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

Lenarz, Thomas ; Avci, Ersin ; Gazibegovic, Dzemal ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2019

In: Otology & Neurotology Vol. 40, No. 7 ( 2019-08), p. 872-877

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In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 7 ( 2019-08), p. 872-877

Abstract: A modern cochlear implant electrode array design must combine: improved surgical ease of use, structure preservation, particularly important for pediatric application, stable position within the cochlea over time, and a meaningful balance between hearing preservation against addressing sufficient cochlear tissue to support electrical-only hearing. The aim of this study was to investigate a new lateral wall electrode array design from Advanced Bionics on human temporal bones (TBs). Methods: Ten fresh-frozen TBs were implanted with the SlimJ electrode array via the round window. The electrode array is 23 mm long, with a cross-section varying from 0.25 × 0.55 mm at the most apical contact to 0.6 × 0.8 mm at the proximal marker contact. To assess location of the electrode array, the TBs were postoperatively scanned using cone beam computed tomography, and histology was performed to assess intracochlear trauma (Grades 0–4). Results: All electrode arrays were considered easy to insert. The average insertion depth was 432 degrees measured from the round window with a range from 411 to 450 degrees azimuth. Nine out of 10 electrode arrays were inserted fully ( 〈 0.5 mm out of the cochlea), one electrode array was left 1.5 mm out of the cochlea. No translocations were observed in all 10 cochleae, slight touching of the basilar membrane at the distal portion of the array was observed in 50% of the cases. Conclusion: The results from the new thin lateral wall electrode array from Advanced Bionics provided consistent scala tympani locations. No translocations were observed and almost all electrode arrays were fully inserted. These results are promising and the new electrode array will be further studied in clinical practice investigating hearing preservation capabilities and speech performance.

Type of Medium: Online Resource

ISSN: 1531-7129 , 1537-4505

URL: Article

DOI: 10.1097/MAO.0000000000002251

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2019

detail.hit.zdb_id: 2058738-7

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Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion?

Harris, Michael S. ; Koka, Kanth ; Riggs, William J. ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Otology & Neurotology Vol. 43, No. 7 ( 2022-8), p. 789-796

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In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 7 ( 2022-8), p. 789-796

Abstract: To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. Study Design Prospective, randomized clinical trial. Setting Ten high-volume, tertiary care CI centers. Patients Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. Methods Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. Results Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was “good” (i.e., LF-PTA change 0–15 dB) in 34.5%, “fair” (i.e., LF-PTA change 〉 15–29 dB) in 22.5%, and “poor” (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG “on,” mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG “off” ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. Conclusions Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG “on” compared with ECochG “off.”

Type of Medium: Online Resource

ISSN: 1537-4505 , 1531-7129

URL: Article

DOI: 10.1097/MAO.0000000000003588

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

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Preclinical evaluation of a tool for insertion force measurements in cochlear implant surgery

Böttcher-Rebmann, Georg ; Schell, Viktor ; Zuniga, M. Geraldine ; [et al.]

Springer Science and Business Media LLC ; 2023

In: International Journal of Computer Assisted Radiology and Surgery

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In: International Journal of Computer Assisted Radiology and Surgery, Springer Science and Business Media LLC

Abstract: Trauma that may be inflicted to the inner ear (cochlea) during the insertion of an electrode array (EA) in cochlear implant (CI) surgery can significantly decrease the hearing outcome of patients with residual hearing. Interaction forces between the EA and the cochlea are a promising indicator for the likelihood of intracochlear trauma. However, insertion forces have only been measured in laboratory setups. We recently developed a tool to measure the insertion force during CI surgery. Here, we present the first ex vivo evaluation of our tool with a focus on usability in the standard surgical workflow. Methods Two CI surgeons inserted commercially available EAs into three temporal bone specimens. The insertion force and the orientation of the tool were recorded together with camera footage. The surgeons answered a questionnaire after each insertion to evaluate the surgical workflow with respect to CI surgery. Results The EA insertion using our tool was rated successful in all 18 trials. The surgical workflow was evaluated to be equivalent to standard CI surgery. Minor handling challenges can be overcome through surgeon training. The peak insertion forces were 62.4 mN ± 26.7 mN on average. Peak forces significantly correlated to the final electrode insertion depth, supporting the assumption that the measured forces mainly correspond to intracochlear events and not extracochlear friction. Gravity-induced forces of up to 28.8 mN were removed from the signal, illustrating the importance of the compensation of such forces in manual surgery. Conclusion The results show that the tool is ready for intraoperative use. In vivo insertion force data will improve the interpretability of experimental results in laboratory settings. The implementation of live insertion force feedback to surgeons could further improve residual hearing preservation.

Type of Medium: Online Resource

ISSN: 1861-6429

URL: Article

DOI: 10.1007/s11548-023-02975-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2235881-X

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The Codacs™ Direct Acoustic Cochlear Implant Actuator: Exploring Alternative Stimulation Sites and Their Stimulation Efficiency

Grossöhmichen, Martin ; Salcher, Rolf ; Kreipe, Hans-Heinrich ; [et al.]

Public Library of Science (PLoS) ; 2015

In: PLOS ONE Vol. 10, No. 3 ( 2015-3-18), p. e0119601-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 10, No. 3 ( 2015-3-18), p. e0119601-

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0119601

DOI: 10.1371/journal.pone.0119601.g001

DOI: 10.1371/journal.pone.0119601.g002

DOI: 10.1371/journal.pone.0119601.g003

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DOI: 10.1371/journal.pone.0119601.g007

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DOI: 10.1371/journal.pone.0119601.g009

DOI: 10.1371/journal.pone.0119601.g010

DOI: 10.1371/journal.pone.0119601.t001

DOI: 10.1371/journal.pone.0119601.t002

DOI: 10.1371/journal.pone.0119601.s001

DOI: 10.1371/journal.pone.0119601.s002

DOI: 10.1371/journal.pone.0119601.s003

DOI: 10.1371/journal.pone.0119601.s004

DOI: 10.1371/journal.pone.0119601.s005

DOI: 10.1371/journal.pone.0119601.s006

DOI: 10.1371/journal.pone.0119601.s007

DOI: 10.1371/journal.pone.0119601.s008

DOI: 10.1371/journal.pone.0119601.s009

DOI: 10.1371/journal.pone.0119601.s010

DOI: 10.1371/journal.pone.0119601.s011

DOI: 10.1371/journal.pone.0119601.s012

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2015

detail.hit.zdb_id: 2267670-3

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Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservation

Buechner, Andreas ; Bardt, Michael ; Haumann, Sabine ; [et al.]

Public Library of Science (PLoS) ; 2022

In: PLOS ONE Vol. 17, No. 4 ( 2022-4-22), p. e0266077-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 4 ( 2022-4-22), p. e0266077-

Abstract: Access to low-frequency acoustic information in cochlear implant patients leads to better speech understanding in noise. Electrocochleography (ECochG) can provide real-time feedback about the health of the cochlea during the insertion process with the potential to reduce insertion trauma. We describe our experiences of using this technique. Data from 47 adult subjects with measurable residual hearing and an Advanced Bionics (Valencia, CA) SlimJ (46) or MidScala (1) electrode array were analyzed. ECochGs were recorded intraoperatively via the implant. The surgeon adjusted the course of the electrode insertion based on drops in the ECochG. The final array position was assessed using postoperative imaging and pure tone thresholds were measured before and after surgery. Three different patterns of ECochG response amplitude were observed: Growth, Fluctuating and Total Loss. Subjects in the growth group showed the smallest postoperative hearing loss. However, the group with fluctuating amplitudes showed no meaningful correlation between the ECochG responses and the postoperative hearing loss, indicating that amplitude alone is insufficient for detecting damage. Considering the phase of the signal additionally to the amplitude and reclassifying the data by both the phase and amplitude of the response into three groups Type I–Type III produced statistically significant correlations between postoperative hearing loss and the grouping based on amplitude and phase respectively. We showed significantly better hearing preservation for Type I (no drop in amplitude) and Type II (drop with a concurrent phase shift), while Type III (drop without concurrent phase shift) had more surgery induced hearing loss. ECochG potentials measured through the implant could provide valuable feedback during the electrode insertion. Both the amplitude and phase of the ECochG response are important to consider. More data needs to be evaluated to better understand the impact of the different signal components to design an automated system to alert the surgeon ahead of damaging the cochlea.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0266077

DOI: 10.1371/journal.pone.0266077.g001

DOI: 10.1371/journal.pone.0266077.g002

DOI: 10.1371/journal.pone.0266077.g003

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DOI: 10.1371/journal.pone.0266077.g007

DOI: 10.1371/journal.pone.0266077.g008

DOI: 10.1371/journal.pone.0266077.t001

DOI: 10.1371/journal.pone.0266077.s001

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2022

detail.hit.zdb_id: 2267670-3

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Patient specific selection of lateral wall cochlear implant electrodes based on anatomical indication ranges

Timm, Max Eike ; Majdani, Omid ; Weller, Tobias ; [et al.]

Public Library of Science (PLoS) ; 2018

In: PLOS ONE Vol. 13, No. 10 ( 2018-10-26), p. e0206435-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 13, No. 10 ( 2018-10-26), p. e0206435-

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0206435

DOI: 10.1371/journal.pone.0206435.g001

DOI: 10.1371/journal.pone.0206435.g002

DOI: 10.1371/journal.pone.0206435.g003

DOI: 10.1371/journal.pone.0206435.g004

DOI: 10.1371/journal.pone.0206435.g005

DOI: 10.1371/journal.pone.0206435.g006

DOI: 10.1371/journal.pone.0206435.g007

DOI: 10.1371/journal.pone.0206435.g008

DOI: 10.1371/journal.pone.0206435.g009

DOI: 10.1371/journal.pone.0206435.g010

DOI: 10.1371/journal.pone.0206435.g011

DOI: 10.1371/journal.pone.0206435.t001

DOI: 10.1371/journal.pone.0206435.t002

DOI: 10.1371/journal.pone.0206435.s001

DOI: 10.1371/journal.pone.0206435.s002

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2018

detail.hit.zdb_id: 2267670-3

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Long‐Term Hearing Outcome of Cochlear Implantation in Cases with Simultaneous Intracochlear Schwannoma Resection

Di Micco, Riccardo ; Salcher, Rolf ; Lesinski‐Schiedat, Anke ; [et al.]

Wiley ; 2023

In: The Laryngoscope

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In: The Laryngoscope, Wiley

Abstract: The aim was to analyze the long‐term hearing results after simultaneous microsurgical extirpation via enlarged cochleostomy and cochlear implantation in intracochlear schwannoma as compared with non‐tumor single‐side deafness patients. Methods Microsurgical extirpation via enlarged cochleostomy with simultaneous cochlear implantation was performed in 15 cases of intracochlear schwannoma between 2014 and 2021. Speech recognition tests in German language and impedance performances were collected over 36 months of observation and compared with an internal cohort of 52 age matched non‐tumor single‐side deafness patients. Retrospective cohort study in a tertiary referral center. Results The surgery proved feasible and uneventful in all cases. In the case of intracochlear schwannoma, the hearing rehabilitation results were highly satisfactory and comparable to those of the non‐tumor single‐side deafness cohort. The speech recognition performance improved steadily in the first 12 months; afterward, it remained stable, providing indirect evidence against tumor recurrence during the follow‐up. One patient required implant revision surgery related to device failure, but no recurrence was registered in the 36 months of observation. Conclusions Cochlear implantation is the strategy of choice for hearing rehabilitation in case of intracochlear schwannomas in the long term. In particular, the combination of tumor extirpation via cochleostomy with a cochlear implantation in the same surgical time offers a viable therapy for intracochlear schwannoma, granting a sufficient degree of radicality without compromising the cochlear integrity. This technique allows for revision surgery if required. Level of Evidence 4 Laryngoscope , 2023

Type of Medium: Online Resource

ISSN: 0023-852X , 1531-4995

URL: Article

DOI: 10.1002/lary.31025

Language: English

Publisher: Wiley

Publication Date: 2023

detail.hit.zdb_id: 2026089-1

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Comparison of Two Different Titanium Couplers for an Active Middle Ear Implant

Schwab, Burkard ; Salcher, Rolf ; Teschner, Magnus

Ovid Technologies (Wolters Kluwer Health) ; 2014

In: Otology & Neurotology Vol. 35, No. 9 ( 2014-10), p. 1615-1620

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In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 9 ( 2014-10), p. 1615-1620

Type of Medium: Online Resource

ISSN: 1531-7129

URL: Article

DOI: 10.1097/MAO.0000000000000577

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2014

detail.hit.zdb_id: 2058738-7

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Electro-Mechanical Stimulation of the Cochlea by Vibrating Cochlear Implant Electrodes

Mueller, Mathias ; Salcher, Rolf ; Majdani, Omid ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2015

In: Otology & Neurotology Vol. 36, No. 10 ( 2015-12), p. 1753-1758

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In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 10 ( 2015-12), p. 1753-1758

Type of Medium: Online Resource

ISSN: 1531-7129

URL: Article

DOI: 10.1097/MAO.0000000000000872

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2015

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On the Intracochlear Location of Straight Electrode Arrays After Cochlear Implantation: How Lateral Are Lateral Wall Electrodes?

Salcher, Rolf ; Boruchov, Aaron ; Timm, Max ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Otology & Neurotology Vol. 42, No. 2 ( 2021-02), p. 242-250

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In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 2 ( 2021-02), p. 242-250

Abstract: Cochlear implants are the gold standard for patients with severe sensorineural hearing loss. A focused electrical stimulation of individual spiral ganglion neurons has not been achieved yet because the scala tympani is a fluid-filled compartment and does not offer a matrix for neuritic outgrowth. Coating of the electrode contacts with swelling hydrogels could fill that gap between the electrode array and the medial wall of the cochlea. Therefore, the exact position of the electrode array within the scala tympani has to be known. Study Design: Retrospective analysis of patient data sets. Setting: Tertiary referral center. A total of 95 patients with cochlear implants from one manufacturer were included in this study. The lateral wall, the modiolar wall, and the cochlear implant electrode were segmented using OsiriX MD. For repositioning and reconstructing the respective contours and measuring distances, files were analyzed in MATLAB. The distances from the edge of each electrode contact to the cochlear walls showed no significant differences. But between the different contacts within each patient, there were significant differences. Around 180 degree insertion, electrodes start to get in contact with the lateral wall. The tip of the electrode array was always facing toward the modiolar wall independent of the length of the electrode. We established a method to analyze the position of electrodes within the cochlea.

Type of Medium: Online Resource

ISSN: 1531-7129 , 1537-4505

URL: Article

DOI: 10.1097/MAO.0000000000002880

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

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