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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 after individual optimization of the complete insertion process (the AOS part). For all examined implants and inner ear geometries, it was possible to markedly reduce the risk of insertion trauma. Compare this figure with (optIns) Figure 10 (manAOS) and Figure 12 (autoAOS). The poorest outcomes are observed with RE01. However, after adjusting the curling of the electrode array to the surrounding anatomy, the insertion process is subject to trauma risk of grade 0 for all investigated cases.
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fig14: Histogram of the distribution (observation frequency) of the trauma risk after individual optimization of the complete insertion process (the AOS part). For all examined implants and inner ear geometries, it was possible to markedly reduce the risk of insertion trauma. Compare this figure with (optIns) Figure 10 (manAOS) and Figure 12 (autoAOS). The poorest outcomes are observed with RE01. However, after adjusting the curling of the electrode array to the surrounding anatomy, the insertion process is subject to trauma risk of grade 0 for all investigated cases.

Mentions: While insertion processes using the conventional AOS technique are mainly characterized by trauma risk grades III and IV, it is possible to reduce the risk of insertion trauma by means of the individual optimization strategy introduced. Figure 14 shows the percentage distribution of the trauma risk assessment for the optimized insertion (optIns). In comparison with manAOS (see Figure 10) and minAOS (see Figure 12), it is evident that the overall insertion process is shifted toward less traumatic implantation. After optimization, by tailoring the specific curling behaviour of the electrode array to the individual anatomical constraints, the insertion process is chiefly characterized by trauma risk grade 0. In all 12 investigated cases (combinations of differing curling behaviour and cochlear anatomy), the rating of the trauma risk with grade 0 has the largest share.


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 after individual optimization of the complete insertion process (the AOS part). For all examined implants and inner ear geometries, it was possible to markedly reduce the risk of insertion trauma. Compare this figure with (optIns) Figure 10 (manAOS) and Figure 12 (autoAOS). The poorest outcomes are observed with RE01. However, after adjusting the curling of the electrode array to the surrounding anatomy, the insertion process is subject to trauma risk of grade 0 for all investigated cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig14: Histogram of the distribution (observation frequency) of the trauma risk after individual optimization of the complete insertion process (the AOS part). For all examined implants and inner ear geometries, it was possible to markedly reduce the risk of insertion trauma. Compare this figure with (optIns) Figure 10 (manAOS) and Figure 12 (autoAOS). The poorest outcomes are observed with RE01. However, after adjusting the curling of the electrode array to the surrounding anatomy, the insertion process is subject to trauma risk of grade 0 for all investigated cases.
Mentions: While insertion processes using the conventional AOS technique are mainly characterized by trauma risk grades III and IV, it is possible to reduce the risk of insertion trauma by means of the individual optimization strategy introduced. Figure 14 shows the percentage distribution of the trauma risk assessment for the optimized insertion (optIns). In comparison with manAOS (see Figure 10) and minAOS (see Figure 12), it is evident that the overall insertion process is shifted toward less traumatic implantation. After optimization, by tailoring the specific curling behaviour of the electrode array to the individual anatomical constraints, the insertion process is chiefly characterized by trauma risk grade 0. In all 12 investigated cases (combinations of differing curling behaviour and cochlear anatomy), the rating of the trauma risk with grade 0 has the largest share.

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