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Fröhlich M, Deutz J, Wangenheim M, Rau TS, Lenarz T, Kral A, Schurzig D. The role of pressure and friction forces in automated insertion of cochlear implants. Front Neurol 2024; 15:1430694. [PMID: 39170077 PMCID: PMC11337231 DOI: 10.3389/fneur.2024.1430694] [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: 05/10/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Objectives Despite the success of cochlear implant (CI) surgery for hearing restoration, reducing CI electrode insertion forces is an ongoing challenge with the goal to further reduce post-implantation hearing loss. While research in this field shows that both friction and quasistatic pressure forces occur during CI insertion, there is a lack of studies distinguishing between these origins. The present study was conducted to analyze the contribution of both force phenomena during automated CI insertion. Methods Five MED-EL FLEX28 CI electrode arrays were inserted into both a regular and uncoiled version of the same average scala tympani (ST). Both ST models had a pressure release hole at the apical end, which was kept open or closed to quantify pressure forces. ST models were filled with different sodium dodecyl sulfate (SDS) lubricants (1, 5, and 10% SDS, water). The viscosity of lubricants was determined using a rheometer. Insertions were conducted with velocities ranging from v= 0.125 mm/s to 2.0 mm/s. Results Viscosity of SDS lubricants at 20°C was 1.28, 1.96, and 2.51 mPas for 1, 5, and 10% SDS, respectively, which lies within the values reported for human perilymph. In the uncoiled ST model, forces remained within the noise floor (maximum: 0.049 × 10-3 N ± 1.5 × 10-3 N), indicating minimal contribution from quasistatic pressure. Conversely, forces using the regular, coiled ST model were at least an order of magnitude larger (minimum: Fmax = 28.95 × 10-3 N, v = 1 mm/s, 10% SDS), confirming that friction forces are the main contributor to total insertion forces. An N-way ANOVA revealed that both lubricant viscosity and insertion speed significantly reduce insertion forces (p < 0.001). Conclusion For the first time, this study demonstrates that at realistic perilymph viscosities, quasistatic pressure forces minimally affect the total insertion force profile during insertion. Mixed friction is the main determinant, and significantly decreases with increaseing insertion speeds. This suggests that in clinical settings with similar ST geometries and surgical preparation, quasistatic pressure plays a subordinate role. Moreover, the findings indicate that managing the hydrodynamics of the cochlear environment, possibly through pre-surgical preparation or the use of specific lubricants, could effectively reduce insertion forces.
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Affiliation(s)
- Max Fröhlich
- MED-EL Research Center, MED-EL Medical Electronics GmbH, Hannover, Germany
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Jaro Deutz
- MED-EL Research Center, MED-EL Medical Electronics GmbH, Hannover, Germany
- Institute of Dynamic and Vibration Research, Leibniz University Hannover, Hannover, Germany
| | - Matthias Wangenheim
- Institute of Dynamic and Vibration Research, Leibniz University Hannover, Hannover, Germany
| | - Thomas S. Rau
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Andrej Kral
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
| | - Daniel Schurzig
- MED-EL Research Center, MED-EL Medical Electronics GmbH, Hannover, Germany
- Department of Otolaryngology, Hannover Medical School, Hanover, Germany
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Dhanasingh A, Nielsen SB, Beal F, Schilp S, Hessler R, Jolly C, Hochmair I. Cochlear implant electrode design for safe and effective treatment. Front Neurol 2024; 15:1348439. [PMID: 38756216 PMCID: PMC11096578 DOI: 10.3389/fneur.2024.1348439] [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: 12/02/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
The optimal placement of a cochlear implant (CI) electrode inside the scala tympani compartment to create an effective electrode-neural interface is the base for a successful CI treatment. The characteristics of an effective electrode design include (a) electrode matching every possible variation in the inner ear size, shape, and anatomy, (b) electrically covering most of the neuronal elements, and (c) preserving intra-cochlear structures, even in non-hearing preservation surgeries. Flexible electrode arrays of various lengths are required to reach an angular insertion depth of 680° to which neuronal cell bodies are angularly distributed and to minimize the rate of electrode scalar deviation. At the time of writing this article, the current scientific evidence indicates that straight lateral wall electrode outperforms perimodiolar electrode by preventing electrode tip fold-over and scalar deviation. Most of the available literature on electrode insertion depth and hearing outcomes supports the practice of physically placing an electrode to cover both the basal and middle turns of the cochlea. This is only achievable with longer straight lateral wall electrodes as single-sized and pre-shaped perimodiolar electrodes have limitations in reaching beyond the basal turn of the cochlea and in offering consistent modiolar hugging placement in every cochlea. For malformed inner ear anatomies that lack a central modiolar trunk, the perimodiolar electrode is not an effective electrode choice. Most of the literature has failed to demonstrate superiority in hearing outcomes when comparing perimodiolar electrodes with straight lateral wall electrodes from single CI manufacturers. In summary, flexible and straight lateral wall electrode type is reported to be gentle to intra-cochlear structures and has the potential to electrically stimulate most of the neuronal elements, which are necessary in bringing full benefit of the CI device to recipients.
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Morales-Puebla JM, Gavilán J, Lassaletta L. Inverted clip technique for cochlear implant electrode array fixation: how I do it. Eur Arch Otorhinolaryngol 2024; 281:1057-1060. [PMID: 38001386 DOI: 10.1007/s00405-023-08329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Electrode migration has been identified as a complication primarily related to straight electrodes. To address this issue, the use of a fixation clip has been suggested as an alternative to stabilize the electrode lead and reduce the risk of migration. METHODS A modified approach to the standard fixation clip procedure is introduced. Steps and technical considerations are presented in the video attached. CONCLUSIONS This novel configuration offers enhanced fixation of the electrode array without requiring additional surgical time and without posing any additional risk to the facial nerve.
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Affiliation(s)
- José Manuel Morales-Puebla
- Department of Otorhinolaryngology, La Paz University Hospital, Paseo La Castellana 261, 28046, Madrid, Spain.
- IdiPAZ Research Institute, Madrid, Spain.
- Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain.
| | - Javier Gavilán
- Department of Otorhinolaryngology, La Paz University Hospital, Paseo La Castellana 261, 28046, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Paseo La Castellana 261, 28046, Madrid, Spain
- IdiPAZ Research Institute, Madrid, Spain
- Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
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Gatto A, Tofanelli M, Costariol L, Rizzo S, Borsetto D, Gardenal N, Uderzo F, Boscolo-Rizzo P, Tirelli G. Otological Planning Software-OTOPLAN: A Narrative Literature Review. Audiol Res 2023; 13:791-801. [PMID: 37887851 PMCID: PMC10603892 DOI: 10.3390/audiolres13050070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
The cochlear implant (CI) is a widely accepted option in patients with severe to profound hearing loss receiving limited benefit from traditional hearing aids. CI surgery uses a default setting for frequency allocation aiming to reproduce tonotopicity, thus mimicking the normal cochlea. One emerging instrument that may substantially help the surgeon before, during, and after the surgery is a surgical planning software product developed in collaboration by CASCINATION AG (Bern, Switzerland) and MED-EL (Innsbruck Austria). The aim of this narrative review is to present an overview of the main features of this otological planning software, called OTOPLAN®. The literature was searched on the PubMed and Web of Science databases. The search terms used were "OTOPLAN", "cochlear planning software" "three-dimensional imaging", "3D segmentation", and "cochlear implant" combined into different queries. This strategy yielded 52 publications, and a total of 31 studies were included. The review of the literature revealed that OTOPLAN is a useful tool for otologists and audiologists as it improves preoperative surgical planning both in adults and in children, guides the intraoperative procedure and allows postoperative evaluation of the CI.
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Affiliation(s)
- Annalisa Gatto
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Ludovica Costariol
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Serena Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Francesco Uderzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
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Tirkkonen M, Iso-Mustajärvi M, Dhanasingh A, Linder P, Myller K, Dietz A. The growth of the mastoid volume in children with a cochlear implant. Sci Rep 2023; 13:10967. [PMID: 37414822 PMCID: PMC10325979 DOI: 10.1038/s41598-023-37160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/16/2023] [Indexed: 07/08/2023] Open
Abstract
The aim of this study was to understand the mastoid volume development in children who undergo cochlear implantation surgery. Cochlear implant (CI) database of our clinic (Kuopio University Hospital) was reviewed for computed tomography (CT) images of CI patients (age under 12 years at the time of implantation) with a minimum time interval of twelve months between their pre- and postoperative CT. Eight patients (nine ears) were found eligible for inclusion. Three linear measurements were taken by using picture archiving and communication systems (PACS) software and the volume of the MACS was measured with Seg 3D software. The mastoid volume increased on average 817.5 mm3 between the pre- and the postoperative imaging time point. The linear distances measured between anatomical points like the round window (RW)- bony ear canal (BEC), the RW-sigmoid sinus (SS), the BEC-SS, and the mastoid tip (MT)-superior semicircular canal (SSC) increased significantly with the age of the patient at both the pre-op and post-op time points. The linear measurements between key anatomical points and mastoid volume showed a positive linear correlation. The correlation between linear measurement and volume were significant between the MT-SSC (r = 0.706, p = 0.002), RW-SS (r = 0.646, p = 0.005) and RW-BEC (r = 0.646, p = 0.005). Based on our findings from the CI implanted patients and comparing it with the previous literature findings from non-CI implanted patients, we could say that the CI surgery seem to have no effect on the development of mastoid volume in children.
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Affiliation(s)
- Minna Tirkkonen
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | | | | | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Katariina Myller
- Department of Oncology, Vaasa Central Hospital, Vaasa, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
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Gantz JA, Gantz BJ, Kaufmann CR, Henslee AM, Dunn CC, Hua X, Hansen MR. A Steadier Hand: The First Human Clinical Trial of a Single-Use Robotic-Assisted Surgical Device for Cochlear Implant Electrode Array Insertion. Otol Neurotol 2023; 44:34-39. [PMID: 36509435 PMCID: PMC9757840 DOI: 10.1097/mao.0000000000003749] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the safety and utility of an investigational robotic-assisted cochlear implant insertion system. STUDY DESIGN Prospective, single-arm, open-label study under abbreviated Investigational Device Exemption requirements. SETTING All procedures were performed, and all data were collected, at a single tertiary referral center. PATIENTS Twenty-one postlingually deafened adult subjects that met Food and Drug Administration indication criteria for cochlear implantation. INTERVENTION All patients underwent standard-of-care surgery for unilateral cochlear implantation with the addition of a single-use robotic-assisted insertion device during cochlear electrode insertion. MAIN OUTCOME MEASURES Successful insertion of cochlear implant electrode array, electrode array insertion time, postoperative implant function. RESULTS Successful robotic-assisted insertion of lateral wall cochlear implant electrode arrays was achieved in 20 (95.2%) of 21 patients. One insertion was unable to be achieved by either robotic-assisted or manual insertion methods, and the patient was retrospectively found to have a preexisting cochlear fracture. Mean intracochlear electrode array insertion time was 3 minutes 15 seconds. All implants with successful robotic-assisted electrode array insertion (n = 20) had normal impedance and neural response telemetry measures for up to 6 months after surgery. CONCLUSIONS Here we report the first human trial of a single-use robotic-assisted surgical device for cochlear implant electrode array insertion. This device successfully and safely inserted lateral wall cochlear implant electrode arrays from the three device manufacturers with devices approved but he Food and Drug Administration.
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Affiliation(s)
- Jay A. Gantz
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
| | - Bruce J. Gantz
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
- Department of Neurosurgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
| | | | | | - Camille C Dunn
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
| | - Xiaoyang Hua
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
| | - Marlan R. Hansen
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
- Department of Neurosurgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1089, USA
- iotaMotion Inc, 14 ½ South Clinton St. Iowa City, IA 52240, USA
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Sprinzl GM, Magele A. Personalized Medicine in Otolaryngology: Special Topic Otology. J Pers Med 2022; 12:jpm12111820. [PMID: 36579531 PMCID: PMC9697707 DOI: 10.3390/jpm12111820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Globally, more than 1.5 billion people experience some degree of hearing loss [...].
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Affiliation(s)
- Georg Mathias Sprinzl
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, Dunant-Platz 1, 3100 St. Pölten, Austria
- Karl Landsteiner Institute of Implantable Hearing Devices, Henri Dunant Platz 1, 3100 St. Pölten, Austria
- Correspondence: ; Tel.: +43-2742-9004-11500
| | - Astrid Magele
- University Clinic St. Poelten, Department of Otorhinolaryngology, Head & Neck Surgery, Dunant-Platz 1, 3100 St. Pölten, Austria
- Karl Landsteiner Institute of Implantable Hearing Devices, Henri Dunant Platz 1, 3100 St. Pölten, Austria
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Van de Heyning PH, Dazert S, Gavilan J, Lassaletta L, Lorens A, Rajan GP, Skarzynski H, Skarzynski PH, Tavora-Vieira D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Polak M. Systematic Literature Review of Hearing Preservation Rates in Cochlear Implantation Associated With Medium- and Longer-Length Flexible Lateral Wall Electrode Arrays. Front Surg 2022; 9:893839. [PMID: 36034377 PMCID: PMC9407249 DOI: 10.3389/fsurg.2022.893839] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe last two decades have demonstrated that preoperative functional acoustic hearing (residual hearing) can be preserved during cochlear implant (CI) surgery. However, the relationship between the electrode array length and postoperative hearing preservation (HP) with lateral wall flexible electrode variants is still under debate.Aims/ObjectivesThis is a systematic literature review that aims to analyze the HP rates of patients with residual hearing for medium-length and longer-length lateral wall electrodes.MethodA systematic literature review methodology was applied following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations to evaluate the HP rates of medium-length and longer-length lateral wall electrodes from one CI manufacturer (medium length FLEX 24, longer length FLEX 28 and FLEX SOFT, MED-EL, Innsbruck, Austria). A search using search engine PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) was performed using the search terms “hearing preservation” or “residual hearing” and “cochlear implant” in “All fields.” Articles published only in English between January 01, 2009 and December 31, 2020 were included in the search.ResultsThe HP rate was similar between medium-length (93.4%–93.5%) and longer (92.1%–86.8%) electrodes at 4 months (p = 0.689) and 12 months (p = 0.219). In the medium-length electrode group, patients under the age of 45 years had better HP than patients above the age of 45 years.ConclusionsBoth medium-length and longer electrode arrays showed high hearing preservation rates. Considering the hearing deterioration over time, implanting a longer electrode at primary surgery should be considered, thus preventing the need for future reimplantation.
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Affiliation(s)
- Paul H Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Correspondence: Paul H Van de Heyning
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos, III, (CIBERER-U761), Madrid, Spain
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
| | - Dayse Tavora-Vieira
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
- Audiology Department, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Vedat Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Belgium
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Marek Polak
- Department of Electrophysiology, R&D, MED-EL, Innsbruck, Austria
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