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 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.

Electrode Migration in Patients with Perimodiolar Cochlear Implant Electrodes

2015 ◽  
Vol 20 (6) ◽  
pp. 349-353 ◽  
Author(s):  
Philipp Mittmann ◽  
Grit Rademacher ◽  
Sven Mutze ◽  
Arneborg Ernst ◽  
Ingo Todt
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Lateral Wall ◽  
Electrode Arrays ◽  
Insertion Depth ◽  
Lower Extent ◽  
Uncommon Complication

Migration of a cochlear implant electrode is a hitherto uncommon complication. So far, array migration has only been observed in lateral wall electrodes. Between 1999 and 2014, a total of 27 patients received bilateral perimodiolar electrode arrays at our institution. The insertion depth angle was estimated on the initial postoperative scans and compared with the insertion depth angle of the postoperative scans performed after contralateral cochlear implantation. Seven (25.93%) patients were found to have an electrode array migration of more than 15°. Electrode migration in perimodiolar electrodes seems to be less frequent and to occur to a lower extent than in lateral wall electrodes. Electrode migration was clinically asymptomatic in all cases.

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 Evaluation of the Relationship between the NRT-Ratio, Cochlear Anatomy, and Insertions Depth of Perimodiolar Cochlear Implant Electrodes

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Philipp Mittmann ◽  
Grit Rademacher ◽  
Sven Mutze ◽  
Frederike Hassepass ◽  
Arneborg Ernst ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Array ◽  
Scala Tympani ◽  
Flat Panel ◽  
Insertion Depth ◽  
Tomography System ◽  
Neural Response Telemetry ◽  
Auditory Performance ◽  
The Relationship ◽  
Scala Vestibuli

The position of the cochlear implant electrode array within the scala tympani is essential for an optimal postoperative hearing benefit. If the electrode array changes in between the scalae intracochlearly (i.e., from scala tympani to scala vestibuli), a reduced auditory performance can be assumed. We established a neural response telemetry-ratio (NRT-ratio) which corresponds with the scalar position of the electrodes but shows within its limits a variability. The aim of this study was to determine if insertion depth angle or cochlea size influences the NRT-ratio. The intraoperative electrophysiological NRT data of 26 patients were evaluated. Using a flat panel tomography system, the position of the electrode array was evaluated radiologically. The insertion depth angle of the electrode, the cochlea size, and the NRT-ratio were calculated postoperatively. The radiological results were compared with the intraoperatively obtained electrophysiological data (NRT-ratio) and statistically evaluated. In all patients the NRT-ratio, the insertion depth angle, and the cochlea size could be determined. A significant correlation between insertional depth, cochlear size, and the NRT-ratio was not found. The NRT-ratio is a reliable electrophysiological tool to determine the scalar position of a perimodiolar electrode array. The NRT-ratio can be applied independent from insertion depth and cochlear size.

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.

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.

scholarly journals Cochlear implantation in Van der Hoeve de Kleyn syndrome with severe hearing loss and deafness

2020 ◽  
Vol 19 (4) ◽  
pp. 94-101
Author(s):  
Kh. M. Diab ◽  
◽  
N. A. Daikhes ◽  
V. S. Korvyakov ◽  
A. A. Kaibov ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Bone Tissue ◽  
Cochlear Implantation ◽  
Type I Collagen ◽  
Electrode Array ◽  
Connective Tissue Disorder ◽  
Type I ◽  
Diagnostic Features ◽  
Severe Hearing Loss ◽  
Temporal Bones

Van der Hoove syndrome is an inherited genetically determined generalized connective tissue disorder characterized by the formation of „pathologically immature type I collagen“. The literature describes the results of cochlear implantation in patients with van der Howe syndrome, after which there are often complications both intraoperative and postoperative. This article describes two clinical cases of van der Howe syndrome with severe hearing loss and deafness. In cases described: preoperative diagnosis and features of the surgical stage of cochlear implantation and postoperative results. Diagnostic features – thinning of bone tissue according to CT of temporal bones, expansion of cochlear duct, deafness according to tonal threshold audiometry. Cochlear implantation performed with the use of the endotracheal anesthesia under the control of the microscope, straight electrode grids were used, testing was normal. A distinctive feature of this syndrome is the softness of the cochlea’s bone tissue, the danger is that when the electrode array is inserted, it may fall outside the cochlea. Also, during the first connection or later, there may be pathological stimulation of the facial nerve.

Histopathologic Changes in the Vestibule after Cochlear Implantation

2002 ◽  
Vol 127 (4) ◽  
pp. 260-264 ◽  
Author(s):  
Hui-Chi Tien ◽  
Fred H. Linthicum
Keyword(s):  
Cochlear Implantation ◽  
Basilar Membrane ◽  
Clinical Performance ◽  
Disease Process ◽  
Electrode Array ◽  
Histopathologic Changes ◽  
Highly Correlated ◽  
Temporal Bones ◽  
Vestibular Damage ◽  
Histopathologic Findings

OBJECTIVE: The study goal was to determine the histopathologic changes of the vestibular end organs after cochlear implantation and to relate them to clinical performance. STUDY DESIGN: To differentiate the effect of implantation from the disease process that originally destroyed the hearing, 11 pairs of temporal bones from unilateral implantees were studied with light microscopy to compare the vestibular damage in the implanted ears with that in the nonimplanted ears. RESULTS: Significant histopathologic damage of the vestibular end organs was noted in 6 patients (54.5%). The major histopathologic findings were fibrosis in the vestibule, saccule membrane distortion, new bone formation, and reactive neuromas. The scala vestibuli involvement, as a result of damage to the osseous spiral lamina or basilar membrane in cochlear basal turn, was highly correlated with vestibular damage (75%). CONCLUSIONS: Although the clinical incidence of balance disturbance after cochlear implantation is low, damage of the vestibular end organs may occur and be asymptomatic. Keeping the electrode array in the scala tympani will minimize vestibular damage.

Incidence of Complete Insertion in Cochlear Implant Recipients of Long Lateral Wall Arrays

2021 ◽  
pp. 019459982098745
Author(s):  
Michael W. Canfarotta ◽  
Margaret T. Dillon ◽  
Kevin D. Brown ◽  
Harold C. Pillsbury ◽  
Matthew M. Dedmon ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Array ◽  
Lateral Wall ◽  
Electrode Arrays ◽  
Tertiary Referral ◽  
Insertion Depth ◽  
Future Studies ◽  
Tertiary Referral Center ◽  
Cochlear Duct Length ◽  
Cochlear Morphology

Objective High rates of partial insertion have been reported for cochlear implant (CI) recipients of long lateral wall electrode arrays, presumably caused by resistance encountered during insertion due to cochlear morphology. With recent advances in long-electrode array design, we sought to investigate (1) the incidence of complete insertions among patients implanted with 31.5-mm flexible arrays and (2) whether complete insertion is limited by cochlear duct length (CDL). Study Design Retrospective review. Setting Tertiary referral center. Methods Fifty-one adult CI recipients implanted with 31.5-mm flexible lateral wall arrays underwent postoperative computed tomography to determine the rate of complete insertion, defined as all contacts being intracochlear. CDL and angular insertion depth (AID) were compared between complete and partial insertion cohorts. Results Most cases had a complete insertion (96.1%, n = 49). Among the complete insertion cohort, the median CDL was 33.6 mm (range, 30.3-37.9 mm), and median AID was 641° (range, 533-751°). Two cases of partial insertion had relatively short CDL (31.8 mm and 32.3 mm) and shallow AID (542° and 575°). Relatively shallow AID for the 2 cases of partial insertion fails to support the idea that CDL alone prevents a complete insertion. Conclusion Complete insertion of a 31.5-mm flexible array is feasible in most cases and does not appear to be limited by the range of CDL observed in this cohort. Future studies are needed to estimate other variations in cochlear morphology that could predict resistance and failure to achieve complete insertion with long arrays.

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