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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

As Figure 16, but now the results of different electrode arrays are shown in grouped bar plots (cf. Figure 3(b)). This means visualizing the results highlights the fact that the influence of cochlear size on trauma risk is less than the actual curling behaviour of the implant. This becomes clear if one compares, for example, the probability of trauma grade III in autoAOS for all three different cochleae. The grouped bar plots are quite similar in appearance (elliptical label), implying that there is not much difference in trauma risk between a small or a medium-sized cochlea. By contrast, in each ellipse, the results for different electrode arrays vary strongly, indicating a strong influence of electrode curling behaviour on the degree of exposure involved in the insertion process.
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fig17: As Figure 16, but now the results of different electrode arrays are shown in grouped bar plots (cf. Figure 3(b)). This means visualizing the results highlights the fact that the influence of cochlear size on trauma risk is less than the actual curling behaviour of the implant. This becomes clear if one compares, for example, the probability of trauma grade III in autoAOS for all three different cochleae. The grouped bar plots are quite similar in appearance (elliptical label), implying that there is not much difference in trauma risk between a small or a medium-sized cochlea. By contrast, in each ellipse, the results for different electrode arrays vary strongly, indicating a strong influence of electrode curling behaviour on the degree of exposure involved in the insertion process.

Mentions: Notwithstanding the inaccuracies involved in modelling of minAOS/autoAOS due to the insufficient consideration of the influence of a guiding tube, the results presented clearly demonstrate the advantages of individual optimization of the insertion process. Comparison of Figures 12, 10, and 14 clearly indicates that the entire insertion process is shifted toward a gentler procedure, which means a less traumatic and therefore less risky insertion process in terms of hearing preservation. This finding is highlighted by the contrasting juxtaposition, in Figures 16 and 17, of all three insertion strategies investigated. For the first strategy mentioned, the results of the risk rating for the different electrode arrays are shown in separate rows. The outcomes for the small, medium-sized, and large cochleae are summarized within each bar chart. In Figure 17, however, the results are sorted by size of cochlea, with separate rows for CS, CM, and CL. The different electrode arrays are colour-coded in each bar chart. The shift in trauma risk toward lower values due to the increasing level of optimization is clearly visible in Figures 16 and 17: from autoAOS without adjustable insertion parameters, to manAOS with slightly adjustable orientation, and finally optIns representing holistic optimization.


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

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

As Figure 16, but now the results of different electrode arrays are shown in grouped bar plots (cf. Figure 3(b)). This means visualizing the results highlights the fact that the influence of cochlear size on trauma risk is less than the actual curling behaviour of the implant. This becomes clear if one compares, for example, the probability of trauma grade III in autoAOS for all three different cochleae. The grouped bar plots are quite similar in appearance (elliptical label), implying that there is not much difference in trauma risk between a small or a medium-sized cochlea. By contrast, in each ellipse, the results for different electrode arrays vary strongly, indicating a strong influence of electrode curling behaviour on the degree of exposure involved in the insertion process.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4581552&req=5

fig17: As Figure 16, but now the results of different electrode arrays are shown in grouped bar plots (cf. Figure 3(b)). This means visualizing the results highlights the fact that the influence of cochlear size on trauma risk is less than the actual curling behaviour of the implant. This becomes clear if one compares, for example, the probability of trauma grade III in autoAOS for all three different cochleae. The grouped bar plots are quite similar in appearance (elliptical label), implying that there is not much difference in trauma risk between a small or a medium-sized cochlea. By contrast, in each ellipse, the results for different electrode arrays vary strongly, indicating a strong influence of electrode curling behaviour on the degree of exposure involved in the insertion process.
Mentions: Notwithstanding the inaccuracies involved in modelling of minAOS/autoAOS due to the insufficient consideration of the influence of a guiding tube, the results presented clearly demonstrate the advantages of individual optimization of the insertion process. Comparison of Figures 12, 10, and 14 clearly indicates that the entire insertion process is shifted toward a gentler procedure, which means a less traumatic and therefore less risky insertion process in terms of hearing preservation. This finding is highlighted by the contrasting juxtaposition, in Figures 16 and 17, of all three insertion strategies investigated. For the first strategy mentioned, the results of the risk rating for the different electrode arrays are shown in separate rows. The outcomes for the small, medium-sized, and large cochleae are summarized within each bar chart. In Figure 17, however, the results are sorted by size of cochlea, with separate rows for CS, CM, and CL. The different electrode arrays are colour-coded in each bar chart. The shift in trauma risk toward lower values due to the increasing level of optimization is clearly visible in Figures 16 and 17: from autoAOS without adjustable insertion parameters, to manAOS with slightly adjustable orientation, and finally optIns representing holistic optimization.

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