scholarly journals The Importance of Intraoperative Plain Radiographs during Cochlear Implant Surgery in Patients with Normal Anatomy

2021 ◽  
Vol 11 (9) ◽  
pp. 4144
Author(s):  
Ohad Cohen ◽  
Jean-Yves Sichel ◽  
Chanan Shaul ◽  
Itay Chen ◽  
J. Thomas Roland ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Array ◽  
Cost Effective ◽  
X Rays ◽  
Normal Anatomy ◽  
Electrode Arrays ◽  
Plain Radiographs ◽  
Hearing Function ◽  
Tertiary Center ◽  
Cochlear Implant Surgery

Although malpositioning of the cochlear implant (CI) electrode array is rare in patients with normal anatomy, when occurring it may result in reduced hearing outcome. In addition to intraoperative electrophysiologic tests, imaging is an important modality to assess correct electrode array placement. The purpose of this report was to assess the incidence and describe cases in which intraoperative plain radiographs detected a malpositioned array. Intraoperative anti-Stenver’s view plain X-rays are conducted routinely in all CI surgeries in our tertiary center before awakening the patient and breaking the sterile field. Data of patients undergoing 399 CI surgeries were retrospectively analyzed. A total of 355 had normal inner ear and temporal bone anatomy. Patients with intra or extracochlear malpositioned electrode arrays demonstrated in the intraoperative X-ray were described. There were four cases of electrode array malposition out of 355 implantations with normal anatomy (1.1%): two tip fold-overs, one extracochlear placement and one partial insertion. All electrodes were reinserted immediately; repeated radiographs were normal and the patients achieved good hearing function. Intraoperative plain anti-Stenver’s view X-rays are valuable to confirm electrode array location, allowing correction before the conclusion of surgery. These radiographs are cheaper, faster, and emit much less radiation than other imaging options, making them a viable cost-effective tool in patients with normal anatomy.

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.

Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays

2019 ◽  
Vol 40 (4) ◽  
pp. e373-e380 ◽  
Author(s):  
Cristina Sierra ◽  
Manuela Calderón ◽  
Eduardo Bárcena ◽  
Alexandra Tisaire ◽  
Eduardo Raboso
Keyword(s):  
Cochlear Implant ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Implant Surgery ◽  
Deep Insertion ◽  
Cochlear Implant Surgery

Electrode design and insertional depth-dependent intra-cochlear pressure changes: a model experiment

2017 ◽  
Vol 132 (3) ◽  
pp. 224-229 ◽  
Author(s):  
P Mittmann ◽  
A Ernst ◽  
I Todt
Keyword(s):  
Cochlear Implant ◽  
Fluid Pressure ◽  
Electrode Array ◽  
Lateral Wall ◽  
Peak Frequency ◽  
Peak Amplitude ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Pressure Peak ◽  
Pressure Changes

AbstractBackground:Preservation of residual hearing is one of the major goals in modern cochlear implant surgery. Intra-cochlear fluid pressure changes influence residual hearing, and should be kept low before, during and after cochlear implant insertion.Methods:Experiments were performed in an artificial cochlear model. A pressure sensor was inserted in the apical part. Five insertions were performed on two electrode arrays. Each insertion was divided into three parts, and statistically evaluated in terms of pressure peak frequency and pressure peak amplitude.Results:The peak frequency over each third part of the electrode increased in both electrode arrays. A slight increase was seen in peak amplitude in the lateral wall electrode array, but not in the midscalar electrode array. Significant differences were found in the first third of both electrode arrays.Conclusion:The midscalar and lateral wall electrode arrays have different intra-cochlear fluid pressure changes associated with intra-cochlear placement, electrode characteristics and insertion.

Comparison of Electrically Evoked Whole-Nerve Action Potential and Electrically Evoked Auditory Brainstem Response Thresholds in Nucleus CI24R Cochlear Implant Recipients

2002 ◽  
Vol 13 (08) ◽  
pp. 416-427 ◽  
Author(s):  
Marcia J. Hay-McCutcheon ◽  
Carolyn J. Brown ◽  
Kelly Schmidt Clay ◽  
Keely Seyle
Keyword(s):  
Action Potential ◽  
Cochlear Implant ◽  
Auditory Brainstem Response ◽  
Electrode Array ◽  
Auditory Brainstem ◽  
Electrode Arrays ◽  
Direct Stimulation ◽  
Nerve Action ◽  
Brainstem Response ◽  
Response Thresholds

In this study, differences between electrically evoked whole-nerve action potential (EAP) and electrically evoked auditory brainstem response (EABR) measurements within Nucleus CI24R cochlear implant recipients were evaluated. Precurved modiolus-hugging internal electrode arrays, such as the CI24R, are designed to provide more direct stimulation of neural elements of the modiolus. If the electrode array is closer to the modiolus, electrically evoked and behavioral levels might be lower than were previously recorded for the straight electrode array, the CI24M. EAP and EABR growth functions and behavioral levels were obtained for 10 postlingually deafened adults. Results revealed no significant differences between EAP and EABR threshold levels, and these levels were not significantly lower than those obtained using the CI24M.

Inroads Toward Robot-Assisted Cochlear Implant Surgery Using Steerable Electrode Arrays

2010 ◽  
Vol 31 (8) ◽  
pp. 1199-1206 ◽  
Author(s):  
Jian Zhang ◽  
Wei Wei ◽  
Jienan Ding ◽  
J. Thomas Roland ◽  
Spiros Manolidis ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Arrays ◽  
Robot Assisted ◽  
Implant Surgery ◽  
Cochlear Implant Surgery

scholarly journals Frictional Behavior of Cochlear Electrode Array Is Dictated by Insertion Speed and Impacts Insertion Force

2021 ◽  
Vol 11 (11) ◽  
pp. 5162
Author(s):  
Dana Dohr ◽  
Nicklas Fiedler ◽  
Wolfram Schmidt ◽  
Niels Grabow ◽  
Robert Mlynski ◽  
...  
Keyword(s):  
Friction Coefficient ◽  
Cochlear Implant ◽  
Electrode Array ◽  
Mechanical Trauma ◽  
Electrode Arrays ◽  
Friction Behavior ◽  
Insertion Force ◽  
Friction Coefficients ◽  
Electrode Insertion ◽  
The Impact

Background: During cochlear implantation, the electrode array has significant friction with the sensitive endocochlear lining and causes mutual mechanical trauma while the array is being inserted. Both, the impact of insertion speed on electrode friction and the relationship of electrode insertion force and friction have not been adequately investigated to date. Methods: In this study, friction coefficients between a CI electrode array (31.5 mm) and a tissue simulating the endocochlear lining have been acquired, depending on different insertion speeds (0.1, 0.5, 1.0, 1.5, and 2.0 mm/s). Additionally, the electrode insertion forces during the placing into a scala tympani model were recorded and correlated with the friction coefficient. Results: It was shown that the friction coefficient reached the lowest value at an insertion speed of 0.1 mm/s (0.24 ± 0.13), a maximum occurred at 1.5 mm/s (0.59 ± 0.12), and dropped again at 2 mm/s (0.45 ± 0.11). Similar patterns were observed for the insertion forces. Consequently, a high correlation coefficient (0.9) was obtained between the insertion forces and friction coefficients. Conclusion: The present study reveals a non-linear increase in electrode array friction, when insertion speed raises and reports a high correlation between friction coefficient and electrode insertion force. This dependence is a relevant future parameter to evaluate and reduce cochlear implant insertion trauma. Significance statement: Here, we demonstrated a dependence between cochlear electrode insertion speed and its friction behavior and a high correlation to insertion force. Our study provides valuable information for the evaluation and prevention of cochlear implant insertion trauma and supports the optimization of cochlear electrode arrays regarding friction characteristics.

scholarly journals Cochlear Implant Surgical Technique: Our Experience

2018 ◽  
Vol 01 (01) ◽  
pp. 007-010
Author(s):  
Milind Kirtane ◽  
Kashmira Chavan
Keyword(s):  
Surgical Technique ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Surgical Approaches ◽  
Implant Surgery ◽  
Original Technique ◽  
Cortical Mastoidectomy ◽  
Cochlear Implant Surgery ◽  
Posterior Tympanotomy

Abstract Introduction Different surgical approaches have been adopted for cochlear implantation, with cortical mastoidectomy–posterior tympanotomy being the most commonly followed technique. Method In this article, we describe the surgical technique for cochlear implant followed at our center, which has been successfully implemented in more than 2,500 cochlear implant surgeries. Cochlear implant surgery using the cortical mastoidectomy–posterior tympanotomy technique has been performed in more than 2,500 cases with some modifications to the original technique over a period of time. Results In spite of not using tie-down holes and securing down the receiver–stimulator with sutures, no cases of receiver–stimulator displacement or outward electrode migration have been noted with the current technique of creating a snug-fitting subperiosteal pocket along with a hook for the electrode array. Conclusion Adhering to a strict intraoperative surgical protocol plays an extremely important role in carrying out successful cochlear implant surgeries with minimal complications.

scholarly journals Reliability of start and stop control of hydraulic actuation for the insertion of electrode arrays

2021 ◽  
Vol 7 (2) ◽  
pp. 109-112
Author(s):  
M. Geraldine Zuniga ◽  
Viktor Schell ◽  
Jakob Cramer ◽  
Thomas Lenarz ◽  
Thomas S. Rau
Keyword(s):  
Cochlear Implant ◽  
Infusion Pump ◽  
Electrode Arrays ◽  
Forward Movement ◽  
Average Delay ◽  
Implant Surgery ◽  
Onset Delay ◽  
Actual Movement ◽  
Cochlear Implant Surgery ◽  
And Control

Abstract Atraumatic insertions of electrode arrays (EA) into the cochlea aim to preserve natural structures and residual hearing. However, there is a limit as to how smooth and slow a surgeon can insert an EA. As a potential solution, we recently presented a tool (cochlea hydro drive, CHD) that makes use of an infusion pump to prompt and control the desired, continuous and very slow (< 1 mm/s) forward movement for such insertions. The present work further describes the onset, delay and cessation of the hydraulic actuation in response to different start and stop mechanisms, to better understand the safety of its application for cochlear implant surgery. Methods: Our previously designed tool was used to perform insertions of an EA into an artificial scala tympani model. The prototype is designed to hold an EA, which is then actuated by a standard infusion pump programmed to operate at 0.4 mm/ and 0.1 mm/s. A tubing system between the CHD and the pump includes a three-way valve. Ten insertions were operated using the functions of the pump and ten using the valve. Results: From the programmed start to the actual movement, we observed a larger average delay using the pump’s start function (5 s at 0.4 mm/s; 17 s at 0.1 mm/s) vs. opening the valve (< 0.7 s for both velocities). Moreover, the average cessation of movement with the valve closure was almost immediate (0.7 s for both velocities; this corresponds to < 0.1 mm with the slower tested velocity), as opposed to 60- 80 s delay when using the pump’s stop function. Conclusion: The use of a 3-way valve facilitates motion cessation to the high accuracy level required for cochlear implant surgery. These promising findings support future clinical translation of our tool.

Another reason for intra-operative imaging during cochlear implantation

2008 ◽  
Vol 122 (4) ◽  
Author(s):  
M Viccaro ◽  
E De Seta ◽  
E Covelli ◽  
V Marvaso ◽  
R Filipo
Keyword(s):  
Cochlear Implant ◽  
Semicircular Canal ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Neural Response ◽  
Radiological Assessment ◽  
Implant Surgery ◽  
Stimulation Intensity ◽  
Cochlear Implant Surgery ◽  
The Right

AbstractObjective:We report a case of a rare cochlear implant complication: the introduction of the electrode array into the superior semicircular canal, with intra-operative measurements of neural response reactions suggesting reasonable functioning of the implant.Case report:A two-year old patient affected by congenital, profound, sensorineural deafness underwent bilateral cochlear implantation at the ENT clinic of the ‘La Sapienza’ University of Rome. Two Clarion 90k devices were implanted, and electrophysiological and radiological checks were performed. After the introduction of the array in the right side, neural response imaging was performed, and a neural potential was found only on two apical electrodes, at a stimulation intensity of 431 clinical units. The situation differed on the left side, where neural response imaging was present at a stimulation intensity of 300 clinical units on the two electrodes tested (one apical electrode (number three), and one middle electrode (number nine)). Intra-operative radiological assessment with a transorbital plain films was performed as usual in order to assess the position of the electrodes inside the cochlea. This radiography showed the electrode array to be in the superior semicircular canal in the right ear.Conclusion:Intra-operative monitoring tests during cochlear implant surgery play different roles; measurement of impedances and neural response imaging can evaluate the integrity of implant electrodes and the status of the electrode–cochlea interface, but it must not be the sole way in which correct positioning of the array is confirmed. In our opinion, intra-operative radiological assessment is mandatory during cochlear implant surgery.

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