determines the risk of cochlear trauma. By slowing down insertion speed tactile feedback is improved. This is highly conducive to control the course of the electrode array along the cochlear contour and prevent translocation from the scala tympani to the scala vestibuli. BACKGROUND Limiting insertion trauma is a dedicated goal in cochlear implantation to maintain the most favorable situation for electrical stimulation of the remaining stimulable neural components of the cochlea. Surgical technique is one of the potential influencers on translocation behavior of the electrode array. METHODS The intrascalar position of 226 patients, all implanted with a precurved electrode array, aiming a mid-scalar position, was evaluated. One group (n = 113) represented implantation with an insertion time less than 25 seconds (fast insertion) and the other group (n = 113) was implanted in 25 or more seconds (slow insertion). A logistic regression analysis studied the effect of insertion speed on insertion trauma, controlled for surgical approach, cochlear size, and angular insertion depth. Furthermore, the effect of translocation on speech performance was evaluated using a linear mixed model. RESULTS The translocation rate within the fast and slow insertion groups were respectively 27 and 10%. A logistic regression analysis showed that the odds of dislocation increases by 2.527 times with a fast insertion, controlled for surgical approach, cochlear size, and angular insertion depth (95% CI = 1.135, 5.625). We failed to find a difference in speech recognition between patients with and without translocated electrode arrays. CONCLUSION Slowing down insertion speed till 25 seconds or longer reduces the incidence of translocation.
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Affiliation(s)
| | | | | | - Berit M Verbist
- Department of Radiology
- Department of Radiology, Radboud University Medical Center Nijmegen, Nijmegen
| | - Johan H M Frijns
- Department of Otorhinolaryngology
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands
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14
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Intracochlear New Fibro-Ossification and Neuronal Degeneration Following Cochlear Implant Electrode Translocation: Long-Term Histopathological Findings in Humans. Otol Neurotol 2022; 43:e153-e164. [PMID: 35015749 DOI: 10.1097/mao.0000000000003402] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We aim to assess the histopathology of human temporal bones (TBs) with evidence of cochlear implantation (CI) electrode scalar translocation. STUDY DESIGN Otopathology study. SETTING Otopathology laboratory. PATIENTS TBs from patients who had a history of CI and histopathological evidence of interscalar translocation. Specimens with electrode placed entirely within the ST served as controls. INTERVENTION Histopathological assessment of human TBs. MAIN OUTCOME MEASURES TBs from each patient were harvested postmortem and histologically analyzed for intracochlear changes in the context of CI electrode translocation and compared to controls. Intracochlear new fibro-ossification, and spiral ganglion neuron (SGN) counts were assessed. Postoperative word recognition scores (WRS) were also compared. RESULTS Nineteen human TBs with electrode translocation and eight controls were identified. The most common site of translocation was the ascending limb of the basal turn (n = 14 TBs). The average angle of insertion at the point of translocation was 159° ± 79°. Eighteen translocated cases presented moderate fibroosseous changes in the basal region of the cochlea, extending to the translocation point and/or throughout the electrode track in 42%. Lower SGN counts were more pronounced in translocated cases compared to controls, with a significant difference for segment II (p = 0.019). Although final postoperative hearing outcomes were similar between groups, translocated cases had slower rate of improvement in WRS (p = 0.021). CONCLUSIONS Cochlear implant electrode translocation was associated with greater fibroosseous formation and lower SGN population. Our findings suggest that scalar translocations may slow the rate of improvement in WRS overtime as compared to atraumatic electrode insertions.Level of evidence: IV.
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15
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Dong Y, Briaire JJ, Siebrecht M, Stronks HC, Frijns JHM. Detection of Translocation of Cochlear Implant Electrode Arrays by Intracochlear Impedance Measurements. Ear Hear 2021; 42:1397-1404. [PMID: 33974777 PMCID: PMC8378542 DOI: 10.1097/aud.0000000000001033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Misplacement of the electrode array is associated with impaired speech perception in patients with cochlear implants (CIs). Translocation of the electrode array is the most common misplacement. When a CI is translocated, it crosses the basilar membrane from the scala tympani into the scala vestibuli. The position of the implant can be determined on a postoperative CT scan. However, such a scan is not obtained routinely after CI insertion in many hospitals, due to radiation exposure and processing time. Previous studies have shown that impedance measures might provide information on the placement of the electrode arrays. The electrode impedance was measured by dividing the plateau voltage at the end of the first phase of the pulse by the injected current. The access resistance was calculated using the so-called access voltage at the first sampled time point after the start of the pulse divided by the injected current. In our study, we obtained the electrode impedance and the access resistance to detect electrode translocations using electrical field imaging. We have investigated how reliably these two measurements can detect electrode translocation, and which method performed best. DESIGN We calculated the electrode impedances and access resistances using electrical field imaging recordings from 100 HiFocus Mid-Scala CI (Advanced Bionics, Sylmar, CA) recipients. We estimated the normal values of these two measurements as the baselines of the implant placed in the cochlea without translocation. Next, we calculated the maximal electrode impedance deviation and the maximal access-resistance deviation from the respective baselines as predictors of translocation. We classified these two predictors as translocations or nontranslocations based on the bootstrap sampling method and receiver operating characteristics curves analysis. The accuracy could be calculated by comparing those predictive results to a gold standard, namely the clinical CT scans. To determine which measurement more accurately detected translocation, the difference between the accuracies of the two measurements was calculated. RESULTS Using the bootstrap sampling method and receiver operating characteristics-based optimized threshold criteria, the 95% confidence intervals of the accuracies of translocation detections ranged from 77.8% to 82.1% and from 89.5% to 91.2% for the electrode impedance and access resistance, respectively. The accuracies of the maximal access-resistance deviations were significantly larger than that of the maximal electrode impedance deviations. The location of the translocation as predicted by the access resistance was significantly correlated with the result derived from the CT scans. In contrast, no significant correlation was observed for the electrode impedance. CONCLUSIONS Both the electrode impedance and access resistance proved reliable metrics to detect translocations for HiFocus Mid-Scala electrode arrays. The access resistance had, however, significantly better accuracy and it also reliably detected the electrode-location of translocations. The electrode impedance did not correlate significantly with the location of translocation. Measuring the access resistance is, therefore, the recommended method to detect electrode-array translocations. These measures can provide prompt feedback for surgeons after insertion, improving their surgical skills, and ultimately reducing the number of translocations. In the future, such measurements may allow near-real-time monitoring of the electrode array during insertion, helping to avoid translocations.
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Affiliation(s)
- Yu Dong
- ENT-Department, Leiden University Medical Centre, RC Leiden, the Netherlands
| | - Jeroen J. Briaire
- ENT-Department, Leiden University Medical Centre, RC Leiden, the Netherlands
| | - Michael Siebrecht
- ENT-Department, Leiden University Medical Centre, RC Leiden, the Netherlands
| | | | - Johan H. M. Frijns
- ENT-Department, Leiden University Medical Centre, RC Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, RC Leiden, the Netherlands
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16
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Avallone E, Lenarz T, Timm ME. On the Accuracy of Clinical Insertion Angle Predictions With a Surgical Planning Platform for Cochlear Implantation. Otol Neurotol 2021; 42:e1242-e1249. [PMID: 34282099 DOI: 10.1097/mao.0000000000003272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Various studies over the last few decades have shown that the cochlea is not a uniform structure, but that its size and shape may vary quite substantially in between subjects. The surgical planning platform enables the user to quickly approximate the size of a cochlea within clinical imaging data by measuring the basal cochlear diameters A and B. It also allows for contact specific insertion angle predictions for MED-EL cochlear implant electrode arrays based on this individual anatomy approximation. The proposed, retrospective study was performed to evaluate the accuracy of these predictions. METHODS Preoperative CBCT scans of N = 91 MED-EL cochlear implant patients with different types of FLEX electrode arrays (flexible, thin, and straight arrays) were evaluated using a planning module. Both the initial version (based on an equation proposed by Escudé et al.) as well as a novel, recently proposed approach (called elliptic-circular approximation) was employed. All predictions were then compared to the actual insertion angles which were derived from postoperative CBCT images of the same patient. RESULTS Most prediction deviations of the investigated cases stayed below 45deg for all electrode arrays and both prediction methods. In general, prediction deviations increased from base to apex were found to be larger for longer electrode arrays. Hardly any significant differences between the two prediction methods were observed. However, particularly large deviations were found for the Escudé method and could be substantially deceased with the updated elliptic-circular approximation approach. CONCLUSIONS The new platform version with its updated prediction module allows to reliably predict insertion angles even for cochlear anatomies with slightly unusual features and shapes.
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Affiliation(s)
| | - Thomas Lenarz
- Department of Otolaryngology
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany
| | - Max E Timm
- Department of Otolaryngology
- Cluster of Excellence Hearing4all, Hannover Medical School, Hannover, Germany
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CT imaging-based approaches to cochlear duct length estimation-a human temporal bone study. Eur Radiol 2021; 32:1014-1023. [PMID: 34463797 PMCID: PMC8794899 DOI: 10.1007/s00330-021-08189-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 01/12/2023]
Abstract
Objectives Knowledge about cochlear duct length (CDL) may assist electrode choice in cochlear implantation (CI). However, no gold standard for clinical applicable estimation of CDL exists. The aim of this study is (1) to determine the most reliable radiological imaging method and imaging processing software for measuring CDL from clinical routine imaging and (2) to accurately predict the insertion depth of the CI electrode. Methods Twenty human temporal bones were examined using different sectional imaging techniques (high-resolution computed tomography [HRCT] and cone beam computed tomography [CBCT]). CDL was measured using three methods: length estimation using (1) a dedicated preclinical 3D reconstruction software, (2) the established A-value method, and (3) a clinically approved otosurgical planning software. Temporal bones were implanted with a 31.5-mm CI electrode and measurements were compared to a reference based on the CI electrode insertion angle measured by radiographs in Stenvers projection (CDLreference). Results A mean cochlear coverage of 74% (SD 7.4%) was found. The CDLreference showed significant differences to each other method (p < 0.001). The strongest correlation to the CDLreference was found for the otosurgical planning software-based method obtained from HRCT (CDLSW-HRCT; r = 0.87, p < 0.001) and from CBCT (CDLSW-CBCT; r = 0.76, p < 0.001). Overall, CDL was underestimated by each applied method. The inter-rater reliability was fair for the CDL estimation based on 3D reconstruction from CBCT (CDL3D-CBCT; intra-class correlation coefficient [ICC] = 0.43), good for CDL estimation based on 3D reconstruction from HRCT (CDL3D-HRCT; ICC = 0.71), poor for CDL estimation based on the A-value method from HRCT (CDLA-HRCT; ICC = 0.29), and excellent for CDL estimation based on the A-value method from CBCT (CDLA-CBCT; ICC = 0.87) as well as for the CDLSW-HRCT (ICC = 0.94), CDLSW-CBCT (ICC = 0.94) and CDLreference (ICC = 0.87). Conclusions All approaches would have led to an electrode choice of rather too short electrodes. Concerning treatment decisions based on CDL measurements, the otosurgical planning software-based method has to be recommended. The best inter-rater reliability was found for CDLA-CBCT, for CDLSW-HRCT, for CDLSW-CBCT, and for CDLreference. Key Points • Clinically applicable calculations using high-resolution CT and cone beam CT underestimate the cochlear size. • Ten percent of cochlear duct length need to be added to current calculations in order to predict the postoperative CI electrode position. • The clinically approved otosurgical planning software-based method software is the most suitable to estimate the cochlear duct length and shows an excellent inter-rater reliability.
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18
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Du Q, Wang C, He G, Sun Z. Insertion trauma of a new cochlear implant electrode: evaluated by histology in fresh human temporal bone specimens. Acta Otolaryngol 2021; 141:490-494. [PMID: 33784954 DOI: 10.1080/00016489.2021.1897159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Combining acoustic and electrical stimulation has been successfully used in patients with low-frequency residual hearing. Electrode insertion trauma, such as electrode translocation could result in loss of residual hearing. OBJECTIVES The aim of the study is to evaluate the LCI-20PI electrode array insertion trauma to the intra-cochlear structures in fresh human temporal bone specimens. MATERIALS AND METHODS The LCI-20PI electrode arrays were inserted into scalae tympani through round window membrane in 10 cochleae from ten fresh human cadavers. The intracochlear trauma was evaluated histologically by a scale of 0-4: 0 - no observable trauma, 1 - elevation of basilar membrane, 2 - rupture of basilar membrane or spiral ligament, 3-dislocation into scala vestibuli and 4 - fracture of modiolus or osseous spiral lamina. The insertion depth was measured by radiography. RESULTS Histological results revealed no observable trauma in seven specimens; basal membrane elevation and rupture in two specimens; the electrode array misled into scala vestibuli in one specimen. The insertion depth varied from 228° to 288°. CONCLUSIONS AND SIGNIFICANCE The insertion of the LCI-20PI electrode arrays caused no trauma in the majority of the fresh temporal bone specimens. No translocation of the electrode arrays from the scala tympani to the scala vestibuli was observed.
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Affiliation(s)
- Qiang Du
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, PR China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, PR China
- Shanghai Hearing Medical Center, Shanghai, PR China
| | - Cheng Wang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, PR China
| | - Guangming He
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, PR China
| | - Zengjun Sun
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, PR China
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19
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On the Intracochlear Location of Straight Electrode Arrays After Cochlear Implantation: How Lateral Are Lateral Wall Electrodes? Otol Neurotol 2021; 42:242-250. [PMID: 33026778 DOI: 10.1097/mao.0000000000002880] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Cochlear implants are the gold standard for patients with severe sensorineural hearing loss. A focused electrical stimulation of individual spiral ganglion neurons has not been achieved yet because the scala tympani is a fluid-filled compartment and does not offer a matrix for neuritic outgrowth. Coating of the electrode contacts with swelling hydrogels could fill that gap between the electrode array and the medial wall of the cochlea. Therefore, the exact position of the electrode array within the scala tympani has to be known. STUDY DESIGN Retrospective analysis of patient data sets. SETTING Tertiary referral center. A total of 95 patients with cochlear implants from one manufacturer were included in this study. The lateral wall, the modiolar wall, and the cochlear implant electrode were segmented using OsiriX MD. For repositioning and reconstructing the respective contours and measuring distances, files were analyzed in MATLAB. The distances from the edge of each electrode contact to the cochlear walls showed no significant differences. But between the different contacts within each patient, there were significant differences. Around 180 degree insertion, electrodes start to get in contact with the lateral wall. The tip of the electrode array was always facing toward the modiolar wall independent of the length of the electrode. We established a method to analyze the position of electrodes within the cochlea.
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Eisenhut F, Lang S, Taha L, Hoelter P, Wiesmueller M, Uder M, Iro H, Doerfler A, Hornung J. Identification of anatomic risk factors for scalar translocation in cochlear implant patients. Z Med Phys 2021; 31:254-264. [PMID: 33648794 DOI: 10.1016/j.zemedi.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
AIM Microanatomical evaluation of cochlear implant (CI) patients to identify anatomical risk factors for a scalar translocation. METHODS CI patients with both a regular scala tympani spiralization (group A) and a scalar translocation (group B) were identified via postoperative flat-detector computed tomography (FD-CT). Then, the corresponding preoperative multislice computed tomography (MS-CT) and postoperative FD-CT datasets were assessed: First, the cochleae were separated in 6 segments of 45° each. Next, quantitative (cochlea height, length, depth, cochlear duct diameter [CD] per segment; percentual tapering of the CD per segment named cochlear geometry index [CGI]) and qualitative (identifiability of the CI model; CI-integrity; intracochlear array position) parameters were evaluated and compared for both groups. Receiver-operating-characteristics (ROC) analysis was performed for the CGI. RESULTS In total, 40 preoperative MS-CT and postoperative FD-CT datasets (nA=20; nB=20) were analysed. Model "CI 512" was successfully identified and CI-integrity has been confirmed in all cases. Quantitative analysis showed a significant difference of both the CD at 0° (CDA0°= 2.06± 0.23mm; CDB0°= 2.19±0.18mm; p0°= 0.04) and the CGI of the first segment (CGIA0°-45°= 18.87±6.04%; CGIB0°-45°= 28.89±8.58%; p0°-45°= 0.0001). For all other 5 cochlear segments there was no significant difference of CD and CGI; there was no significant difference of external cochlea diameters. The area under the curve (AUC) of the CGI0-45° was 0.864 with 24.50° as the optimal cut-off value to discriminate patients with a scala tympani spiralization and a scalar translocation. CGI0-45° of> 24.50° allowed the correct identification of 85% of patients with a scalar translocation. CONCLUSION CI insertion trauma is associated with a significantly higher narrowing of the proximal basal cochlea turn (BCT). The CGI as percentual tapering of the BCT turned out as reliable, clinically applicable parameter for identification of patients with an increased risk for a scalar translocation.
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Affiliation(s)
- Felix Eisenhut
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Stefan Lang
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Philip Hoelter
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Marco Wiesmueller
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Joachim Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
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21
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A cochlear scaling model for accurate anatomy evaluation and frequency allocation in cochlear implantation. Hear Res 2021; 403:108166. [PMID: 33453642 DOI: 10.1016/j.heares.2020.108166] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
The human cochlea has a highly individual microanatomy. Cochlear implantation therefore requires an evaluation of the individual cochlear anatomy to reduce surgical risk of implantation trauma. However, in-vivo cochlear imaging is limited in resolution. To overcome this issue, cochlear models based on exact anatomical data have been developed. These models can be fitted to the limited parameters available from clinical imaging to provide a prediction of the precise cochlear microanatomy. Recently, models have become available with improved precision that additionally allow predicting the 3D form of an individual cochlea. The present study has further improved the precision of modelling by incorporating microscopic details of a large set of 108 human cochleae from corrosion casts. The new model provides a more flexible geometric shape that can better predict local variations like vertical dips and jumps and provides an approximation of frequency allocation in the cochlea. The outcome of this and five other models have been quantified (validated) on an independent set of 20 µCTs of human cochleae. The new model outperformed previous models and is freely available for download and use.
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Heutink F, Koch V, Verbist B, van der Woude WJ, Mylanus E, Huinck W, Sechopoulos I, Caballo M. Multi-Scale deep learning framework for cochlea localization, segmentation and analysis on clinical ultra-high-resolution CT images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105387. [PMID: 32109685 DOI: 10.1016/j.cmpb.2020.105387] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Performing patient-specific, pre-operative cochlea CT-based measurements could be helpful to positively affect the outcome of cochlear surgery in terms of intracochlear trauma and loss of residual hearing. Therefore, we propose a method to automatically segment and measure the human cochlea in clinical ultra-high-resolution (UHR) CT images, and investigate differences in cochlea size for personalized implant planning. METHODS 123 temporal bone CT scans were acquired with two UHR-CT scanners, and used to develop and validate a deep learning-based system for automated cochlea segmentation and measurement. The segmentation algorithm is composed of two major steps (detection and pixel-wise classification) in cascade, and aims at combining the results of a multi-scale computer-aided detection scheme with a U-Net-like architecture for pixelwise classification. The segmentation results were used as an input to the measurement algorithm, which provides automatic cochlear measurements (volume, basal diameter, and cochlear duct length (CDL)) through the combined use of convolutional neural networks and thinning algorithms. Automatic segmentation was validated against manual annotation, by the means of Dice similarity, Boundary-F1 (BF) score, and maximum and average Hausdorff distances, while measurement errors were calculated between the automatic results and the corresponding manually obtained ground truth on a per-patient basis. Finally, the developed system was used to investigate the differences in cochlea size within our patient cohort, to relate the measurement errors to the actual variation in cochlear size across different patients. RESULTS Automatic segmentation resulted in a Dice of 0.90 ± 0.03, BF score of 0.95 ± 0.03, and maximum and average Hausdorff distance of 3.05 ± 0.39 and 0.32 ± 0.07 against manual annotation. Automatic cochlear measurements resulted in errors of 8.4% (volume), 5.5% (CDL), 7.8% (basal diameter). The cochlea size varied broadly, ranging between 0.10 and 0.28 ml (volume), 1.3 and 2.5 mm (basal diameter), and 27.7 and 40.1 mm (CDL). CONCLUSIONS The proposed algorithm could successfully segment and analyze the cochlea on UHR-CT images, resulting in accurate measurements of cochlear anatomy. Given the wide variation in cochlear size found in our patient cohort, it may find application as a pre-operative tool in cochlear implant surgery, potentially helping elaborate personalized treatment strategies based on patient-specific, image-based anatomical measurements.
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Affiliation(s)
- Floris Heutink
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Valentin Koch
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Berit Verbist
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Willem Jan van der Woude
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Dutch Expert Center for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands
| | - Marco Caballo
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
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Khurayzi T, Almuhawas F, Sanosi A. Direct measurement of cochlear parameters for automatic calculation of the cochlear duct length. Ann Saudi Med 2020; 40:212-218. [PMID: 32493102 PMCID: PMC7270618 DOI: 10.5144/0256-4947.2020.218] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cochlear morphology and cochlear duct length (CDL) play important roles in the selection of appropriate electrodes. Cochlear parameters such as diameter (A value) and width (B value) are used as inputs for calculating the CDL. Current measurements of these parameters are inefficient and time consuming. Recently developed otological planning software (OTOPLAN) allows surgeons to directly measure these parameters and then automatically calculate the CDL. OBJECTIVES The primary objective was to validate this new software for measuring the cochlear parameters and CDL. The secondary aim was to investigate the correlation between each cochlear parameter with the calculated CDL. DESIGN Retrospective. SETTINGS Ear specialist hospital. PATIENTS AND METHODS The measurement of cochlear diameter (A value) was chosen as the validation parameter. To do this, the A value was measured by a neurotologist on the new OTOPLAN planning software and was validated to the one measured on the currently used DICOM viewer. Upon the validation of the OTOPLAN software, the other two cochlear parameters, namely width (B value) and height (H value) were measured, and CDL was automatically calculated. Finally, the correlation of all parameters with the CDL was statistically analyzed. MAIN OUTCOME MEASURES Validation of OTOPLAN and CDL estimation. SAMPLE SIZE 88 ears. RESULTS There was no significant difference between the A-value measured on the DICOM viewing software and that on the new planning software by the two independent neurotologists (P=.27). Both A-and B-values showed a high positive correlation to the CDL. However, the B-value showed a stronger correlation to the CDL than the A-value (r=0.63 for A, and r=0.96 for B). CONCLUSION The direct measurement of cochlea parameters and automatic calculation of the CDL could improve the efficiency of clinical workflow and make otology surgeons more independent. Moreover, the cochlear width (B) has a strong correlation to the CDL. Thus, we suggest using the combination of A and B to accurately estimate the CDL rather than using only one. LIMITATIONS Single center and small sample size. CONFLICT OF INTEREST None. No relationship with manufacturers.
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Affiliation(s)
- Tawfiq Khurayzi
- From the King Abdullah Ear Specialist Center (KAESC), Department of Otolaryngology, College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia
| | - Fida Almuhawas
- From the King Abdullah Ear Specialist Center (KAESC), Department of Otolaryngology, College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia
| | - Abdulrahman Sanosi
- From the King Abdullah Ear Specialist Center (KAESC), Department of Otolaryngology, College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia
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Rau TS, Kreul D, Lexow J, Hügl S, Zuniga MG, Lenarz T, Majdani O. Characterizing the size of the target region for atraumatic opening of the cochlea through the facial recess. Comput Med Imaging Graph 2019; 77:101655. [DOI: 10.1016/j.compmedimag.2019.101655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/05/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
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Timm ME, Majdani O, Weller T, Windeler M, Lenarz T, Büchner A, Salcher RB. Patient specific selection of lateral wall cochlear implant electrodes based on anatomical indication ranges. PLoS One 2018; 13:e0206435. [PMID: 30365565 PMCID: PMC6203394 DOI: 10.1371/journal.pone.0206435] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify anatomical indication ranges for different lateral wall cochlear implant electrodes to support surgeons in the preoperative preparation. METHODS 272 patients who were implanted with a FLEX20, FLEX24, FLEX28, or a custom-made device (CMD) were included in this study. The cochlear duct length (CDL) and basal cochlear diameter (length A) were measured within preoperative imaging data. The parameter A was then employed to additionally compute CDL estimates using literature approaches. Moreover, the inserted electrode length (IEL) and insertion angle (IA) were measured in postoperative CT data. By combining the preoperative measurements with the IA data, the covered cochlea length (CCL) and relative cochlear coverage (CC) were determined for each cochlea. RESULTS The measurements of the CDL show comparable results to previous studies. While CDL measurements and estimations cover similar ranges overall, severe deviations occur in individual cases. The electrode specific IEL and CCL are fairly consistent and increase with longer electrodes, but relatively wide ranges of electrode specific CC values were found due to the additional dependence on the respective CDL. Using the correlation of IEL and CCL across electrode arrays, CDL ranges for selected arrays were developed (FLEX24: 31.3-34.4, FLEX28: 36.2-40.1, FLEXSoft: 40.6-44.9). CONCLUSIONS Our analysis shows that electrode specific CC varies due to the CDL variation. Preoperative measurement of the CDL allows for an individualized implant length selection yielding optimized stimulation and a reduced risk of intraoperative trauma. The CDL, as derived from preoperative CT imaging studies, can help the implant surgeon select the appropriate electrode array to maximize the patient's outcomes.
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Affiliation(s)
- Max Eike Timm
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
- * E-mail:
| | - Omid Majdani
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Tobias Weller
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Mayra Windeler
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Andreas Büchner
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Rolf Benedikt Salcher
- Cluster of Excellence Hearing4all, Department of Otorhinolaryngology, Hannover Medical School, Hannover, Lower Saxony, Germany
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Zahara D, Dewi RD, Aboet A, Putranto FM, Lubis ND, Ashar T. Variations in Cochlear Size of Cochlear Implant Candidates. Int Arch Otorhinolaryngol 2018; 23:184-190. [PMID: 30956703 PMCID: PMC6449142 DOI: 10.1055/s-0038-1661360] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction
The cochlear anatomy varies in each individual, and that has an impact on decisions regarding the insertion of electrodes. The measurement of the cochlear size is the routine examination required to choose the proper cochlear implant (CI) electrodes.
Objective
To acquire normative data on the size of the cochlea (length, width, height, scala timpani [ST] height, cochlear duct length [CDL]) of CI candidates in Medan, Indonesia.
Methods
This descriptive study was conducted based on high-resolution computed tomography (HRCT) temporal bone data and on HRCT temporal data manipulated to reconstruct three-dimensional (3D) multiplanar images with OsiriX MD DICOM Viewer version 9.5.1 (Pixmeo SARL, Bernex, Geneva, Switzerland) viewer of 18 patients (36 ears) who were CI candidates in Medan, Indonesia, in order to determine cochlear length (A), cochlear width, cochlear height, ST height and CDL, calculated through a simple mathematical function.
Results
The average cochlear length (A) was 8.75 mm (standard deviation [SD] = 0.31 mm); the average cochlear width was 6.53 mm (SD = 0.35 mm); the average cochlear height was 3.26 mm (SD = 0.24 mm) and the average ST height at the basal cochlea was 1.00 mm (SD = 0.1 mm); and 0.71 mm (SD = 0.1 mm) at the half turn of cochlea. The average total CDL was 32.45 mm (SD = 1.31 mm; range: 30.01–34.83 mm).
Conclusion
The cochlear size varies in each individual; therefore, the temporal bone measurement of CI candidates using HRCT is essential: for the selection of suitable implant electrodes; to minimize cochlear damages at the insertion of the electrode arrays; and to maximize the hearing improvements.
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Affiliation(s)
- Devira Zahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Rima Diana Dewi
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Askaroellah Aboet
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Fikri Mirza Putranto
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, and Health Sciences, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Jakarta, Indonesia
| | - Netty Delvrita Lubis
- Department of Radiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Taufik Ashar
- Department of Environmental Health, Faculty of Public Health, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
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Analysis of Different Approaches for Clinical Cochlear Coverage Evaluation After Cochlear Implantation. Otol Neurotol 2018; 39:e642-e650. [DOI: 10.1097/mao.0000000000001904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schurzig D, Timm ME, Lexow GJ, Majdani O, Lenarz T, Rau TS. Cochlear helix and duct length identification – Evaluation of different curve fitting techniques. Cochlear Implants Int 2018; 19:268-283. [DOI: 10.1080/14670100.2018.1460025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Daniel Schurzig
- MED-EL Medical Electronics, Hannover Research Center, Hannover, Germany
| | - Max Eike Timm
- Cluster of Excellence Hearing4all, Dept. of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - G. Jakob Lexow
- Cluster of Excellence Hearing4all, Dept. of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Omid Majdani
- Cluster of Excellence Hearing4all, Dept. of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Dept. of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas S. Rau
- Cluster of Excellence Hearing4all, Dept. of Otolaryngology, Hannover Medical School, Hannover, Germany
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Variations in cochlear duct shape revealed on clinical CT images with an automatic tracing method. Sci Rep 2017; 7:17566. [PMID: 29242508 PMCID: PMC5730551 DOI: 10.1038/s41598-017-16126-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022] Open
Abstract
Cochlear size and morphology vary greatly and may influence the course of a cochlear implant electrode array during insertion and its final intra-cochlear position. Detailed insight into these variations is valuable for characterizing each cochlea and offers the opportunity to study possible correlations with surgical or speech perception outcomes. This study presents an automatic tracing method to assess individual cochlear duct shapes from clinical CT images. On pre-operative CT scans of 479 inner ears the cochlear walls were discriminated by interpolating voxel intensities along radial and perpendicular lines within multiplanar reconstructions at 1 degree intervals from the round window. In all 479 cochleas, the outer wall could be traced automatically up to 720 degrees. The inner wall and floor of the scala tympani in 192 cochleas. The shape of the cochlear walls were modelled using a logarithmic spiral function including an offset value. The vertical trajectories of the scala tympani exhibited a non-monotonous spiral slope with specific regions at risk for CI-related insertion trauma, and three slope categories could be distinguished. This presented automatic tracing method allows the detailed description of cochlear morphology and can be used for both individual and large cohort evaluation of cochlear implant patients.
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Gerber N, Reyes M, Barazzetti L, Kjer HM, Vera S, Stauber M, Mistrik P, Ceresa M, Mangado N, Wimmer W, Stark T, Paulsen RR, Weber S, Caversaccio M, Ballester MAG. A multiscale imaging and modelling dataset of the human inner ear. Sci Data 2017; 4:170132. [PMID: 28925991 PMCID: PMC5604133 DOI: 10.1038/sdata.2017.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/24/2017] [Indexed: 11/25/2022] Open
Abstract
Understanding the human inner ear anatomy and its internal structures is paramount to advance hearing implant technology. While the emergence of imaging devices allowed researchers to improve understanding of intracochlear structures, the difficulties to collect appropriate data has resulted in studies conducted with few samples. To assist the cochlear research community, a large collection of human temporal bone images is being made available. This data descriptor, therefore, describes a rich set of image volumes acquired using cone beam computed tomography and micro-CT modalities, accompanied by manual delineations of the cochlea and sub-compartments, a statistical shape model encoding its anatomical variability, and data for electrode insertion and electrical simulations. This data makes an important asset for future studies in need of high-resolution data and related statistical data objects of the cochlea used to leverage scientific hypotheses. It is of relevance to anatomists, audiologists, computer scientists in the different domains of image analysis, computer simulations, imaging formation, and for biomedical engineers designing new strategies for cochlear implantations, electrode design, and others.
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Affiliation(s)
- Nicolas Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Mauricio Reyes
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern 3100, Switzerland
| | - Livia Barazzetti
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern 3100, Switzerland
| | | | | | | | | | | | | | - Wilhelm Wimmer
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland.,Department of Otorhinolaryngology, Technical University Munich, Munich 80333, Germany
| | - Thomas Stark
- Department of Otorhinolaryngology, Technical University Munich, Munich 80333, Germany
| | | | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Marco Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital, University Hospital of Bern, Bern 3100, Switzerland
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Evaluation of Rigid Cochlear Models for Measuring Cochlear Implant Electrode Position. Otol Neurotol 2017; 37:1560-1564. [PMID: 27755453 DOI: 10.1097/mao.0000000000001245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the accuracy of rigid cochlear models in measuring intra-cochlear positions of cochlear implant (CI) electrodes. PATIENTS Ninety three adults who had undergone CI and pre- and postoperative computed tomographic (CT) imaging. MAIN OUTCOME MEASURES Seven rigid models of cochlear anatomy were constructed using micro-CTs of cochlear specimens. Using each of the seven models, the position of each electrode in each of the 98 ears in our dataset was measured as its depth along the length of the cochlea, its distance to the basilar membrane, and its distance to the modiolus. Cochlear duct length was also measured using each model. RESULTS Standard deviation (SD) across rigid cochlear models in measures of electrode depth, distance to basilar membrane, distance to modiolus, and length of the cochlear duct at two turns were 0.68, 0.11, 0.15, and 1.54 mm. Comparing the estimated position of the electrodes with respect to the basilar membrane, i.e., deciding whether an electrode was located within the scala tympani (ST) or the scala vestibuli (SV), there was not a unanimous agreement between the models for 19% of all the electrodes. With respect to the modiolus, each electrode was classified into one of the three groups depending on its modiolar distance: close, medium, and far. Rigid models did not unanimously agree on modiolar distance for approximately 50% of the electrodes tested. CONCLUSIONS Inter-model variance of rigid cochlear models exists, demonstrating that measurements made using rigid cochlear models are limited in terms of accuracy because of non-rigid inter-subject variations in cochlear anatomy.
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Using Electrically-evoked Compound Action Potentials to Estimate Perceptive Levels in Experienced Adult Cochlear Implant Users. Otol Neurotol 2017; 38:1278-1289. [PMID: 28834942 DOI: 10.1097/mao.0000000000001548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The cochlear implant (CI) fitting level prediction accuracy of electrically-evoked compound action potential (ECAP) should be enhanced by the addition of demographic data in models. INTRODUCTION No accurate automated fitting of CI based on ECAP has yet been proposed. METHODS We recorded ECAP in 45 adults who had been using MED-EL CIs for more than 11 months and collected the most comfortable loudness level (MCL) used for CI fitting (prog-MCL), perception thresholds (meas-THR), and MCL (meas-MCL) measured with the stimulation used for ECAP recording. Linear mixed models taking into account cochlear site factors were computed to explain prog-MCL, meas-MCL, and meas-THR. RESULTS Cochlear region and ECAP threshold were predictors of the three levels. In addition, significant predictors were the ECAP amplitude for the prog-MCL and the duration of deafness for the prog-MCL and the meas-THR. Estimations were more accurate for the meas-THR, then the meas-MCL, and finally the prog-MCL. CONCLUSION These results show that 1) ECAP thresholds are more closely related to perception threshold than to comfort level, 2) predictions are more accurate when the inter-subject and cochlear regions variations are considered, and 3) differences between the stimulations used for ECAP recording and for CI fitting make it difficult to accurately predict the prog-MCL from the ECAP recording. Predicted prog-MCL could be used as bases for fitting but should be used with care to avoid any uncomfortable or painful stimulation.
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Automated analysis of human cochlea shape variability from segmented μ CT images. Comput Med Imaging Graph 2017; 59:1-12. [DOI: 10.1016/j.compmedimag.2017.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/10/2017] [Accepted: 04/04/2017] [Indexed: 12/21/2022]
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Singla A, Gupta T, Sahni D, Gupta AK, Aggarwal A. Topography of neurovascular structures in relation to round window and how it relates to cochlear implantation. Surg Radiol Anat 2017; 39:1309-1316. [PMID: 28597033 DOI: 10.1007/s00276-017-1884-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/01/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this investigation was to evaluate the distances and angles on basal turn of cochlea in relation to round window at which the jugular bulb, internal carotid artery and facial nerve are at maximal risk and their implications in cochlear implantation (CI). METHODS Fifty-four cadaveric temporal bones were microdissected to expose the basal turn of cochlea, the carotid canal, the facial canal and the jugular fossa. The points were marked on the basal turn of cochlea, where there was minimum distance of basal turn of cochlea from the roof of the jugular fossa (point a), carotid canal (point b) and facial canal (point c). The distances and angles of these points from the round window were measured. RESULTS The points a, b and c were at mean (range) distances of 2.8 mm (1.3-4.1 mm), 8.4 mm (6.5-10.4 mm) and 16.4 mm (12.5-20.5 mm) and at mean angles of 30° (15°-45°), 111° (71°-136°) and 284° (255°-315°), respectively, from the round window. CONCLUSIONS This study highlights that 2.8 ± 0.5 mm (30 ± 5.40), 8.4 ± 1 mm (111 ± 12.70) and 16.4 ± 1.7 mm (284 ± 13.5) from the round window are the high-risk points on the basal turn of the cochlea for the jugular bulb, internal carotid artery and facial nerve, respectively. A wide range found for each parameter indicates that it is mandatory to evaluate these distances in each CI patient on preoperative radiographs to avoid intraoperative injury to these vital structures.
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Affiliation(s)
- Anjali Singla
- Department of Anatomy, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India.
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Gupta
- Department of Otolaryngology and Head Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Connor SEJ. Contemporary imaging of auditory implants. Clin Radiol 2017; 73:19-34. [PMID: 28388970 DOI: 10.1016/j.crad.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
There have been significant advances in the diversity and effectiveness of hearing technologies in recent years. Implanted auditory devices may be divided into those that stimulate the cochlear hair cells (bone conduction devices and middle ear implants), and those that stimulate the neural structures (cochlear implants and central auditory implants). Contemporary preoperative and postoperative imaging may be used to help individualise implant selection, optimise surgical technique and predict auditory outcome. This review will introduce the concepts behind auditory implants, and explains how imaging is increasingly used to aid insertion and evaluation of these devices.
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Affiliation(s)
- S E J Connor
- Neuroradiology Department, King's College Hospital, London, UK; Radiology Department, Guy's and St Thomas' Hospital, London, UK.
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The Effect of Scala Tympani Morphology on Basilar Membrane Contact With a Straight Electrode Array: A Human Temporal Bone Study. Otol Neurotol 2017; 38:47-53. [DOI: 10.1097/mao.0000000000001259] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elfarnawany M, Alam SR, Rohani SA, Zhu N, Agrawal SK, Ladak HM. Micro-CT versus synchrotron radiation phase contrast imaging of human cochlea. J Microsc 2016; 265:349-357. [PMID: 27935035 DOI: 10.1111/jmi.12507] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 10/30/2016] [Indexed: 11/26/2022]
Abstract
High-resolution images of the cochlea are used to develop atlases to extract anatomical features from low-resolution clinical computed tomography (CT) images. We compare visualization and contrast of conventional absorption-based micro-CT to synchrotron radiation phase contrast imaging (SR-PCI) images of whole unstained, nondecalcified human cochleae. Three cadaveric cochleae were imaged using SR-PCI and micro-CT. Images were visually compared and contrast-to-noise ratios (CNRs) were computed from n = 27 regions-of-interest (enclosing soft tissue) for quantitative comparisons. Three-dimensional (3D) models of cochlear internal structures were constructed from SR-PCI images using a semiautomatic segmentation method. SR-PCI images provided superior visualization of soft tissue microstructures over conventional micro-CT images. CNR improved from 7.5 ± 2.5 in micro-CT images to 18.0 ± 4.3 in SR-PCI images (p < 0.0001). The semiautomatic segmentations yielded accurate reconstructions of 3D models of the intracochlear anatomy. The improved visualization, contrast and modelling achieved using SR-PCI images are very promising for developing atlas-based segmentation methods for postoperative evaluation of cochlear implant surgery.
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Affiliation(s)
- M Elfarnawany
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Riyahi Alam
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S A Rohani
- Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada
| | - N Zhu
- Bio-Medical Imaging and Therapy Facility, Canadian Light Source Inc., University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - H M Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Biomedical Engineering Graduate Program, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
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O'Connell BP, Hunter JB, Wanna GB. The importance of electrode location in cochlear implantation. Laryngoscope Investig Otolaryngol 2016; 1:169-174. [PMID: 28894813 PMCID: PMC5510268 DOI: 10.1002/lio2.42] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2016] [Indexed: 11/29/2022] Open
Abstract
Objectives As indications for cochlear implantation have expanded to include patients with more residual hearing, increasing emphasis has been placed on minimally traumatic electrode insertion. Histopathologic evaluation remains the gold standard for evaluation of cochlear trauma, but advances in imaging techniques have allowed clinicians to determine scalar electrode location in vivo. This review will examine the relationship between scalar location of electrode arrays and audiologic outcomes. In addition, the impact that surgical approach, electrode design, and insertion depth have on scalar location will be evaluated. Data Sources: PubMed literature review Review Methods: A review of the current literature was conducted to analyze the relationship between scalar location of cochlear implant electrode arrays and speech perception outcomes. Further, data were reviewed to determine the impact that surgical variables have on scalar electrode location. Results Electrode insertions into the scala tympani are associated with superior speech perception and higher rates of hearing preservation. Lateral wall electrodes, and round window/extended round window approaches appear to maximize the likelihood of a scala tympani insertion. It does not appear that deeper insertions are associated with higher rates of scalar translocation. Conclusion Superior audiologic outcomes are observed for electrode arrays inserted entirely within the scala tympani. The majority of clinical data demonstrate that lateral wall design and a round window approach increase the likelihood of a scala tympani insertion. Level of Evidence N/A.
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Affiliation(s)
- Brendan P O'Connell
- Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee U.S.A
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee U.S.A
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee U.S.A
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Cochlear Size and Shape Variability and Implications in Cochlear Implantation Surgery. Otol Neurotol 2016; 37:1307-13. [DOI: 10.1097/mao.0000000000001189] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schurzig D, Lexow GJ, Majdani O, Lenarz T, Rau TS. Three-dimensional modeling of the cochlea by use of an arc fitting approach. Comput Methods Biomech Biomed Engin 2016; 19:1785-1799. [DOI: 10.1080/10255842.2016.1188921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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De Seta D, Nguyen Y, Bonnard D, Ferrary E, Godey B, Bakhos D, Mondain M, Deguine O, Sterkers O, Bernardeschi D, Mosnier I. The Role of Electrode Placement in Bilateral Simultaneously Cochlear-Implanted Adult Patients. Otolaryngol Head Neck Surg 2016; 155:485-93. [DOI: 10.1177/0194599816645774] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/01/2016] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the influence of the electrode placement on hearing performance in adult patients who were simultaneously and bilaterally cochlear implanted. Study Design Case series with planned data collection. Setting Tertiary referral university centers. Subjects and Methods The postoperative computed tomography scan was studied for 19 patients who were simultaneously and bilaterally implanted with a long straight electrode array. The size of the cochlea was measured in consideration of the major cochlear diameter and cochlear height. The electrode-to-modiolus distance for the electrodes positioned at 180 and 360 degrees and the angular depth of insertion of the array were also measured. Speech perception was assessed at 1 and 5 years postimplantation with disyllabic word lists in quiet and in noise, with the speech coming from the front and a background noise (cocktail party) coming from 5 loudspeakers. Results At 1 year postimplantation, the electrode-to-modiolus distance at 180 degrees was correlated with the speech perception scores in both quiet and noise. In patients with a full electrode insertion, no correlation was found between the angular depth of insertion and hearing performance. The speech perception scores in noise gradually declined as a function of the number of inserted and active electrodes. No relationship between electrode position and speech perception scores was found at 5 years postimplantation. Conclusion In adult patients who were simultaneously and bilaterally implanted, the use of a long straight array, the full electrode array insertion, and the proximity to the modiolus might be determining factors to obtain the best speech performance at 1 year, without influence on the speech perception scores after long-term use.
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Affiliation(s)
- Daniele De Seta
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- Sensory Organs Department, Sapienza University of Rome, Rome, Italy
| | - Yann Nguyen
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- UMR-S 1159 Inserm / Université Paris 6 Pierre et Marie Curie, France
| | | | - Evelyne Ferrary
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- UMR-S 1159 Inserm / Université Paris 6 Pierre et Marie Curie, France
| | - Benoit Godey
- Service ORL, Hôpital Pontchailloux, Rennes, France
| | | | - Michel Mondain
- Service ORL, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Olivier Sterkers
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- UMR-S 1159 Inserm / Université Paris 6 Pierre et Marie Curie, France
| | - Daniele Bernardeschi
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- UMR-S 1159 Inserm / Université Paris 6 Pierre et Marie Curie, France
| | - Isabelle Mosnier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, 75013, Paris, France
- UMR-S 1159 Inserm / Université Paris 6 Pierre et Marie Curie, France
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Cho HS, Lee KY, Choi H, Jang JH, Lee SH. Dexamethasone Is One of the Factors Minimizing the Inner Ear Damage from Electrode Insertion in Cochlear Implantation. Audiol Neurootol 2016; 21:178-86. [PMID: 27229744 DOI: 10.1159/000445099] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate the efficacy of preoperative and intraoperative steroid administration for inner ear protection in cochlear implantation (CI). Nineteen subjects who underwent CI were included in the study, and 10 subjects were enrolled as controls (steroid-administered group, n = 19; control group, n = 10). Dexamethasone (dexamethasone sodium phosphate, 5 mg/ml) was systemically administered preoperatively (1 ml) and topically applied during CI (0.5 ml). The extent of hearing preservation (HP) after CI and the change in the bithermal caloric response were evaluated. Hearing level was calculated using mean thresholds [(250 Hz + 500 Hz + 1,000 Hz + 2,000 Hz)/4]. Preoperative hearing thresholds were similar in the steroid-administered and control groups (100.92 ± 12.60 vs. 103.29 ± 14.39 dB, p = 0.650). The mean thresholds significantly increased in both groups after surgery (108.46 ± 14.08 dB, p = 0.006, for the steroid-administered group; 117.50 ± 6.34 dB, p = 0.027, for the control group), and the difference between the groups was also significant (p = 0.027). The postoperative shift in the hearing thresholds at frequencies of 500 and 1,000 Hz was significant in the steroid-administered group and that at the frequencies of 500, 1,000 and 2,000 Hz was significant in the control group. However, the extent of the shift in hearing threshold levels at each frequency was not significantly different between the groups. Preservation of hearing thresholds was compared between the groups, and there were significantly more subjects with complete and partial HP in the steroid-administered group than in the control group (p = 0.008). The preoperative caloric response was maintained after CI in the steroid-administered group. This study suggests that the perioperative use of a steroid could minimize the inner ear damage after CI.
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Affiliation(s)
- Hyun Soo Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, Kyungpook National University College of Medicine, Daegu, South Korea
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Visualization, measurement and modelling of the cochlea using rotating midmodiolar slice planes. Int J Comput Assist Radiol Surg 2016; 11:1855-69. [DOI: 10.1007/s11548-016-1374-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/02/2016] [Indexed: 01/14/2023]
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Ryu KA, Lyu AR, Park H, Choi JW, Hur GM, Park YH. Intracochlear Bleeding Enhances Cochlear Fibrosis and Ossification: An Animal Study. PLoS One 2015; 10:e0136617. [PMID: 26308864 PMCID: PMC4550248 DOI: 10.1371/journal.pone.0136617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/12/2015] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to investigate the effects of intracochlear bleeding during cochleostomy on cochlear inflammatory response and residual hearing in a guinea pig animal model. Auditory brainstem response threshold shifts were greater in blood injected ears (p<0.05). Interleukin-1β, interleukin-10, tumor necrosis factor-α and nitric oxide synthase 2, cytokines that are related to early stage inflammation, were significantly increased in blood injected ears compared to normal and cochleostomy only ears at 1 day after surgery; with the increased IL-1β being sustained until 3 days after the surgery (p<0.05). Hair cells were more severely damaged in blood injected ears than in cochleostomy only ears. Histopathologic examination revealed more extensive fibrosis and ossification in blood injected ears than cochleostomy only ears. These results show that intracochlear bleeding enhanced cochlear inflammation resulting in increased fibrosis and ossification in an experimental animal model.
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Affiliation(s)
- Kyeung A. Ryu
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ah-Ra Lyu
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Heesung Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jin Woong Choi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Gang Min Hur
- Department of Pharmacology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yong-Ho Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Brain Research Institute, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- * E-mail:
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Scalar localization by cone-beam computed tomography of cochlear implant carriers: a comparative study between straight and periomodiolar precurved electrode arrays. Otol Neurotol 2015; 36:422-9. [PMID: 25575374 DOI: 10.1097/mao.0000000000000705] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the incidence of dislocation of precurved versus straight flexible cochlear implant electrode arrays using cone-beam computed tomography (CBCT) image analyses. STUDY DESIGN Consecutive nonrandomized case-comparison study. SETTINGS Tertiary referral center. PATIENTS Analyses of patients' CBCT images after cochlear implant surgery. INTERVENTION(S) Precurved and straight flexible electrode arrays from two different manufacturers were implanted. A round window insertion was performed in most cases. Two cases necessitated a cochleostomy. The patients' CBCT images were reconstructed in the coronal oblique, sagittal oblique, and axial oblique section. MAIN OUTCOME MEASURES The insertion depth angle and the incidence of dislocation from the scala tympani to the scala vestibuli were determined. RESULTS The CBCT images and the incidence of dislocation were analyzed in 54 patients (61 electrode arrays). Thirty-one patients were implanted with a precurved perimodiolar electrode array and 30 patients with a straight flexible electrode array. A total of nine (15%) scalar dislocations were observed in both groups. Eight (26%) scalar dislocations were observed in the precurved array group and one (3%) in the straight array group. Dislocation occurred at an insertion depth angle between 170 and 190 degrees in the precurved array group and at approximately 370 degrees in the straight array group. CONCLUSION With precurved arrays, dislocation usually occurs in the ascending part of the basal turn of the cochlea. With straight flexible electrode arrays, the incidence of dislocation was lower, and it seems that straight flexible arrays have a higher chance of a confined position within the scala tympani than perimodiolar precurved arrays.
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Surgical Anatomy of the Basal Turn of the Human Cochlea as Pertaining to Cochlear Implantation. Otol Neurotol 2015; 36:323-8. [PMID: 24770412 DOI: 10.1097/mao.0000000000000371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Jeschke M, Moser T. Considering optogenetic stimulation for cochlear implants. Hear Res 2015; 322:224-34. [PMID: 25601298 DOI: 10.1016/j.heares.2015.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/09/2014] [Accepted: 01/08/2015] [Indexed: 02/04/2023]
Abstract
Electrical cochlear implants are by far the most successful neuroprostheses and have been implanted in over 300,000 people worldwide. Cochlear implants enable open speech comprehension in most patients but are limited in providing music appreciation and speech understanding in noisy environments. This is generally considered to be due to low frequency resolution as a consequence of wide current spread from stimulation contacts. Accordingly, the number of independently usable stimulation channels is limited to less than a dozen. As light can be conveniently focused, optical stimulation might provide an alternative approach to cochlear implants with increased number of independent stimulation channels. Here, we focus on summarizing recent work on optogenetic stimulation as one way to develop optical cochlear implants. We conclude that proof of principle has been presented for optogenetic stimulation of the cochlea and central auditory neurons in rodents as well as for the technical realization of flexible μLED-based multichannel cochlear implants. Still, much remains to be done in order to advance the technique for auditory research and even more for eventual clinical translation. This article is part of a Special Issue entitled <Lasker Award>.
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Affiliation(s)
- Marcus Jeschke
- Institute for Auditory Neuroscience, University Medical Center Goettingen, Goettingen, Germany; Auditory Neuroscience Group, German Primate Center, Goettingen, Germany.
| | - Tobias Moser
- Institute for Auditory Neuroscience, University Medical Center Goettingen, Goettingen, Germany; Auditory Neuroscience Group, German Primate Center, Goettingen, Germany; Bernstein Focus for Neurotechnology, University of Göttingen, Goettingen, Germany; Collaborative Research Center 889, University of Goettingen Medical Center, Goettingen, Germany; Center for Nanoscale Microscopy and Molecular Physiology of the Brain, University of Goettingen, Goettingen, Germany.
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Colby CC, Todd NW, Harnsberger HR, Hudgins PA. Standardization of CT depiction of cochlear implant insertion depth. AJNR Am J Neuroradiol 2014; 36:368-71. [PMID: 25339650 DOI: 10.3174/ajnr.a4105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Imaging a cochlear implant with CT is challenging because of implant-induced artifacts, anatomic cochlear variations, and lack of standard terminology for cochlear anatomy. The purposes of this project were to determine whether the cochlear implant tip was more accurately located on oblique CT reformations than on standard images, to review radiology reports for accurate cochlear implant locations, and to assess agreement between an implant surgeon and neuroradiologist by using standardized cochlear anatomy terminology for cochlear implant depth. MATERIALS AND METHODS In this retrospective study, a neuroradiologist and an implant surgeon independently viewed temporal bone CT images of 36 ears with cochlear implants. Direct axial images, standard coronal reformations, and oblique reformations parallel to the cochlea were compared to determine implant tip location, which was described by using a proposed standardized quadrant terminology. Implant locations were compared with the initial formal report generated by the original interpreting neuroradiologist. RESULTS Thirty-six temporal bones with cochlear implants underwent CT interpretation for implant location. Interobserver agreement was similar when comparing cochlear implant tip location by using a quadrant nomenclature on axial and coronal images and on oblique reformations. Clinical radiology reports all were imprecise and ambiguous in describing the location of the cochlear implant tip. CONCLUSIONS Accurate determination of insertion depth of the cochlear implant array can be determined by assessment of the implant tip on axial, coronal, and oblique CT images, but description of the tip location can be inaccurate due to lack of standardized terminology. We propose using a standardized terminology to communicate tip location by using the round window as the zero reference and quadrant numbering to describe cochlear turns. This results in improvement in radiology report accuracy and consistency regarding the cochlear implant insertion depth.
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Affiliation(s)
- C C Colby
- From the Department of Otolaryngology and Head and Neck Surgery (C.C.C.), University of Minnesota, Minneapolis, Minnesota
| | - N W Todd
- Department of Otolaryngology and Head and Neck Surgery (N.W.T.)
| | - H R Harnsberger
- Division of Neuroradiology (H.R.H.), Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - P A Hudgins
- Head and Neck Imaging Section (P.A.H.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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