scholarly journals The Pull-Back Technique for the 532 Slim Modiolar Electrode

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
C. Riemann ◽  
H. Sudhoff ◽  
I. Todt
Keyword(s):  
Temporal Bone ◽  
Round Window ◽  
Spiral Ganglion ◽  
Electrode Array ◽  
Electrode Arrays ◽  
Current Spread ◽  
Temporal Bones ◽  
Hearing Outcomes ◽  
White Marker

Introduction. The distance between the modiolus and the electrode array is one factor that has become the focus of many discussions and studies. Positioning the electrode array closer to the spiral ganglion with the goal of reducing the current spread has been shown to improve hearing outcomes. The perimodiolar electrode arrays can be complemented with a surgical manoeuvre called the pull-back technique. This study focuses its attention on the recently developed 532 slim modiolar electrode. Objective. To investigate the intracochlear movements and pull-back technique for the 532 slim modiolar electrode. Material and Methods. A decapping procedure of the cochlea was performed on 5 temporal bones. The electrode array was inserted, and the intracochlear movements were microscopically examined and digitally captured. Three situations were analysed: the initial insertion, the overinsertion, and the pull-back position. The position of the three white markers of the electrode array in relation to the round window (RW) was evaluated while performing these three actions. Results. The initial insertion achieved an acceptable perimodiolar position of the electrode array, but a gap was still observed between the mid-portion of the array and the modiolus (the first white marker was seen in the RW). When we inserted the electrode more deeply, the mid-portion of the array was pushed away from the modiolus (the second and third white markers were seen in the RW). After applying the pull-back technique, the gap observed during the initial insertion disappeared, resulting in an optimal perimodiolar position (the first white marker was once again visible in the RW). Conclusion. This temporal bone study demonstrated that when applying the pull-back technique for the 532 slim modiolar electrode, a closer proximity to the modiolus was achieved when the first white marker of the electrode array was visible in the round window.

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.

Otologic Histopathology of Fabry's Disease

1989 ◽  
Vol 98 (5) ◽  
pp. 359-363 ◽  
Author(s):  
Patricia A. Schachern ◽  
Michael M. Paparella ◽  
Donald A. Shea ◽  
Tae H. Yoon
Keyword(s):  
Temporal Bone ◽  
Ganglion Cells ◽  
Spiral Ganglion ◽  
Cell Loss ◽  
The Body ◽  
Spiral Ligament ◽  
Fabry’S Disease ◽  
Fabry's Disease ◽  
Temporal Bones ◽  
Spiral Ganglia

Fabry's disease is a rare progressive X-linked recessive disorder of glycosphingolipid metabolism. The accumulation of glycosphingolipids occurs in virtually all areas of the body, including the endothelial, perithelial, and smooth-muscle cells of blood vessels, the ganglion cells of the autonomic nervous system, and the glomeruli and tubules of the kidney. Although otologic symptoms have been described in these patients, to our knowledge there have been no temporal bone histopathologic reports. We describe the clinical histories, audiometric results, and temporal bone findings of two patients with this rare disorder. Both patients demonstrated a bilateral sloping sensorineural hearing loss audiometrically. Middle ear findings of seropurulent effusions and hyperplastic mucosa were seen in all four temporal bones. Strial and spiral ligament atrophy in all turns, and hair cell loss mainly in the basal turns, were also common findings. The number of spiral ganglion cells was reduced in all temporal bones; however, evidence of glycosphingolipid accumulation was not observed in the spiral ganglia.

Locating the scala media in the fixed human temporal bone for therapeutic access: a preliminary study

2006 ◽  
Vol 120 (11) ◽  
pp. 914-915 ◽  
Author(s):  
H Pau ◽  
P Fagan ◽  
S Oleskevich
Keyword(s):  
Temporal Bone ◽  
Round Window ◽  
Oval Window ◽  
Horizontal Line ◽  
Point Of Entry ◽  
Anterior Edge ◽  
Human Temporal Bone ◽  
Round Window Niche ◽  
Temporal Bones ◽  
A Site

Objective: To investigate the location of the scala media in relation to the round window niche in human temporal bones.Design: Ten human temporal bones were investigated by radical mastoidectomy and promontory drill-out.Setting: Temporal bone laboratory.Outcome measures: The distance from the scala media to the anterior edge of the round window niche, measured by Fisch's stapedectomy measuring cylinders.Results: The scala media was identified at the transection point of a vertical line 1.6 to 2.2 mm (mean=1.8 mm; standard deviation=0.2) anterior to the anterior edge of the round window niche and a horizontal line 0.2 mm inferior to the lower border of the oval window.Conclusion: This report demonstrates the point of entry into the scala media via the promontory in fixed temporal bone models, which may provide a site of entry for stem cells and gene therapy insertion.

scholarly journals Radiological evaluation of a new straight electrode array compared to its precursors

2020 ◽  
Author(s):  
Manuel Christoph Ketterer ◽  
A. Aschendorff ◽  
S. Arndt ◽  
I. Speck ◽  
A. K. Rauch ◽  
...  
Keyword(s):  
Round Window ◽  
Electrode Array ◽  
Lateral Wall ◽  
Study Groups ◽  
Cone Beam ◽  
Special Focus ◽  
Electrode Arrays ◽  
Academic Center ◽  
Cochlear Morphology ◽  
Array Position

Abstract Objective The aim of this study is to examine electrode array coverage, scalar position and dislocation rate in straight electrode arrays with special focus on a new electrode array with 26 mm in lengths. Study design Retrospective study. Setting Tertiary academic center. Patients 201 ears implanted between 2013 and 2019. Main outcome measures We conducted a comparative analysis of patients implanted with lateral wall electrode arrays of different lengths (F24 = MED-EL Flex24, F26 = MED-EL Flex26, F28 = MED-EL Flex28 and F31.5 = MED-EL FlexSoft). Cone beam computed tomography was used to determine electrode array position (scala tympani (ST) versus scala vestibuli (SV), intracochlear dislocation, position of dislocation and insertion angle). Results Study groups show no significant differences regarding cochlear size which excludes influences by cochlear morphology. As expected, the F24 showed significant shorter insertion angles compared to the longer electrode arrays. The F26 electrode array showed no signs of dislocation or SV insertion. The electrode array with the highest rate of ST dislocations was the F31.5 (26.3%). The electrode array with the highest rates of SV insertions was the F28 (5.75%). Most of the included electrode arrays dislocate between 320° and 360° (mean: 346.4°; range from 166° to 502°). Conclusion The shorter F24 and the new straight electrode array F26 show less or no signs of scalar dislocation, neither for round window nor for cochleostomy insertion than the longer F28 and the F31.5 array. As expected, the cochlear coverage is increasing with length of the electrode array itself but with growing risk for scalar dislocation and with the highest rates of dislocation for the longest electrode array F31.5. Position of intracochlear dislocation is in the apical cochlear part in the included lateral wall electrode arrays.

Temporal Bone Pathology in Scuba Diving Deaths

1993 ◽  
Vol 109 (3) ◽  
pp. 514-521 ◽  
Author(s):  
Patrick J. Antonelli ◽  
G. Joseph Parell ◽  
Gary D. Becker ◽  
Michael M. Paparella
Keyword(s):  
Inner Ear ◽  
Temporal Bone ◽  
Round Window ◽  
Scuba Diving ◽  
Round Window Membrane ◽  
Bone Pathology ◽  
Rapid Ascent ◽  
Temporal Bones ◽  
Inner Ear Damage ◽  
Air Cells

Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissner's membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable. (OTOLARYNGOL HEAD NECK SURG 1993;109:514-21.)

Temporal Bone Findings in Cases of Salt Water Drowning

1983 ◽  
Vol 92 (2) ◽  
pp. 134-136 ◽  
Author(s):  
George Kelemen
Keyword(s):  
Inner Ear ◽  
Temporal Bone ◽  
Middle Ear ◽  
Salt Water ◽  
Round Window ◽  
Scuba Diving ◽  
Serial Sections ◽  
Histopathological Findings ◽  
Histopathological Features ◽  
Temporal Bones

The otologic literature contains no description of the histopathological features of temporal bones of persons who perished in drowning accidents. Three temporal bones from two fatal cases of drowning were studied in serial sections. Two temporal bones were from a man aged 31 years who collapsed after scuba diving and died three days later. One temporal bone was from a 32-year-old man, serving in the navy, who drove his car, probably accidentally, into the sea and drowned in it. Histopathological findings appeared to be similar in the two cases. Diffuse hemorrhage was evident throughout the middle ear and inner ear. The tympanic and round window membranes appeared to be intact although hemorrhage had occurred within the tissue layers of the membranes. This finding contrasts with observations of ruptured membranes by other investigators.

Intraoperative Correction of Cochlear Implant Electrode Translocation

2021 ◽  
pp. 1-5
Author(s):  
William G. Morrel ◽  
Nauman F. Manzoor ◽  
Benoit M. Dawant ◽  
Jack H. Noble ◽  
Robert F. Labadie
Keyword(s):  
Cochlear Implant ◽  
Average Distance ◽  
Electrode Array ◽  
High Rate ◽  
Insertion Depth ◽  
Electrode Contact ◽  
Temporal Bones ◽  
Hearing Outcomes ◽  
Rate Of Success

<b><i>Introduction:</i></b> Translocation of precurved cochlear implant (CI) electrodes reduces hearing outcomes, but it is not known whether it is possible to correct scalar translocation such that all electrodes reside fully in the scala tympani (ST). <b><i>Methods:</i></b> Six cadaveric temporal bones were scanned with CT and segmented to delineate intracochlear anatomy. Mastoidectomy with facial recess was performed. Precurved CI electrodes (CI532; Cochlear Limited) were implanted until scalar translocation was confirmed with postoperative CT. Then, electrodes were removed and replaced. CT scan was repeated to assess for translocation correction. Scalar position of electrode contacts, angular insertion depth (AID) of the electrode array, and <i>M</i>– (average distance between each electrode contact and the modiolus) were measured. An in vivo case is reported in which intraoperative translocation detection led to removal and replacement of the electrode. <b><i>Results:</i></b> Five of 6 cadaveric translocations (83%) were corrected with 1 attempt, resulting in full ST insertions. AID averaged 285 ± 77° for translocated electrodes compared to 344 ± 28° for nontranslocated electrodes (<i>p</i> = 0.109). <i>M</i>– averaged 0.75 ± 0.18 mm for translocated electrodes and 0.45 ± 0.11 mm for nontranslocated electrodes (<i>p</i> = 0.016). Reduction in <i>M</i>– with translocation correction averaged 38%. In the in vivo case, translocation was successfully corrected in a single attempt. <b><i>Conclusion:</i></b> Scalar translocation of precurved CI electrodes can be corrected by removal and reinsertion. This significantly improves the perimodiolar positioning of these electrodes. There was a high rate of success (83%) in this cadaveric model as well as a successful in vivo attempt.

Anatomy of the round Window with Respect to Cochlear Implant Surgery

1987 ◽  
Vol 96 (1_suppl) ◽  
pp. 17-19 ◽  
Author(s):  
A. R. Clifford ◽  
W. P. R. Gibson
Keyword(s):  
Round Window ◽  
Electrode Array ◽  
Careful Analysis ◽  
Cochlear Duct ◽  
Video Recordings ◽  
Cochlear Implant Surgery ◽  
Electrode Insertion ◽  
Channel Electrode ◽  
Temporal Bones ◽  
Insertion Length

Twenty-three human temporal bones were dissected to study the anatomy of the round window with respect to cochlear implantation. Information was also gathered concerning the passage of a 22-channel electrode array along the cochlear duct by using cochlear surface dissection preparations. The insertion length and any insertion trauma were noted both by observation at the time of insertion and by careful analysis of video recordings. The crista semilunaris did not interfere with smooth electrode insertion. The recommendation is made that enlarging the round window anteroinferiorly is unnecessary and potentially hazardous in most cases.

Histopathology of Cochlear Implants in Humans

2001 ◽  
Vol 110 (9) ◽  
pp. 883-891 ◽  
Author(s):  
Joseph B. Nadol ◽  
Barbara J. Burgess ◽  
Bruce J. Gantz ◽  
Newton J. Coker ◽  
Darlene R. Ketten ◽  
...  
Keyword(s):  
Ganglion Cell ◽  
Cochlear Implantation ◽  
Single Channel ◽  
Spiral Ganglion ◽  
Electrode Array ◽  
Speech Comprehension ◽  
Spiral Ganglion Cell ◽  
Cell Counts ◽  
Significant Difference ◽  
Temporal Bones

The insertion of an intrascalar electrode array during cochlear implantation causes immediate damage to the inner ear and may result in delayed onset of additional damage that may interfere with neuronal stimulation. To date, there have been reports on fewer than 50 temporal bone specimens from patients who had undergone implantation during life. The majority of these were single-channel implants, whereas the majority of implants inserted today are multichannel systems. This report presents the histopathologic findings in temporal bones from 8 individuals who in life had undergone multichannel cochlear implantation, with particular attention to the type and location of trauma and to long-term changes within the cochlea. The effect of these changes on spiral ganglion cell counts and the correlation between speech comprehension and spiral ganglion cell counts were calculated. In 4 of the 8 cases, the opposite, unimplanted ear was available for comparison. In 3 of the 4 cases, there was no significant difference between the spiral ganglion cell counts on the implanted and unimplanted sides. In addition, in this series of 8 cases, there was an apparent negative correlation between residual spiral ganglion cell count and hearing performance during life as measured by single-syllable word recognition. This finding suggests that abnormalities in the central auditory pathways are at least as important as spiral ganglion cell loss in limiting the performance of implant users.

scholarly journals Definition of Metrics to Evaluate Cochlear Array Insertion Forces Performed with Forceps, Insertion Tool, or Motorized Tool in Temporal Bone Specimens

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Yann Nguyen ◽  
Guillaume Kazmitcheff ◽  
Daniele De Seta ◽  
Mathieu Miroir ◽  
Evelyne Ferrary ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Electrode Array ◽  
Random Order ◽  
Lateral Wall ◽  
Force Sensor ◽  
Insertion Force ◽  
Minimal Trauma ◽  
Force Profile ◽  
Definition Of ◽  
Temporal Bones

Introduction. In order to achieve a minimal trauma to the inner ear structures during array insertion, it would be suitable to control insertion forces. The aim of this work was to compare the insertion forces of an array insertion into anatomical specimens with three different insertion techniques: with forceps, with a commercial tool, and with a motorized tool.Materials and Methods. Temporal bones have been mounted on a 6-axis force sensor to record insertion forces. Each temporal bone has been inserted, with a lateral wall electrode array, in random order, with each of the 3 techniques.Results. Forceps manual and commercial tool insertions generated multiple jerks during whole length insertion related to fits and starts. On the contrary, insertion force with the motorized tool only rose at the end of the insertion. Overall force momentum was 1.16 ± 0.505 N (mean ± SD,n=10), 1.337 ± 0.408 N (n=8), and 1.573 ± 0.764 N (n=8) for manual insertion with forceps and commercial and motorized tools, respectively.Conclusion. Considering force momentum, no difference between the three techniques was observed. Nevertheless, a more predictable force profile could be observed with the motorized tool with a smoother rise of insertion forces.

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