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Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array.

Rau TS, Lenarz T, Majdani O - Int J Otolaryngol (2015)

Bottom Line: Conclusion.This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion.Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma. Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed "trauma risk" rating scale. Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique. Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

No MeSH data available.


Related in: MedlinePlus

Graphical user interface (GUI) of the custom-made simulation tool “SimCInsert.” It enables visualisation of both the geometrical data for the investigated inner ears (1, here: medium-sized) and the shape of the electrode arrays (2, here: RE06). Using the slider (3), the stylet (not visualized) can be virtually moved; that is, the array's shape is manipulated. Using six cursor buttons (4, two for each interactively adjustable parameter Δx, Δy, and Δφ), the location and orientation of the electrode array for each shape can be manipulated with respect to the cochlea plotted at the same (fixed) position. Use of both input options enables a complete insertion process to be simulated. Radio buttons (5) were included to interactively rate the risk of insertion trauma (see Section 2.5).
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fig7: Graphical user interface (GUI) of the custom-made simulation tool “SimCInsert.” It enables visualisation of both the geometrical data for the investigated inner ears (1, here: medium-sized) and the shape of the electrode arrays (2, here: RE06). Using the slider (3), the stylet (not visualized) can be virtually moved; that is, the array's shape is manipulated. Using six cursor buttons (4, two for each interactively adjustable parameter Δx, Δy, and Δφ), the location and orientation of the electrode array for each shape can be manipulated with respect to the cochlea plotted at the same (fixed) position. Use of both input options enables a complete insertion process to be simulated. Radio buttons (5) were included to interactively rate the risk of insertion trauma (see Section 2.5).

Mentions: Both in order to model intracochlear curling behaviour and for the intended optimization of the insertion process, a simulation tool called “SimCInsert” was developed using MATLAB (R2008b, MathWorks, Natick, MA, USA). The corresponding graphical user interface (GUI) is shown in Figure 7. The GUI allows loading of the prepared cochlear contours (see Section 2.3.2) which are visualized at a constant (fixed) position within the main window. In contrast, the visualization of the electrode array (also loaded via a task menu entry) is dynamic and based on the stored data on curling behaviour as a function both of stylet extraction and of interactively adjustable parameters for the position (Δx, Δy) and orientation (Δφ) relative to the cochlear contour. By using a slider at the bottom of the GUI, the user is able to control stylet retraction. The corresponding configuration of the electrode array is automatically loaded from the database (see Section 2.2.3). These “raw data” are transformed according to the manually chosen location parameters. As choosing the desired position and orientation of the electrode array relative to the cochlea's geometry involves a 2D task, there are displacements in both x and y directions, as well as one rotation around the cochleostomy. These “transformed data” are extended to the 2D representation of the electrode array as described in Section 2.2.4 and visualized in addition to the cochlear contour within the main window. Via translation in the negative x direction, for example, the feeding of the implant into the inner ear is simulated in SimCInsert (which is equal to insertion depth). In this way, SimCInsert provides a fairly simple means of simulating the conventional AOS technique, while also allowing manual optimization of the insertion process.


Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array.

Rau TS, Lenarz T, Majdani O - Int J Otolaryngol (2015)

Graphical user interface (GUI) of the custom-made simulation tool “SimCInsert.” It enables visualisation of both the geometrical data for the investigated inner ears (1, here: medium-sized) and the shape of the electrode arrays (2, here: RE06). Using the slider (3), the stylet (not visualized) can be virtually moved; that is, the array's shape is manipulated. Using six cursor buttons (4, two for each interactively adjustable parameter Δx, Δy, and Δφ), the location and orientation of the electrode array for each shape can be manipulated with respect to the cochlea plotted at the same (fixed) position. Use of both input options enables a complete insertion process to be simulated. Radio buttons (5) were included to interactively rate the risk of insertion trauma (see Section 2.5).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581552&req=5

fig7: Graphical user interface (GUI) of the custom-made simulation tool “SimCInsert.” It enables visualisation of both the geometrical data for the investigated inner ears (1, here: medium-sized) and the shape of the electrode arrays (2, here: RE06). Using the slider (3), the stylet (not visualized) can be virtually moved; that is, the array's shape is manipulated. Using six cursor buttons (4, two for each interactively adjustable parameter Δx, Δy, and Δφ), the location and orientation of the electrode array for each shape can be manipulated with respect to the cochlea plotted at the same (fixed) position. Use of both input options enables a complete insertion process to be simulated. Radio buttons (5) were included to interactively rate the risk of insertion trauma (see Section 2.5).
Mentions: Both in order to model intracochlear curling behaviour and for the intended optimization of the insertion process, a simulation tool called “SimCInsert” was developed using MATLAB (R2008b, MathWorks, Natick, MA, USA). The corresponding graphical user interface (GUI) is shown in Figure 7. The GUI allows loading of the prepared cochlear contours (see Section 2.3.2) which are visualized at a constant (fixed) position within the main window. In contrast, the visualization of the electrode array (also loaded via a task menu entry) is dynamic and based on the stored data on curling behaviour as a function both of stylet extraction and of interactively adjustable parameters for the position (Δx, Δy) and orientation (Δφ) relative to the cochlear contour. By using a slider at the bottom of the GUI, the user is able to control stylet retraction. The corresponding configuration of the electrode array is automatically loaded from the database (see Section 2.2.3). These “raw data” are transformed according to the manually chosen location parameters. As choosing the desired position and orientation of the electrode array relative to the cochlea's geometry involves a 2D task, there are displacements in both x and y directions, as well as one rotation around the cochleostomy. These “transformed data” are extended to the 2D representation of the electrode array as described in Section 2.2.4 and visualized in addition to the cochlear contour within the main window. Via translation in the negative x direction, for example, the feeding of the implant into the inner ear is simulated in SimCInsert (which is equal to insertion depth). In this way, SimCInsert provides a fairly simple means of simulating the conventional AOS technique, while also allowing manual optimization of the insertion process.

Bottom Line: Conclusion.This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion.Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

View Article: PubMed Central - PubMed

Affiliation: Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma. Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed "trauma risk" rating scale. Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique. Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.

No MeSH data available.


Related in: MedlinePlus