Evaluation of a new slim lateral wall electrode for cochlear implantation: an imaging study in human temporal bones

2018 ◽  
Vol 275 (7) ◽  
pp. 1723-1729 ◽  
Author(s):  
Aarno Dietz ◽  
Matti Iso-Mustajärvi ◽  
Sini Sipari ◽  
Jyrki Tervaniemi ◽  
Dzemal Gazibegovic
Keyword(s):  
Cochlear Implantation ◽  
Imaging Study ◽  
Lateral Wall ◽  
Temporal Bones

scholarly journals Cone beam CT for perioperative imaging in hearing preservation Cochlear implantation – a human cadaveric study

2019 ◽  
Vol 48 (1) ◽  
Author(s):  
Kayvan Nateghifard ◽  
David Low ◽  
Lola Awofala ◽  
Dilakshan Srikanthan ◽  
Jafri Kuthubutheen ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Cochlear Implantation ◽  
Lateral Wall ◽  
Cone Beam ◽  
Insertion Depth ◽  
Cochlear Duct ◽  
Low Radiation Dose ◽  
A Value ◽  
Cochlear Duct Length ◽  
Temporal Bones

Abstract Background Knowledge of the cochlear implant array’s precise position is important because of the correlation between electrode position and speech understanding. Several groups have provided recent image processing evidence to determine scalar translocation, angular insertion depth, and cochlear duct length (CDL); all of which are being used for patient-specific programming. Cone beam computed tomography (CBCT) is increasingly used in otology due to its superior resolution and low radiation dose. Our objectives are as followed: Validate CBCT by measuring cochlear metrics, including basal turn diameter (A-value) and lateral wall cochlear duct length at different angular intervals and comparing it against microcomputed CT (uCT).Explore the relationship between measured lateral wall cochlear duct length at different angular intervals and insertion depth among 3 different length electrodes using CBCT. Methods The study was performed using fixed human cadaveric temporal bones in a tertiary academic centre. Ten temporal bones were subjected to the standard facial recess approach for cochlear implantation and imaged by CBCT followed by uCT. Measurements were performed on a three-dimensional reconstructed model of the cochlea. Sequential insertion of 3 electrodes (Med-El Flex24, 28 and Soft) was then performed in 5 bones and reimaged by CBCT. Statistical analysis was performed using Pearson’s correlation. Results There was good agreement between CBCT and uCT for cochlear metrics, validating the precision of CBCT against the current gold standard uCT in imaging. The A-value recorded by both modalities showed a high degree of linear correlation and did not differ by more than 0.23 mm in absolute values. For the measurement of lateral wall CDL at various points along the cochlea, there was a good correlation between both modalities at 360 deg and 720 deg (r = 0.85, p < 0.01 and r = 0.79, p < 0.01). The Flex24 electrode displayed consistent insertion depth across different bones. Conclusions CBCT reliably performs cochlear metrics and measures electrode insertion depth. The low radiation dose, fast acquisition time, diminished metallic artifacts and portability of CBCT make it a valid option for imaging in cochlear implant surgery.

scholarly journals Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Huan Jia ◽  
Jinxi Pan ◽  
Wenxi Gu ◽  
Haoyue Tan ◽  
Ying Chen ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Electrode Array ◽  
Pure Tone Audiometry ◽  
Lateral Wall ◽  
Robot Assisted ◽  
Insertion Depth ◽  
Safety And Reliability ◽  
Radiological Measurements ◽  
Auditory Performance ◽  
Temporal Bones

Background: As an advanced surgical technique to reduce trauma to the inner ear, robot-assisted electrode array (EA) insertion has been applied in adult cochlear implantation (CI) and was approved as a safe surgical procedure that could result in better outcomes. As the mastoid and temporal bones are generally smaller in children, which would increase the difficulty for robot-assisted manipulation, the clinical application of these systems for CI in children has not been reported. Given that the pediatric candidate is the main population, we aim to investigate the safety and reliability of robot-assisted techniques in pediatric cochlear implantation.Methods: Retrospective cohort study at a referral center in Shanghai including all patients of simultaneous bilateral CI with robotic assistance on one side (RobOtol® system, Collin ORL, Bagneux, France), and manual insertion on the other (same brand of EA and CI in both side), from December 2019 to June 2020. The surgical outcomes, radiological measurements (EA positioning, EA insertion depth, mastoidectomy size), and audiological outcomes (Behavior pure-tone audiometry) were evaluated.Results: Five infants (17.8 ± 13.5 months, ranging from 10 to 42 months) and an adult (39 years old) were enrolled in this study. Both perimodiolar and lateral wall EAs were included. The robot-assisted EA insertion was successfully performed in all cases, although the surgical zone in infants was about half the size in adults, and no difference was observed in mastoidectomy size between robot-assisted and manual insertion sides (p = 0.219). The insertion depths of EA with two techniques were similar (P = 0.583). The robot-assisted technique showed no scalar deviation, but scalar deviation occurred for one manually inserted pre-curved EA (16%). Early auditory performance was similar to both techniques.Conclusion: Robot-assisted technique for EA insertion is approved to be used safely and reliably in children, which is possible and potential for better scalar positioning and might improve long-term auditory outcome. Standard mastoidectomy size was enough for robot-assisted technique. This first study marks the arrival of the era of robotic CI for all ages.

scholarly journals Histopathology of the Human Inner Ear in the Cogan Syndrome with Cochlear Implantation

2017 ◽  
Vol 22 (2) ◽  
pp. 116-123 ◽  
Author(s):  
Takefumi Kamakura ◽  
Daniel J. Lee ◽  
Barbara S. Herrmann ◽  
Joseph B. Nadol Jr.
Keyword(s):  
Bone Formation ◽  
Cochlear Implantation ◽  
Fibrous Tissue ◽  
Spiral Ganglion ◽  
New Bone Formation ◽  
Cogan Syndrome ◽  
Interstitial Keratitis ◽  
The Right ◽  
Ganglion Neurons ◽  
Temporal Bones

The Cogan syndrome is a rare disorder characterized by nonsyphilitic interstitial keratitis and audiovestibular symptoms. Profound sensorineural hearing loss has been reported in approximately half of the patients with the Cogan syndrome resulting in candidacy for cochlear implantation in some patients. The current study is the first histopathologic report on the temporal bones of a patient with the Cogan syndrome who during life underwent bilateral cochlear implantation. Preoperative MRI revealed tissue with high density in the basal turns of both cochleae and both vestibular systems consistent with fibrous tissue due to labyrinthitis. Histopathology demonstrated fibrous tissue and new bone formation within the cochlea and vestibular apparatus, worse on the right. Severe degeneration of the vestibular end organs and new bone formation in the labyrinth were seen more on the right than on the left. Although severe bilateral degeneration of the spiral ganglion neurons was seen, especially on the right, the postoperative word discrimination score was between 50 and 60% bilaterally. Impedance measures were generally higher in the right ear, possibly related to more fibrous tissue and new bone found in the scala tympani on the right side.

Cochlear Wall Erosion after Cochlear Implantation

2005 ◽  
Vol 114 (7) ◽  
pp. 543-546 ◽  
Author(s):  
Francisco J. Cervera-Paz ◽  
Frederick H. Linthicum
Keyword(s):  
Cochlear Implants ◽  
Cochlear Implantation ◽  
Single Channel ◽  
Ethylenediaminetetraacetic Acid ◽  
Lymphocytic Infiltration ◽  
Variable Degree ◽  
Histologic Finding ◽  
New Bone Formation ◽  
Anterior Portion ◽  
Temporal Bones

Objectives: Cochlear implantation is a clinically satisfactory procedure, but it is associated with a variable degree of histologic intracochlear trauma. We report a new histologic finding in a cochlear implant specimen from the House Ear Institute collection. Methods: An analysis of 34 temporal bones with single-channel (n = 23) or multichannel (n = 11) cochlear implants was performed. All temporal bones had been fixed for a month in 10% buffered formalin, progressively decalcified in ethylenediaminetetraacetic acid, and embedded in celloidin. After electrode removal, the bones were cut into 20-μm sections and stained. Results: In 1 specimen, the implanted electrode had caused erosion of the bone through the endosteum into the marrow spaces, at the superior-anterior portion of the basal turn. This area showed an intense lymphocytic infiltration surrounded by some new bone formation. Conclusions: Trauma may provoke an inflammatory reaction due to the presence of the foreign body after violation of the endosteum.

First Experience With a New Thin Lateral Wall Electrode in Human Temporal Bones

2019 ◽  
Vol 40 (7) ◽  
pp. 872-877 ◽  
Author(s):  
Thomas Lenarz ◽  
Ersin Avci ◽  
Dzemal Gazibegovic ◽  
Rolf Salcher
Keyword(s):  
Lateral Wall ◽  
Temporal Bones

The role of preoperative imaging for auditory implants in children

2020 ◽  
Vol 74 (6) ◽  
pp. 1-5
Author(s):  
Małgorzata Burzyńska-Makuch ◽  
Józef Mierzwiński ◽  
Karolina Haber
Keyword(s):  
Inner Ear ◽  
Cochlear Implantation ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Clinical Decisions ◽  
Imaging Studies ◽  
Inner Ear Malformations ◽  
Ear Malformations ◽  
Cochlear Ossification ◽  
Temporal Bones

<b>Introduction:</b> Preoperative imaging, besides audiological evaluation, plays a major role in evaluation of candidacy for auditory implants, and in particular cochlear implants. It is essential to assess whether the basic criteria necessary for implantation are met. Diagnostic imaging is crucial not only in determining candidacy, but also determining the feasibility of cochlear implantation as it allow to anticipate surgical difficulties which could preclude or complicate the implantation of the device. The aim of the study is to present the protocol for the evaluation of preoperative imaging studies with particular focus on the factors potentially affecting clinical decisions in children qualified for cochlear implantation. <br><b>Material and method:</b> Preoperative imaging studies of 111 children performed prior to cochlear implantation were analyzed: high-resolution computed tomography (HRCT) of temporal bones and MRI. The assessment was made according to the presented protocol. <br><b>Results:</b> Pathologies and anomalies identified during the assessment of preoperative imaging studies significantly altered clinical decisions in 30% of patients. In the study group, in 17% of patients inner ear malformations were identified. 2.7% of children were disqualified from a cochlear implantation due to severe congenital inner ear malformations. 9% of the patients have had bacterial meningitis. In 50% of them difficulties related to complete or progressive cochlear ossification occurred. In 4.5% of patients less common surgical approaches other than mastoidectomy with a posterior tympanotomy were applied. <br><b>Discussion:</b> Preoperative imaging allow for the identification of significant pathologies and anomalies affecting qualification decisions and further treatment. HRCT and MRI are complementary to each other for preoperative imaging. The two modalities in combination allow accurate and optimal evaluation of the anatomical structures prior to implantation. Inner ear malformations and cochlear ossification following meningitis are relatively frequently encountered in children qualified for a cochlear implant.

Anatomic Considerations of the Medial Cuts in the Subtotal Temporal Bone Resection

1982 ◽  
Vol 90 (5) ◽  
pp. 641-645 ◽  
Author(s):  
J. Gail Neely ◽  
Michael Forrester
Keyword(s):  
Temporal Bone ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Lateral Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection ◽  
Temporal Bones

Eighteen temporal bones, 20 sets of polytomograms, and two sets of histologically sectioned temporal bones were studied and the literature was reviewed in order to describe the evolution and anatomic detail of the medial limits of the subtotal temporal bone resection used when malignant neoplasia has invaded the middle ear. An en bloc resection requires incisions medial to the pneumatized spaces involved. The anatomy of the lines of resection through the glenoid fossa, medial to the lateral wall of the carotid canal, through the cochlea, internal auditory canal, and jugular bulb, and just lateral to cranial nerves IX, X, and XI was described in detail. Regardless of the techniques employed, or the feasibility of the task, the concept of en bloc resection must conform to the anatomy of the region.

scholarly journals Cochlear Implantation in Charcot-Marie-Tooth Disease: Case Report and Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
C. Lane Anzalone ◽  
Sarah Nuhanovic ◽  
Amy P. Olund ◽  
Matthew L. Carlson
Keyword(s):  
Case Report ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
English Literature ◽  
Lateral Wall ◽  
Hereditary Neuropathy ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Disease Case ◽  
Patient Reported

Introduction. Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy associated with motor and sensory impairment and can result in profound sensorineural hearing loss (SNHL). Currently, the role of cochlear implantation in the setting of CMT and other progressive peripheral neurodegenerative disorders is not well established. Methods. Case report and review of the English literature. Results. A 70-year-old male with CMT was referred for evaluation of progressive asymmetric SNHL and reported a 15-year duration of deafness involving the left ear. Audiometric testing confirmed profound SNHL in the left ear, while the right ear exhibited moderate-to-severe SNHL. Left-sided cochlear implantation was performed using a conventional length lateral wall electrode. Intraoperative device testing found normal impedance levels throughout the array; however, electrically evoked auditory potentials were absent on all electrodes. Upon initial activation 3 weeks after surgery, the patient reported excellent access to sound in the cochlear implant-only condition. He has made good progress at each subsequent visit; speech perception testing after seven months showed improvement from 0% to 32% on AzBio sentence and 53% on CNC phoneme testing in the cochlear implant-only condition. Conclusion. We report the third case of cochlear implantation in a patient with CMT. SNHL in CMT is hypothesized to result from disruption of synchronous activity of the cochlear nerve. In patients with CMT, cochlear implantation may reconstitute synchronous neural activity by way of supraphysiological electrical stimulation. Our results corroborate two earlier reports that cochlear implantation is a viable option for rehabilitation of SNHL in this unique subset of patients.

Sustained-Release Triamcinolone Acetonide Hydrogels Reduce Hearing Threshold Shifts in a Model for Cochlear Implantation with Hearing Preservation

2019 ◽  
Vol 24 (5) ◽  
pp. 237-244
Author(s):  
Clemens Honeder ◽  
Chengjing Zhu ◽  
Julia Clara Gausterer ◽  
Hanna Schöpper ◽  
Navid Ahmadi ◽  
...  
Keyword(s):  
Sustained Release ◽  
Triamcinolone Acetonide ◽  
Cochlear Implantation ◽  
Hearing Threshold ◽  
Hearing Preservation ◽  
Poloxamer 407 ◽  
Histological Evaluation ◽  
Control Group ◽  
Spiral Ganglion Cell ◽  
Temporal Bones

Introduction: In recent years, the preservation of residual hearing has become a major factor in patients undergoing cochlear implantation (CI). In studies attempting to pharmaceutically improve hearing preservation rates, glucocorticoids (GCs) applied perioperatively in many institutions have emerged as a promising treatment regimen. Although dexamethasone is most commonly used and has been applied successfully by various research groups, recently pharmacological properties have been reported to be relatively unsuitable for topical delivery to the inner ear. Consequently other glucocorticoids merit further evaluation. The aim of this study was therefore to evaluate the otoprotective effects of the topical application of a sustained-release triamcinolone acetonide (TAAC) hydrogel in CI with hearing preservation. Methods: Normal-hearing pigmented guinea pigs were randomized into a group receiving a single dose of a 6% TAAC poloxamer 407 hydrogel, a group receiving a 30% TAAC hydrogel and a control group. All hydrogel applications were performed 1 day prior to CI. After a cochleostomy was drilled, a specifically designed silicone electrode was inserted into the scala tympani for 5 mm. Frequency-specific compound action potentials of the auditory nerve (0.5–32 kHz) were measured pre- and directly postoperatively as well as on days 3, 7, 14, 21, and 28. Finally, temporal bones were harvested for histological evaluation. Results: Application of the TAAC hydrogels resulted in significantly reduced hearing threshold shifts in low, middle and high frequencies and improved spiral ganglion cell survival in the second turn of the cochlea. Outer hair cell numbers in the basal and second turn of the cochlea were slightly reduced after TAAC application. Conclusion: In summary, we were able to demonstrate functional benefits of a single preoperative application of a TAAC hydrogel in a guinea pig model for CI, which persisted until the end of the observational period, that is, 28 days after surgery.

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