Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure

Todt, Ingo; Karimi, Dania; Luger, J.; Ernst, Arneborg; Mittmann, Philipp

doi:10.1155/2016/3937196

Cited by 10 publications

(15 citation statements)

References 17 publications

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“…Indeed, earlier studies demonstrated that moisturized electrode insertion offers a reliable nontraumatic method for electrode array insertion during CI . Negative pressure changes described here are known from previous studies . The opening of the round window membrane with the carbon dioxide laser or any electrode movements after implantation can cause those negative pressure shifts .…”

Section: Discussionsupporting

confidence: 55%

“…Negative pressure changes described here are known from previous studies . The opening of the round window membrane with the carbon dioxide laser or any electrode movements after implantation can cause those negative pressure shifts . The real impact of those pressure changes, however, on the preservation of residual hearing remains a matter of discussion.…”

Section: Discussionmentioning

confidence: 55%

“…Although the risk of intracochlear trauma increases with postinsertional movements of the electrode, our results indicate that the pullback bears minor risk for intracochlear trauma due to minor intracochlear pressure changes. However, the direct influence of the pullback on subsequent electrophysiological benefits and preservation of residual hearing in these patients remains unknown and needs to be investigated in further studies.…”

Section: Discussionmentioning

confidence: 64%

“…Little is known about possible intracochlear alterations and /or intracochlear pressure changes that occur during the pullback. Intracochlear pressure changes should be kept at a very low level before, during, and after the implantation . The cochlea has a dynamic fluid system, and as such, pressure applied to any part of the cochlea or to the electrode array itself is transferred through the cochlear partitions and can possibly interfere with the cellular structures.…”

Section: Introductionmentioning

confidence: 99%

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Intracochlear Pressure Changes After Cochlea Implant Electrode Pullback—Reduction of Intracochlear Trauma

Lauer

Uçta

Decker

et al. 2019

Laryngoscope Investig Oto

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Objective Different aspects should be considered to achieve an atraumatic insertion of cochlear implant electrode arrays as an important surgical goal. Intracochlear pressure changes are known to influence the preservation of residual hearing. By using the intraoperative “pullback technique,” an electrode position closer to the modiolus can be achieved than without the pullback. The aim of the present study was therefore to investigate to what extent the pullback technique can influence intracochlear pressure changes. Methods Insertions of cochlear implant electrodes were performed in an artificial cochlear model with two different perimodiolar arrays. Intracochlear pressure changes were recorded with a micro‐optical pressure sensor positioned in the apical part of the cochlear. After complete insertion of the electrode array, a so‐called pullback of the electrode was performed. Results Statistically significant pressure differences were measured if the electrode array was wet (ie, moisturized) during the pullback. Relative pressure changes in electrodes with smaller total volume are lower than pressure changes in larger electrodes. Conclusion The preservation of residual hearing and, thus, the resulting postoperative audiological outcome has a major impact on the quality of life of the patients and has become of utmost importance. Intracochlear pressure changes during the pullback manoeuver are small in absolute terms, but can even be still reduced statistically significantly by a moistening the electrode before insertion. Using the pullback technique in cases with residual hearing does not affect the probability of preservation of residual hearing but could lead to a better audiological outcome. Level of Evidence NA

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intracochlear Pressure Changes After Cochlea Implant Electrode Pullback—Reduction of Intracochlear Trauma

Lauer

Uçta

Decker

et al. 2019

Laryngoscope Investig Oto

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“…Awareness of the importance of the round window's atraumatic opening has led to the development of round window opening tools (7). Different studies have evaluated in an artificial cochlea model insertional factors that could influence residual hearing, like force (8) and pressure, in terms of speed (9), moisturized insertion (4), manual tremor and automated insertion (10), and positioning of the cochlear array (11). The clinical importance of these findings has been underlined by various studies (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Effect of Underwater Insertion on Intracochlear Pressure

2020

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Background: The importance of intracochlear pressure during cochlear electrode insertion for the preservation of residual hearing has been widely discussed. Various aspects of pre-insertional, intra-insertional, and post-insertional relevant conditions affect intracochlear pressure. The fluid situation at the round window during electrode insertion has been shown to be an influential factor.Aims/Objectives: The aim of the study was to compare various insertion techniques in terms of the fluid situation at the round window.Material and Methods: We performed insertion of cochlear implant electrodes in a curled artificial cochlear model. We placed and fixed the pressure sensor at the tip of the cochlea. In parallel to the insertions, we evaluated the maximum amplitude of intracochlear pressure under four different fluid conditions at the round window: (1) hyaluronic acid; (2) moisturized electrode, dry middle ear; (3) middle ear filled with fluid (underwater); and (4) moisturized electrode, wet middle ear, indirectly inserted.Results: We observed that the insertional intracochlear pressure is dependent on the fluid situation in front of the round window. The lowest amplitude changes were observed for the moisturized electrode indirectly inserted in a wet middle ear (0.13 mmHg ± 0.07), and the highest values were observed for insertion through hyaluronic acid in front of the round window (0.64 mmHg ± 0.31).Conclusions: The fluid state in front of the round window influences the intracochlear pressure value during cochlear implant electrode insertion in our model. Indirect insertion of a moisturized electrode through a wet middle ear experimentally generated the lowest pressure values. Hyaluronic acid in front of the round window leads to high intracochlear pressure in our non-validated artificial model.

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