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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

Process parameter Δφ against stylet extraction s for all manually optimized insertions, normalized by the initial value at s = 0 mm. (a) All 12 optimized simulations compared with the AOS technique without rotation. (b) Different cochlear size is indicated by different colours. (c) Different electrode arrays are colour-coded.
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fig18: Process parameter Δφ against stylet extraction s for all manually optimized insertions, normalized by the initial value at s = 0 mm. (a) All 12 optimized simulations compared with the AOS technique without rotation. (b) Different cochlear size is indicated by different colours. (c) Different electrode arrays are colour-coded.

Mentions: These findings are supported by a closer look at the insertion parameters, as provided in Figures 18 and 19. In both cases, subfigure (a) shows the optimized insertion parameters Δφ and Δy in comparison with the AOS technique. In subfigure (b), the same graphs are colour-coded by cochlear size, and in subfigure (c) equal colors indicate the same electrode array. Only in the second case can regularities be found in the insertion process supporting the conclusion of a greater impact of curling behaviour on the quality of the insertion process. In a converse consideration, this means that only if the curling behaviour of the used implant is known during preoperative planning can the insertion process be significantly optimized. Knowledge only of the individual anatomy (shape of the cochlea) does not allow prediction of the most useful insertion parameters for gentle and therefore less traumatic insertion.


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

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

Process parameter Δφ against stylet extraction s for all manually optimized insertions, normalized by the initial value at s = 0 mm. (a) All 12 optimized simulations compared with the AOS technique without rotation. (b) Different cochlear size is indicated by different colours. (c) Different electrode arrays are colour-coded.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig18: Process parameter Δφ against stylet extraction s for all manually optimized insertions, normalized by the initial value at s = 0 mm. (a) All 12 optimized simulations compared with the AOS technique without rotation. (b) Different cochlear size is indicated by different colours. (c) Different electrode arrays are colour-coded.
Mentions: These findings are supported by a closer look at the insertion parameters, as provided in Figures 18 and 19. In both cases, subfigure (a) shows the optimized insertion parameters Δφ and Δy in comparison with the AOS technique. In subfigure (b), the same graphs are colour-coded by cochlear size, and in subfigure (c) equal colors indicate the same electrode array. Only in the second case can regularities be found in the insertion process supporting the conclusion of a greater impact of curling behaviour on the quality of the insertion process. In a converse consideration, this means that only if the curling behaviour of the used implant is known during preoperative planning can the insertion process be significantly optimized. Knowledge only of the individual anatomy (shape of the cochlea) does not allow prediction of the most useful insertion parameters for gentle and therefore less traumatic insertion.

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