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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

Histogram of the distribution (observation frequency) of the trauma risk where the procedure is performed in an automated manner. As no additional parameters could be adjusted to tailor the orientation of the electrode array, the simulation of the automated AOS technique (autoAOS) represents its most consistent implementation in this study. The histogram clearly shows the high portion of trauma risks III and IV on the insertion process. Only with RE07 is less trauma risk (≤I) observed. Of the electrode arrays in the study, RE07 is the one with the flattest curling curve and pronounced straightening in the initial phase.
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fig12: Histogram of the distribution (observation frequency) of the trauma risk where the procedure is performed in an automated manner. As no additional parameters could be adjusted to tailor the orientation of the electrode array, the simulation of the automated AOS technique (autoAOS) represents its most consistent implementation in this study. The histogram clearly shows the high portion of trauma risks III and IV on the insertion process. Only with RE07 is less trauma risk (≤I) observed. Of the electrode arrays in the study, RE07 is the one with the flattest curling curve and pronounced straightening in the initial phase.

Mentions: In contrast to the manual approach, the automated procedure is inadequate with regard to the necessary adjustable positioning and orientation, especially when using minimally invasive access to the inner ear. Simulation of the autoAOS scenario results in the trauma risk as shown in Figure 12. This figure clearly illustrates that a high proportion of phases are rated as high-risk (i.e., trauma risk ≥ III). For RE01 and RE08, the insertions were rated as potentially harmful in almost all cases. The RE07 electrode array is the exception; at least in some phases of the insertion process, the actual shape of the implant fits the anatomy of the cochlea, resulting in no or only minimal intersection of both contours.


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

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

Histogram of the distribution (observation frequency) of the trauma risk where the procedure is performed in an automated manner. As no additional parameters could be adjusted to tailor the orientation of the electrode array, the simulation of the automated AOS technique (autoAOS) represents its most consistent implementation in this study. The histogram clearly shows the high portion of trauma risks III and IV on the insertion process. Only with RE07 is less trauma risk (≤I) observed. Of the electrode arrays in the study, RE07 is the one with the flattest curling curve and pronounced straightening in the initial phase.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig12: Histogram of the distribution (observation frequency) of the trauma risk where the procedure is performed in an automated manner. As no additional parameters could be adjusted to tailor the orientation of the electrode array, the simulation of the automated AOS technique (autoAOS) represents its most consistent implementation in this study. The histogram clearly shows the high portion of trauma risks III and IV on the insertion process. Only with RE07 is less trauma risk (≤I) observed. Of the electrode arrays in the study, RE07 is the one with the flattest curling curve and pronounced straightening in the initial phase.
Mentions: In contrast to the manual approach, the automated procedure is inadequate with regard to the necessary adjustable positioning and orientation, especially when using minimally invasive access to the inner ear. Simulation of the autoAOS scenario results in the trauma risk as shown in Figure 12. This figure clearly illustrates that a high proportion of phases are rated as high-risk (i.e., trauma risk ≥ III). For RE01 and RE08, the insertions were rated as potentially harmful in almost all cases. The RE07 electrode array is the exception; at least in some phases of the insertion process, the actual shape of the implant fits the anatomy of the cochlea, resulting in no or only minimal intersection of both contours.

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