Three-Dimensional Force Profile During Cochlear Implantation Depends on Individual Geometry and Insertion Trauma

Avci, Ersin; Nauwelaers, Tim; Hamacher, Volkmar; Kral, Andrej

doi:10.1097/aud.0000000000000394

Cited by 48 publications

(48 citation statements)

References 75 publications

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“…Furthermore, since the proximal ST follows an approximately straight line 8 , the choice of the correct insertion vector will guarantee atraumatic passage of the electrode until the first cochlear turn. Finally, studies suggest that optimization of the insertion vector can also prevent electrode dislocation near 180° 17,18 . In future research, also the optimal distance between the visualized OSL and the electrode should be determined.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with residual hearing, this leads to an even more adverse outcome 15,16 . A large portion of insertion trauma occurs within the first 180° of the cochlea 8,17,18 . Atraumatic insertion requires electrode passage in line with the ST trajectory 8,19,20 .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, current clinical imaging techniques do not provide sufficient spatial resolution for reliable evaluation of the individual ST compartment and the CF region 12,24 . While implementation of soft surgery techniques and modified electrode design have partially reduced the incidence of insertion trauma 3,17,20,25 , intracochlear trauma still occurs in up to 40% of the electrode insertions 15,26 . Thus, there is a need for a high-resolution imaging technique, which can be safely applied in otological clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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High-resolution Imaging of the Human Cochlea through the Round Window by means of Optical Coherence Tomography

Starovoyt

Putzeys

Wouters

et al. 2019

Sci Rep

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The human cochlea is deeply embedded in the temporal bone and surrounded by a thick otic capsule, rendering its internal structure inaccessible for direct visualization. Clinical imaging techniques fall short of their resolution for imaging of the intracochlear structures with sufficient detail. As a result, there is a lack of knowledge concerning best practice for intracochlear therapy placement, such as cochlear implantation. In the past decades, optical coherence tomography (OCT) has proven valuable for non-invasive, high-resolution, cross-sectional imaging of tissue microstructure in various fields of medicine, including ophthalmology, cardiology and dermatology. There is an upcoming interest for OCT imaging of the cochlea, which so far was mostly carried out in small animals. In this temporal bone study, we focused on high-resolution imaging of the human cochlea. The cochlea was approached through mastoidectomy and posterior tympanotomy, both standard surgical procedures. A commercially available spectral-domain OCT imaging system was used to obtain high-resolution images of the cochlear hook region through the intact round window membrane in four cadaveric human temporal bones. We discuss the qualitative and quantitative characteristics of intracochlear structures on OCT images and their importance for cochlear implant surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High-resolution Imaging of the Human Cochlea through the Round Window by means of Optical Coherence Tomography

Starovoyt

Putzeys

Wouters

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…More recently, other groups have also developed motorized insertion tools in laboratory experiments [21][22][23] and although they were also not designed for use under sterile conditions, valuable findings have resulted from these works [9,11,21,[24][25][26][27][28][29]. For example, automated EA insertions have shown its capability in reducing critical peak insertion forces [9,10,30]-subsequently promising to reduce insertion trauma.…”

Section: Introductionmentioning

confidence: 99%

A simple tool to automate the insertion process in cochlear implant surgery

et al. 2020

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Purpose Automated insertion of electrode arrays (EA) in cochlear implant surgery is presumed to be less traumatic than manual insertions, but no tool is widely available in the operating room. We sought (1) to design and create a simple tool able to automate the EA insertion process; and (2) to perform preliminary evaluations of the designed prototype. Methods A first prototype of a tool with maximum simplicity was designed and fabricated to take advantage of hydraulic actuation. The prototype facilitates automated forward motion using a syringe connected to an infusion pump. Initial prototype evaluation included: (1) testing of forward motion at different velocities (2) EA insertion trials into an artificial cochlear model with force recordings, and (3) evaluation of device handling, fixation and positioning using cadaver head specimens and a surgical retractor. Alignment of the tool was explored with CT imaging. Results In this initial phase, the prototype demonstrated easy assembly and ability to respond to hydraulic actuation driven by an infusion pump at different velocities. EA insertions at an ultra-slow velocity of 0.03 mm/s revealed smooth force profiles with mean maximum force of 0.060 N ± 0.007 N. Device positioning with an appropriate insertion axis into the cochlea was deemed feasible and easy to achieve. Conclusions Initial testing of our hydraulic insertion tool did not reveal any serious complications that contradict the initially defined design specifications. Further meticulous testing is needed to determine the safety of the device, its reliability and clinical applicability.

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“…One may also argue a preference for a certain approach based on individual cochlear structures. Several studies for example have clearly shown that each human cochlea has a different 'cochlear hook' in parallel with one's unique ngerprint (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): A study protocol for a randomised single blind controlled trial

Jwair¹,

Boerboom²,

Versnel³

et al. 2020

Preprint

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BackgroundIn order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a ‘straight’ lateral wall lying electrode array (LW), or a ‘pre-curved’ perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that the combination of a RW approach and a LW lying electrode array minimizes insertion trauma, leading to better hearing outcome for SNHL patients. MethodsWe designed a monocenter, 2x2, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar transposition, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG).DiscussionCochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relative simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation. Trial registrationThis trial is registered in the Netherlands Trial Register (NTR) (www.trialregister.nl): NL8586, date of registration: 4th of May 2020. Retrospectively registered; 3/48 participants were included before registration.

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Three-Dimensional Force Profile During Cochlear Implantation Depends on Individual Geometry and Insertion Trauma

Cited by 48 publications

References 75 publications

High-resolution Imaging of the Human Cochlea through the Round Window by means of Optical Coherence Tomography

High-resolution Imaging of the Human Cochlea through the Round Window by means of Optical Coherence Tomography

A simple tool to automate the insertion process in cochlear implant surgery

Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): A study protocol for a randomised single blind controlled trial

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