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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

Change of trauma risk during the manually performed insertion process (manAOS), plotted for RE01 as an example, with corresponding screenshots from SimCInsert. Trauma risk is plotted against stylet extraction s.
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fig11: Change of trauma risk during the manually performed insertion process (manAOS), plotted for RE01 as an example, with corresponding screenshots from SimCInsert. Trauma risk is plotted against stylet extraction s.

Mentions: In total, 36 insertions were modelled using three different cochleae (small, medium, and large) and four different electrode arrays in order to compare three different scenarios. As a reference, the manual procedure for inserting the Contour Advance (CA) electrode array using the Advance Off-Stylet technique (manAOS) was remodelled using SimCInsert. Applying the above-mentioned assumptions about the intuitive adjustment of the insertion process, the trauma risk of the insertion process is distributed as shown in Figure 10. Irrespective of the specific electrode array and the size of the cochlea, a high proportion of the total process is characterized by a risk of trauma of grade ≥ II. More detailed information, using RE01 as an example, is provided in Figure 11. Differentiated according to the three different-sized cochleae, the trauma risk is plotted against stylet extraction (which is inversely proportional to insertion depth). Sample images from SimCInsert show the corresponding insertion depth as well as the contour damage. This schematic illustration demonstrates that insertion is initially less traumatic (in the basal turn of the cochlea) than with progressive insertion depth.


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

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

Change of trauma risk during the manually performed insertion process (manAOS), plotted for RE01 as an example, with corresponding screenshots from SimCInsert. Trauma risk is plotted against stylet extraction s.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig11: Change of trauma risk during the manually performed insertion process (manAOS), plotted for RE01 as an example, with corresponding screenshots from SimCInsert. Trauma risk is plotted against stylet extraction s.
Mentions: In total, 36 insertions were modelled using three different cochleae (small, medium, and large) and four different electrode arrays in order to compare three different scenarios. As a reference, the manual procedure for inserting the Contour Advance (CA) electrode array using the Advance Off-Stylet technique (manAOS) was remodelled using SimCInsert. Applying the above-mentioned assumptions about the intuitive adjustment of the insertion process, the trauma risk of the insertion process is distributed as shown in Figure 10. Irrespective of the specific electrode array and the size of the cochlea, a high proportion of the total process is characterized by a risk of trauma of grade ≥ II. More detailed information, using RE01 as an example, is provided in Figure 11. Differentiated according to the three different-sized cochleae, the trauma risk is plotted against stylet extraction (which is inversely proportional to insertion depth). Sample images from SimCInsert show the corresponding insertion depth as well as the contour damage. This schematic illustration demonstrates that insertion is initially less traumatic (in the basal turn of the cochlea) than with progressive insertion depth.

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