Mechanisms of electrode fold-over in cochlear implant surgery when using a flexible and slim perimodiolar electrode array

Ramos‐Macías, Ángel; Miguel, Angel R. De; Falcón-González, Juan Carlos

doi:10.1080/00016489.2016.1271449

Cited by 27 publications

(21 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In their study, the electrode to modiolus distance was evaluated using CT. As in our study, advancing the CI532 electrode array past the first white marker position into the cochlea opening was undesirable, as it does not result in greater total insertion depths and only serves to increase the insertion depth of the first electrode contact and move basal electrodes away from the modiolus [16]. Ramos-Macías et al also evaluated electrode to modiolus distance using CT and demonstrated that it was constant in all electrode arrays and less than 0.3 mm [18]. Unfortunately, the pull-back technique was not performed in either of the studies.…”

Section: Discussionmentioning

confidence: 95%

“…By contrast, preformed electrode arrays are fabricated in a spiral configuration and adjusted to the human cochlea's modiolar area. These electrode arrays were designed for intracochlear placement next to the modiolus [18]. This position leads to a narrower electric stimulation, a lower current spread to the adjacent neural population, a lower channel interaction, and a reduced risk of facial nerve stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally tip foldovers can occur [19]. With straight flexible electrode arrays, the incidence of dislocation has been found to be lower [18].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Pull-Back Technique for the 532 Slim Modiolar Electrode

Riemann

Sudhoff

Todt

2019

BioMed Research International

View full text Add to dashboard Cite

Introduction. The distance between the modiolus and the electrode array is one factor that has become the focus of many discussions and studies. Positioning the electrode array closer to the spiral ganglion with the goal of reducing the current spread has been shown to improve hearing outcomes. The perimodiolar electrode arrays can be complemented with a surgical manoeuvre called the pull-back technique. This study focuses its attention on the recently developed 532 slim modiolar electrode. Objective. To investigate the intracochlear movements and pull-back technique for the 532 slim modiolar electrode. Material and Methods. A decapping procedure of the cochlea was performed on 5 temporal bones. The electrode array was inserted, and the intracochlear movements were microscopically examined and digitally captured. Three situations were analysed: the initial insertion, the overinsertion, and the pull-back position. The position of the three white markers of the electrode array in relation to the round window (RW) was evaluated while performing these three actions. Results. The initial insertion achieved an acceptable perimodiolar position of the electrode array, but a gap was still observed between the mid-portion of the array and the modiolus (the first white marker was seen in the RW). When we inserted the electrode more deeply, the mid-portion of the array was pushed away from the modiolus (the second and third white markers were seen in the RW). After applying the pull-back technique, the gap observed during the initial insertion disappeared, resulting in an optimal perimodiolar position (the first white marker was once again visible in the RW). Conclusion. This temporal bone study demonstrated that when applying the pull-back technique for the 532 slim modiolar electrode, a closer proximity to the modiolus was achieved when the first white marker of the electrode array was visible in the round window.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Pull-Back Technique for the 532 Slim Modiolar Electrode

Riemann

Sudhoff

Todt

2019

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Tip fold-over may have an occurrence rate of 1.5% and usually occurs with flexible and slim perimodiolar electrodes [ 63 , 66 , 67 ]. Fold-over in the cochlea may lead to the rupture of the basilar membrane.…”

Section: Post-operative Imagingmentioning

confidence: 99%

Pre- and post-operative imaging of cochlear implants: a pictorial review

et al. 2020

View full text Add to dashboard Cite

Cochlear implants are increasingly used to treat sensorineural hearing disorders in both children and adults. Pre-operative computed tomography and magnetic resonance imaging play a pivotal role in patient selection, to rule out findings that preclude surgery or identify conditions which may have an impact on the surgical procedure. The post-operative position of the electrode array within the cochlea can be reliably identified using cone-beam computed tomography. Recognition of scalar dislocation, cochlear dislocation, electrode fold, and malposition of the electrode array may have important consequences for the patient such as revision surgery or adapted fitting.

show abstract

“…This problem, referred to as tip fold-over or roll-over, occurs when the tip of the electrode array impinges the modiolar wall or other structure and is temporarily held stationary. In such a situation, further pushing of the array results in more electrodes advancing past it (Dhanasingh & Jolly, 2019), (Ramos-Macias et al, 2017). It can cause the patient to suffer from various post-operative complications, including reduced speech comprehension (Wanna et al, 2014), vertigo, pitch confusion and tinnitus (Dhanasingh & Jolly, 2019), and even cause injury to important adjacent neurovascular structures (Ying et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

A Capacitive Cochlear Implant Electrode Array Sensing System to Discriminate Fold-Over Pattern

Hou

Boulgouris

et al. 2021

J Speech Lang Hear Res

View full text Add to dashboard Cite

Purpose During insertion of the cochlear implant electrode array, the tip of the array may fold back on itself and can cause serious complications to patients. This article presents a sensing system for cochlear implantation in a cochlear model. The electrode array fold-over behaviors can be detected by analyzing capacitive information from the array tip. Method Depending on the angle of the array tip against the cochlear inner wall when it enters the cochlear model, different insertion patterns of the electrode array could occur, including smooth insertion, buckling, and fold-over. The insertion force simulating the haptic feedback for surgeons and bipolar capacitance signals during the insertion progress were collected and compared. The Pearson correlation coefficient (PCC) was applied to the collected capacitive signals to discriminate the fold-over pattern. Results Forty-six electrode array insertions were conducted and the deviation of the measured insertion force varies between a range of 20% and 30%. The capacitance values from electrode pair (1, 2) were recorded for analyzing. A threshold for the PCC is set to be 0.94 that can successfully discriminate the fold over insertions from the other two types of insertions, with a success rate of 97.83%. Conclusions Capacitive measurement is an effective method for the detection of faulty insertions and the maximization of the outcome of cochlear implantation. The proposed capacitive sensing system can be used in other tissue implants in vessels, spinal cord, or heart.

show abstract

Mechanisms of electrode fold-over in cochlear implant surgery when using a flexible and slim perimodiolar electrode array

Abstract: A perimodiolar position can be achieved with the new CI532 electrode array. The new electrode also seems to be reliable for atraumatic intracochlear placement in scala tympani (ST).

Cited by 27 publications

References 14 publications

The Pull-Back Technique for the 532 Slim Modiolar Electrode

The Pull-Back Technique for the 532 Slim Modiolar Electrode

Pre- and post-operative imaging of cochlear implants: a pictorial review

A Capacitive Cochlear Implant Electrode Array Sensing System to Discriminate Fold-Over Pattern

Contact Info

Product

Resources

About