The Clarion electrode positioner: Temporal bone studies

Fayad, Jose N.; Luxford, W M; Linthicum, Fred H.

doi:10.1016/s0196-0709(00)80013-7

Cited by 43 publications

(25 citation statements)

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“…In recent studies, the extent of cochlear trauma was assessed when implanting a twocomponent electrode array [19,20]. Other concepts of perimodiolar placement of cochlear implant electrodes have been evaluated in human temporal bones, all of which showed an increased rate of cochlear trauma [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Preservation of Basal Inner Ear Structures in Cochlear Implantation

Adunka

Gstœttner

Hambek

et al. 2004

ORL

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The aim of this report was to examine basal trauma in implanted human temporal bones and discuss modified approaches to the basal cochlear turn to avoid destruction of basal cochlear structures. Thirty-three human temporal bones were implanted with four different cochlear implant electrode arrays manufactured by MED-EL using either a caudal approach cochleostomy or round window membrane insertions. All specimens were processed with a special histological technique that allows sectioning of undecalcified bone with the electrode in situ. All bones were evaluated histologically in terms of basal cochlear trauma. Two pathomechanisms of basal trauma could be distinguished and were evaluated separately, buckling of the basal end of the array and trauma by drilling. Using the caudal approach cochleostomy, the total percentage of destructive basal trauma was 48% compared to less than 15% when performing round window membrane insertions. Although it is still unclear whether basal cochlear trauma influences apical cochlear function or not, adapted surgical procedures and no forceful insertion maneuvers should be used when performing cochlear implantations with hearing preservation.

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Section: Discussionmentioning

confidence: 99%

Preservation of Basal Inner Ear Structures in Cochlear Implantation

Adunka

Gstœttner

Hambek

et al. 2004

ORL

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“…Trauma to the delicate structures of the inner ear frequently occurs during insertion of CI electrodes [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. This damage ranges from relatively minor displacement of the basilar membrane to severe fracture of the osseous spiral lamina, tearing of the basilar membrane or spiral ligament, and deviation of the electrode path from its intended location in the ST to the overlying scala media and/or scala vestibuli.…”

Section: Reduced Damagementioning

confidence: 99%

Considerations for design of future cochlear implant electrode arrays: Electrode array stiffness, size,

Rebscher

Hetherington²,

Bonham³

et al. 2008

JRRD

154

121

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Abstract-The level of hearing rehabilitation enjoyed by cochlear implant (CI) recipients has increased dramatically since the introduction of these devices. This improvement is the result of continual development of these systems and the inclusion of subjects with less severe auditory pathology. Developments include advanced signal processing, higher stimulation rates, greater numbers of channels, and more efficient electrode arrays that are less likely to produce insertion damage. New directions in the application of CIs, particularly in combined acoustic and electrical stimulation, and increasing performance expectations will place greater demands on future electrode arrays. Specifically, the next generation of arrays must be reliably inserted without damage, must maintain residual acoustic function, and may need to be inserted more deeply. In this study, we measured the mechanical properties of eight clinical and prototype human CI electrode arrays and evaluated insertion trauma and insertion depth in 79 implanted cadaver temporal bones. We found that the size and shape of the array directly affect the incidence of observed trauma. Further, arrays with greater stiffness in the plane perpendicular to the plane of the cochlear spiral are less likely to cause severe trauma than arrays with similar vertical and horizontal stiffness.

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“…Firstly, such perimodiolar or 'modiolus hugging' arrays bring the electrodes more closely to the neural elements in the spiral ganglion , especially in combination with space-filling devices such as the Clarion Electrode Positioning System (or 'positioner') [Fayad et al, 2000]. The positioner is inserted lateral to the electrode array and is intended to bring the array close to the medial wall of the scala tympani.…”

Section: Introductionmentioning

confidence: 99%

“…If the electrode was in a truly modiolus hugging position where the electrode array is in contact with the medial wall and no fluid is left between array and medial wall, then channel interaction may well be reduced by preventing longitudinal current spread towards distant lowimpedance pathways, forcing current radially instead, towards the modiolus. Although it is clear from temporal bone studies that the positioner in general will bring the array close to the medial wall but not completely in contact with it [Fayad et al, 2000], it may be thought that longitudinal current spread is still reduced because of the increasing impedance of the remaining fluid compartment between array and medial wall. The effects of proximity and of current focussing have not been separated in experimental studies.…”

Section: Introductionmentioning

confidence: 99%

“…Recent temporal bone studies have shown that the different types of positioner reduce the distance between the electrodes and the neural elements more or less consistently [Fayad et al, 2000;Gstoettner et al, 2001;Lenarz et al, 2000;Richter et al, 2001;Tykocinski et al, 2000;Yang et al, 2000], either with a large preformed or a thinner straight electrode array. Some designs have been shown to cause considerable tissue damage, but the design used in the present study has been found safe for clinical use.…”

Section: Introductionmentioning

confidence: 99%

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The Clarion Electrode Positioner: Approximation to the Medial Wall and Current Focussing?

Mens

Boyle²,

Mulder

2003

Audiol Neurotol

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In order to establish whether the electrical field created by a cochlear implant electrode is more focussed in a perimodiolar than in a medial position, voltages at non-stimulated electrodes were collected from the Clarion 1.2 implant before and after insertion of the Clarion Electrode Positioning System. The positioner is inserted lateral to the electrode array and is intended to bring the array close to the medial wall of the scala tympani. These intracochlear electrode voltages (IEVs) were collected in 9 surgeries with the HiFocus I electrode array with positioner. Stapedius reflex thresholds were decreased after insertion of the positioner on 20 out of 22 electrodes. Electrode impedances did not increase significantly. IEVs increased slightly for all stimulated electrodes. However, the positioner did not significantly affect the slope of the IEVs for any of the stimulated electrodes. Individual differences between patients in the mean IEV amplitude were considerable; 2 patients deafened by otosclerosis showed particularly low amplitudes. Thus, IEVs provided no evidence of a focussing of the electrical field by introducing the positioner. Possible benefits of a perimodiolar position regarding efficiency and channel separation are discussed in terms of a reduced distance between electrodes and neural elements.

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The Clarion electrode positioner: Temporal bone studies

Cited by 43 publications

References 0 publications

Preservation of Basal Inner Ear Structures in Cochlear Implantation

Preservation of Basal Inner Ear Structures in Cochlear Implantation

Considerations for design of future cochlear implant electrode arrays: Electrode array stiffness, size,

The Clarion Electrode Positioner: Approximation to the Medial Wall and Current Focussing?

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