Scala-Tympani Phantom With Cochleostomy and Round-Window Openings for Cochlear-Implant Insertion Experiments

2014 ◽  
Vol 8 (4) ◽  
Author(s):  
Lisandro Leon ◽  
Matt S. Cavilla ◽  
Michael B. Doran ◽  
Frank M. Warren ◽  
Jake J. Abbott
Keyword(s):  
Cochlear Implant ◽  
Coordinate System ◽  
Round Window ◽  
Scala Tympani ◽  
Electrode Arrays ◽  
Angular Measurements ◽  
Insertion Techniques

Experiments with scala-tympani (ST) phantoms are used to evaluate new electrode arrays and cochlear-implant insertion techniques. To date, phantoms have not accounted for clinical orientations and geometric differences between round-window (RW) insertions and anteroinferior cochleostomy insertions. For improved assessments of insertion experiments, we present a scala-tympani phantom that offers three distinct benefits over previous phantoms: it mimics the standard otologic position, it accommodates for both round-window and anteroinferior cochleostomy insertions, and it incorporates a visual coordinate system based on industry consensus making standardized angular measurements possible.

scholarly journals Hydraulic insertions of cochlear implant electrode arrays into the human cadaver cochlea: preliminary findings

2021 ◽  
Author(s):  
M. Geraldine ◽  
Thomas Lenarz ◽  
Thomas S. Rau
Keyword(s):  
Cochlear Implant ◽  
Outcome Measurement ◽  
Round Window ◽  
Handling Time ◽  
Human Cadaver ◽  
Hydraulic Actuator ◽  
Electrode Arrays ◽  
Non Invasive ◽  
Insertion Tool ◽  
Set Up

Abstract Objectives (1) To evaluate the feasibility of a non-invasive, novel, simple insertion tool to perform automated, slow insertions of cochlear implant electrode arrays (EA) into a human cadaver cochlea; (2) to estimate the handling time required by our tool. Methods Basic science study conducted in an experimental OR. Two previously anonymized human cadaver heads, three commercially available EAs, and our novel insertion tool were used for the experiments. Our tool operates as a hydraulic actuator that delivers an EA at continuous velocities slower than manually feasible. Intervention(s): the human cadaver heads were prepared with a round-window approach for CI surgery in a standard fashion. Twelve EA insertion trials using our tool involved: non-invasive fixation of the tool to the head; directing the tool to the round window and EA mounting onto the tool; automated EA insertion at approximately 0.1 mm/s driven by hydraulic actuation. Outcome measurement(s): handling time of the tool; post-insertion cone-beam CT scans to provide intracochlear evaluation of the EA insertions. Results Our insertion tool successfully inserted an EA into the human cadaver cochlea (n = 12) while being attached to the human cadaver head in a non-invasive fashion. Median time to set up the tool was 8.8 (7.2–9.4) min. Conclusion The first insertions into the human cochlea using our novel, simple insertion tool were successful without the need for invasive fixation. The tool requires < 10 min to set up, which is clinically acceptable. Future assessment of intracochlear trauma is needed to support its safety profile for clinical translation.

Cochlear Implant Revision: Effects of Reimplantation on the Cochlea

1989 ◽  
Vol 98 (10) ◽  
pp. 813-820 ◽  
Author(s):  
Robert K. Jackler ◽  
Patricia A. Leake ◽  
William S. McKerrow
Keyword(s):  
Adverse Effects ◽  
Cochlear Implant ◽  
Round Window ◽  
Neural Population ◽  
Scala Tympani ◽  
New Device ◽  
Adult Cats ◽  
Electrode Insertion ◽  
Window Area ◽  
Reimplantation Procedure

The removal of an indwelling cochlear implant electrode followed by reinsertion of a new device has been a maneuver of uncertain cosequences to the cochlea and its surviving neural population. The present study was conducted in an attempt to elucidate the factors at determine whether a reimplantation procedure will be successful. Cochlear implantation followed by explanation and subsequent implantation was performed in eight adult cats. Evaluation of cochlear histopathology suggested a significant increase in electrode insertion trauma when there was proliferation of granulation tissue in the round window area and scala tympani. In other cases, atraumatic insertion was achieved without apparent injury to the cochlea. The results of a survey of cochlear implant manufacturers and surgeons indicate that electrode replacement can usually be accomplished without adverse effects. Difficulties have been encountered, however, in moving implants with protuberant electrodes and when reimplantation was attempted on a delayed basis following explanation.

scholarly journals Effect of Underwater Insertion on Intracochlear Pressure

2020 ◽  
Vol 7 ◽  
Author(s):  
Conrad Riemann ◽  
Holger Sudhoff ◽  
Ingo Todt
Keyword(s):  
Hyaluronic Acid ◽  
Cochlear Implant ◽  
Middle Ear ◽  
Round Window ◽  
Maximum Amplitude ◽  
Influential Factor ◽  
Fluid State ◽  
Insertion Techniques ◽  
Electrode Insertion ◽  
Intracochlear Pressure

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.

scholarly journals Surgical anatomy of the round window with special reference to cochlear implantation

1987 ◽  
Vol 101 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Burkhard K. H. Franz ◽  
Graeme M. Clark ◽  
David M. Bloom
Keyword(s):  
Cochlear Implant ◽  
Special Reference ◽  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Anatomy ◽  
Round Window Membrane ◽  
Scala Tympani ◽  
Good View ◽  
Posterior Tympanotomy ◽  
Round Window Niche

AbstractWhen the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

scholarly journals Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Graziela de Souza Queiroz Martins ◽  
Rubens Vuono Brito Neto ◽  
Robinson Koji Tsuji ◽  
Eloisa Maria Mello Santiago Gebrim ◽  
Ricardo Ferreira Bento
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Electrode Array ◽  
Hearing Preservation ◽  
Round Window Membrane ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Minimal Trauma ◽  
Electrode Insertion ◽  
Temporal Bones

Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane.Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation.Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arraysin situ. The resulting images were analyzed for signs of intracochlear trauma.Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion.Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.

scholarly journals Clinical investigation of the Nucleus Slim Modiolar Electrode

2017 ◽  
Vol 22 (3) ◽  
pp. 169-179 ◽  
Author(s):  
Antje Aschendorff ◽  
Robert Briggs ◽  
Goetz Brademann ◽  
Silke Helbig ◽  
Joachim Hornung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Temporal Bone ◽  
Clinical Investigation ◽  
Round Window ◽  
Electrode Array ◽  
Lateral Wall ◽  
Scala Tympani ◽  
Flat Panel ◽  
Insertion Depth

Aims: The Nucleus CI532 cochlear implant incorporates a new precurved electrode array, i.e., the Slim Modiolar electrode (SME), which is designed to bring electrode contacts close to the medial wall of the cochlea while avoiding trauma due to scalar dislocation or contact with the lateral wall during insertion. The primary aim of this prospective study was to determine the final position of the electrode array in clinical cases as evaluated using flat-panel volume computed tomography. Methods: Forty-five adult candidates for unilateral cochlear implantation were recruited from 8 centers. Eleven surgeons attended a temporal bone workshop and received further training with a transparent plastic cochlear model just prior to the first surgery. Feedback on the surgical approach and use of the SME was collected via a questionnaire for each case. Computed tomography of the temporal bone was performed postoperatively using flat-panel digital volume tomography or cone beam systems. The primary measure was the final scalar position of the SME (completely in scala tympani or not). Secondly, medial-lateral position and insertion depth were evaluated. Results: Forty-four subjects received a CI532. The SME was located completely in scala tympani for all subjects. Pure round window (44% of the cases), extended round window (22%), and inferior and/or anterior cochleostomy (34%) approaches were successful across surgeons and cases. The SME was generally positioned close to the modiolus. Overinsertion of the array past the first marker tended to push the basal contacts towards the lateral wall and served only to increase the insertion depth of the first electrode contact without increasing the insertion depth of the most apical electrode. Complications were limited to tip fold-overs encountered in 2 subjects; both were attributed to surgical error, with both reimplanted successfully. Conclusions: The new Nucleus CI532 cochlear implant with SME achieved the design goal of producing little or no trauma as indicated by consistent scala tympani placement. Surgeons should be carefully trained to use the new deployment method such that tip fold-overs and over insertion may be avoided.

Optimal Path Planning for Robotic Insertion of Steerable Electrode Arrays in Cochlear Implant Surgery

2008 ◽  
Vol 3 (1) ◽  
Author(s):  
Jian Zhang ◽  
J. Thomas Roland ◽  
Spiros Manolidis ◽  
Nabil Simaan
Keyword(s):  
Path Planning ◽  
Cochlear Implant ◽  
Optimal Path ◽  
Electrode Array ◽  
Scala Tympani ◽  
Electrode Arrays ◽  
Insertion Force ◽  
Optimal Path Planning ◽  
Cochlear Implant Surgery ◽  
Electrode Insertion

This paper presents an optimal path planning method of steerable electrode arrays for robot-assisted cochlear implant surgery. In this paper, the authors present a novel design of steerable electrode arrays that can actively bend at the tip. An embedded strand in the electrode array provides an active steering degrees-of-freedom (DoF). This paper addresses the calibration of the steerable electrode array and the optimal path planning for inserting it into planar and three-dimensional scala tympani models. The goal of the path planning is to minimize the intracochlear forces that the electrode array applies on the walls of the scala tympani during insertion. This problem is solved by designing insertion path planning algorithms that provide best fit between the shape of the electrode array and the curved scala tympani during insertion. Optimality measures that account for shape discrepancies between the steerable electrode array and the scala tympani are used to solve for the optimal path planning of the robot. Different arrangements of DoF and insertion speed force feedback (ISFF) are simulated and experimentally validated in this paper. A quality of insertion metric describing the gap between the steerable electrode array and the scala tympani model is presented and its correspondence to the insertion force is shown. The results of using 1DoF, 2DoF, and 4DoF electrode array insertion setups are compared. The 1DoF insertion setup uses nonsteerable electrode arrays. The 2DoF insertion setup uses single axis insertion with steerable electrode arrays. The 4DoF insertion setup allows full control of the insertion depth and the approach angle of the electrode with respect to the cochlea while using steerable electrode arrays. It is shown that using steerable electrode arrays significantly reduces the maximal insertion force (59.6% or more) and effectively prevents buckling of the electrode array. The 4DoF insertion setup further reduces the maximal electrode insertion forces. The results of using ISFF for steerable electrodes show a slight decrease in the insertion forces in contrast to a slight increase for nonsteerable electrodes. These results show that further research is required in order to determine the optimal ISFF control law and its effectiveness in reducing electrode insertion forces.

scholarly journals Refined Surgical Technique for Insertion of Banded Electrode Array

1987 ◽  
Vol 96 (1_suppl) ◽  
pp. 15-17 ◽  
Author(s):  
B. K-H. G. Franz ◽  
G. M. Clark
Keyword(s):  
Surgical Technique ◽  
Cochlear Implant ◽  
Round Window ◽  
Electrode Array ◽  
Scala Tympani ◽  
Insertion Technique ◽  
Electrode Insertion ◽  
The Right

A refined electrode insertion technique is presented for the multichannel cochlear implant. It comprises two basic steps. The first step is the removal of the anteroinferior overhang of the round window and crista fenestrae, or alternatively an opening drilled into the scala tympani anteroinferior to the round window. The second is rotation of the electrode during insertion, counterclockwise in the right ear and clockwise in the left ear.

scholarly journals The Effects of Round Window Membrane Injury and the Use of a Model Electrode Application on Hearing in Rats

2021 ◽  
pp. 014556132199018
Author(s):  
Murat Koc ◽  
Abdullah Dalgic ◽  
Mehmet Ziya Ozuer
Keyword(s):  
Hearing Loss ◽  
Cochlear Implant ◽  
Round Window ◽  
Mechanical Trauma ◽  
Round Window Membrane ◽  
Albino Rats ◽  
Topical Steroids ◽  
Distortion Product ◽  
Significant Difference ◽  
Group 3

Objective: To investigate the effects of the mechanical trauma to the round window, a model electrode inserted into the scala tympani on the cochlear reserve, and the efficacy of topical steroids in preventing hearing loss. Materials and Methods: 21 male Wistar Albino rats were equally categorized into three groups. In all groups an initial mechanical injury to round window was created. Only subsequent dexamethasone injection was administrated into the cochlea in the subjects of group 2 while a multichannel cochlear implant guide inserted into the cochlea prior to dexamethasone administration for group 3. Distortion product otoacoustic emissions (DPOAEs) were obtained prior to and immediately after the surgical injury, eventually on postoperative seventh day (d 7). Mean signal/noise ratios (S/Ns) obtained at 2000, 3000, and 4000 Hz were calculated. Data sets were compared with non-parametric statistical tests. Results: The early intraoperative mean S/Ns were significantly less than preoperative measurements for group 1 and 2; however, preoperative and postoperative d 7 average S/Ns did not differ. There was statistically significant difference between preoperative, intraoperative and postoperative d 7 average S/Ns for group 3. Conclusion: We observed that hearing was restored approximately to the preoperative levels following early postoperative repair. However, an electrode insertion into the cochlea via round window subsequent to mechanical trauma seems to cause a progressive hearing loss. Therefore, a special care must be taken to avoid the injury to the round window membrane in the course of the placement of a cochlear implant electrode and surgery for the chronic otitis media.

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