scholarly journals Electrode Afterload: A Valuable Technique in a Case of Short Electrode Insertion

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
C. Riemann ◽  
S. Scholz ◽  
H. Sudhoff ◽  
I. Todt
Keyword(s):  
Case Report ◽  
Revision Surgery ◽  
Round Window ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Speech Understanding ◽  
Insertion Depth ◽  
Speech Performance ◽  
Electrode Insertion ◽  
The Right

Introduction. The location of the electrode inside the cochlea is important for speech performance. However, many variables, including array length, insertion depth, and individual anatomy, may affect the intracochlear position of the electrode. Insertion deeper than 20 mm and revision surgery are critical situations in which residual hearing and electrode integrity may be at risk. This case report challenges this hypothesis and raises the following question: is it possible to achieve a better speech understanding with an electrode afterload without compromising residual hearing? Case Report. A 73-year-old female patient showed up for evaluation of hearing loss. The patient was operated four times in an external hospital due to cholesteatoma formation in the right ear. Related to a poor aided speech understanding, a CI-surgery was performed. 5 months after the surgery, the subject returned with poor speech understanding. A revision surgery was performed, where the first white marker of the electrode was seen in the round window (20 mm). The electrode was inserted 4 mm deeper into the cochlea. After six and twelve months, the results of the Freiburger monosyllabic speech test improved till 25% and 45%, respectively. Discussion. Hearing preservation is possible with a revisional deeper insertion from 20 mm to 24 mm. In this case, a partial obliteration of an open cavity made the electrode surgically easily accessible. This allowed the deeper insertion during the revision surgery. In a regular surgical field with a posterior tympanotomy, the revision surgery is more challenging and brings the electrode into the risk of an iatrogenic destruction. Conclusion. This case of an electrode afterload after having inserted the electrode initially to mm, demonstrates that hearing can be preserved and speech perception can improve after performing this maneuver.

scholarly journals Evaluation of Intracochlear Trauma Caused by Insertion of Cochlear Implant Electrode Arrays through Different Quadrants of the Round Window

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Graziela de Souza Queiroz Martins ◽  
Rubens Vuono Brito Neto ◽  
Robinson Koji Tsuji ◽  
Eloisa Maria Mello Santiago Gebrim ◽  
Ricardo Ferreira Bento
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Electrode Array ◽  
Hearing Preservation ◽  
Round Window Membrane ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Minimal Trauma ◽  
Electrode Insertion ◽  
Temporal Bones

Hypothesis. This study aimed to evaluate whether there is a difference in the degree of intracochlear trauma when the cochlear implant electrode arrays is inserted through different quadrants of the round window membrane.Background. The benefits of residual hearing preservation in cochlear implant recipients have promoted the development of atraumatic surgeries. Minimal trauma during electrode insertion is crucial for residual hearing preservation.Methods. In total, 25 fresh human temporal bones were subjected to mastoidectomy and posterior tympanotomy. The cochlear implant electrode array was inserted through the anterosuperior quadrant of the round window membrane in 50% of the bones and through the anteroinferior quadrant in the remaining 50%. The temporal bones were dehydrated, embedded in epoxy, serially polished, stained, viewed through a stereomicroscope, and photographed with the electrode arraysin situ. The resulting images were analyzed for signs of intracochlear trauma.Results. Histological examinations revealed varying degrees of damage to the intracochlear structures, although the incidence and severity of intracochlear trauma were not influenced by the quadrant of insertion.Conclusions. The incidence and severity of intracochlear trauma were similar in all samples, irrespective of electrode array insertion through the anterosuperior or anteroinferior quadrant of the round window membrane.

Preservation of cochlear structures and hearing when using the Nucleus Slim Straight (CI422) electrode in children

2016 ◽  
Vol 130 (4) ◽  
pp. 332-339 ◽  
Author(s):  
H Skarzynski ◽  
M Matusiak ◽  
A Lorens ◽  
M Furmanek ◽  
A Pilka ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Round Window ◽  
Pure Tone Audiometry ◽  
Hearing Preservation ◽  
Electrode Placement ◽  
Insertion Depth ◽  
Electrode Insertion ◽  
Window Approach ◽  
Selection Of ◽  
Categorical Scale

AbstractObjective:In cochlear implantation, there are two crucial factors promoting hearing preservation: an atraumatic surgical approach and selection of an electrode that does not damage cochlear structures. This study aimed to evaluate hearing preservation in children implanted with the Nucleus Slim Straight (CI422) electrode.Methods:Nineteen children aged 6–18 years, with partial deafness, were implanted using the 6-step Skarzynski procedure. Electrode insertion depth was 20–25 mm. Hearing status was assessed with pure tone audiometry before surgery, and at 1, 5, 9, 12 and 24 months after surgery. Electrode placement was confirmed with computed tomography.Results:Mean hearing preservation in the study group at activation of the cochlear implant was 73 per cent (standard deviation = 37 per cent). After 24 months, it was 67 per cent (standard deviation = 45 per cent). On a categorical scale, hearing preservation was possible in 100 per cent of cases.Conclusion:Hearing preservation in children implanted with the Nucleus CI422 slim, straight electrode is possible even with 25 mm insertion depth, although the recommended insertion depth is 20 mm. A round window approach using a soft, straight electrode is most conducive to hearing preservation.

scholarly journals Comparison of Insertion Depth and Hearing Preservation Results between HiFocus 1j and HiFocus Mid-Scala Electrodes in Pediatric Population

2018 ◽  
Vol 01 (02) ◽  
pp. 068-076
Author(s):  
Shweta Deshpande ◽  
Neelam Vaid ◽  
Dzemal Gazibegovic ◽  
Ajimsha KM
Keyword(s):  
Pediatric Population ◽  
Round Window ◽  
Lateral Wall ◽  
Hearing Preservation ◽  
Plain Radiography ◽  
Residual Hearing ◽  
Partial Loss ◽  
Insertion Depth ◽  
Prior Surgery ◽  
Cover Up

Abstract Background Various electrodes are available with a range of features and designs to fulfil anatomical and geometrical variations of the cochlea. The HiFocus 1j (1j) electrode developed by Advanced Bionics LLC is a lateral wall electrode designed to cover up to 1.5 turns or approximately 540° of the cochlea. The HiFocus Mid-Scala (HFms) was recently introduced and designed for structure preservation with a target insertion depth of 420°. Objective To evaluate the average insertion depth and variation, and to assess the potential for hearing preservation with 1j and HFms electrodes in children. Method A group of prelingually deafened children with regular anatomy who received the HiRes90K implant (either 1j or HFms electrode) underwent a plain radiography investigation shortly after the surgery to determine the angular insertion depth. The median age in each group was 3.6 years (1j) and 4.3 years (HFms). The amount of residual hearing was measured through audiometry prior surgery and then monitored at device activation and 1,3, 6, and 12 months later. Results Seventeen subjects were included for calculation of insertion depth. The median insertion depth and the variation for the 1j electrode was higher than for the HFms electrode (1j 476°; 443°–540°, HFms 413°; 390°–468°). Only eleven subjects were assessed for hearing preservation. Complete hearing preservation was achieved in seven subjects (five HFms and two 1j) and partial loss was observed in two subjects (one HFms and one 1j). Conclusion Both 1j and HFms electrodes are suitable for young children. Their flexible design allows round window insertions. The HFms group showed higher rates of hearing preservation (HP) than the 1j group.

Partial Deafness Cochlear Implantation at the University of Kansas: Techniques and Outcomes

2010 ◽  
Vol 21 (03) ◽  
pp. 197-203 ◽  
Author(s):  
Sandra Prentiss ◽  
Kevin Sykes ◽  
Hinrich Staecker
Keyword(s):  
Hearing Loss ◽  
Cochlear Implantation ◽  
Signal To Noise Ratio ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Speech Discrimination ◽  
Insertion Depth ◽  
Low Frequencies ◽  
Hearing In Noise ◽  
Electrode Insertion

Background: One of the most significant recent advances in cochlear implantation is the implantation of patients with residual hearing. These patients have a downsloping sensorineural hearing loss with poor speech discrimination and perform poorly with standard amplification. Studies using a variety of different electrode designs have demonstrated that it is possible to implant an inner ear and preserve residual hearing. Initial studies have demonstrated that a combination of residual acoustic hearing in the low frequencies with electrical stimulation in the mid- to high frequencies resulted in superior hearing performance in background noise. Purpose: The objective of this study was to determine the effect of electrode insertion depth on hearing preservation. Study Sample: Eighteen patients with mild to severe hearing loss in the low frequencies combined with poor word recognition were recruited for the study. Intervention: Cochlear implantation. Data Collection and Analysis: Pre- and postoperative hearing test, Hearing in Noise Test, and consonant–nucleus–consonant testing. Data analysis was performed with Kruskal Wallis and Mann-Whitney testing. Results: In our study of 18 patients implanted with a Med-El PulsarCI100 we demonstrated the ability to preserve residual hearing with implant insertion depths ranging from 20 to 28 mm, giving us the possibility of near complete cochlear frequency coverage with an implant array while preserving residual hearing. These patients performed well both in quiet and in 10 dB signal-to-noise ratio conditions. Conclusion: Hearing preservation was achievable even with deep implant insertion. Patients performed well in combined acoustic and electric conditions.

scholarly journals Speech understanding dependent from Electrode Insertion depth within CI recipients

2018 ◽  
Author(s):  
A Lesinski-Schiedat ◽  
D Manecke ◽  
E Kludt ◽  
T Lenarz ◽  
E Bültmann
Keyword(s):  
Speech Understanding ◽  
Insertion Depth ◽  
Electrode Insertion

Evaluating Intracochlear Trauma after Cochlear Implant Electrode Insertion through Middle Fossa Approach in Temporal Bones

2017 ◽  
Vol 158 (2) ◽  
pp. 350-357 ◽  
Author(s):  
Juan Carlos Cisneros Lesser ◽  
Rubens de Brito ◽  
Graziela de Souza Queiroz Martins ◽  
Eloisa Maria Mello Santiago Gebrim ◽  
Ricardo Ferreira Bento
Keyword(s):  
Cochlear Implant ◽  
Round Window ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Insertion Depth ◽  
Middle Fossa Approach ◽  
Basal Turn ◽  
Fresh Frozen ◽  
Electrode Insertion ◽  
Temporal Bones

Objective To evaluate cochlear trauma after cochlear implant insertion through a middle fossa approach by means of histologic and imaging studies in temporal bones. Study Design Prospective cadaveric study. Setting University-based temporal bone laboratory. Subjects and Methods Twenty fresh-frozen temporal bones were implanted through a middle cranial fossa basal turn cochleostomy. Ten received a straight electrode and 10 a perimodiolar electrode. Samples were fixed in epoxy resin. Computed tomography (CT) scans determined direction, depth of insertion, and the cochleostomy to round window distance. The samples were polished by a microgrinding technique and microscopically visualized to evaluate intracochlear trauma. Descriptive and analytic statistics were performed to compare both groups. Results The CT scan showed intracochlear insertions in every bone, 10 directed to the middle/apical turn and 10 to the basal turn. In the straight electrode group, the average number of inserted electrodes was 12.3 vs 15.1 for the perimodiolar group ( U = 78, P = .0001). The median insertion depth was larger for the perimodiolar group (14.4 mm vs 12.5 mm, U = 66, P = .021). Only 1 nontraumatic insertion was achieved and 14 samples (70%) had important trauma (Eshraghi grades 3 and 4). No differences were identified comparing position or trauma grades for the 2 electrode models or when comparing trauma depending on the direction of insertion. Conclusion The surgical technique allows a proper intracochlear insertion, but it does not guarantee a correct scala tympani position and carries the risk of important trauma to cochlear microstructures.

scholarly journals Preservation of residual hearing after cochlear implant surgery with slim modiolar electrode

2019 ◽  
Vol 277 (2) ◽  
pp. 367-375 ◽  
Author(s):  
Matti Iso-Mustajärvi ◽  
Sini Sipari ◽  
Heikki Löppönen ◽  
Aarno Dietz
Keyword(s):  
Low Frequency ◽  
Hearing Preservation ◽  
Acoustic Stimulation ◽  
Residual Hearing ◽  
Insertion Depth ◽  
Cochlear Implant Surgery ◽  
Computed Tomography Scans ◽  
Electric Acoustic Stimulation ◽  
Speech Recognition In Noise

Abstract Purpose To evaluate the insertion results and hearing preservation of a novel slim modiolar electrode (SME) in patients with residual hearing. Methods We retrospectively collected the data from the medical files of 17 patients (18 ears) implanted with a SME. All patients had functional low frequency hearing (PTA (0.125–0.5 kHz) ≤ 80 dB HL). The insertion results were re-examined from the postoperative cone-beam computed tomography scans. Postoperative thresholds were obtained at the time of switch-on of the sound processors (mean 43 days) and at latest follow-up (mean 582 days). The speech recognition in noise was measured with the Finnish matrix sentence test preoperatively and at follow-up. Results The mean insertion depth angle (IDA) was 395°. Neither scala dislocations nor tip fold over were detected. There were no total hearing losses. Functional low-frequency hearing was preserved in 15/18 (83%) ears at switch-on and in 14/17 (82%) ears at follow-up. According to HEARRING classification, 55% (10/18) had complete HP at switch-on and 41% (7/17) still at follow-up. Thirteen patients (14 ears) were initially fitted with electric–acoustic stimulation and seven patients (8 ears) continued to use it after follow-up. Conclusions The preliminary hearing preservation results with the SME were more favorable than reported for other perimodiolar electrodes. The results show that the array may also be feasible for electro-acoustic stimulation; it is beneficial in that it provides adequate cochlear coverage for pure electrical stimulation in the event of postoperative or progressive hearing loss.

scholarly journals The evaluation of a slim perimodiolar electrode: surgical technique in relation to intracochlear position and cochlear implant outcomes

2019 ◽  
Vol 277 (2) ◽  
pp. 343-350 ◽  
Author(s):  
Floris Heutink ◽  
Berit M. Verbist ◽  
Lucas H. M. Mens ◽  
Wendy J. Huinck ◽  
Emmanuel A. M. Mylanus
Keyword(s):  
Speech Perception ◽  
Surgical Technique ◽  
Round Window ◽  
Hearing Preservation ◽  
Electrode Position ◽  
Residual Hearing ◽  
High Resolution Computed Tomography ◽  
Absolute Increase ◽  
Window Approach

Abstract Purpose In cochlear implantation (CI), the two factors that are determined by the surgeon with a potential significant impact on the position of the electrode within the cochlea and the potential outcome, are the surgical technique and electrode type. The objective of this prospective study was to evaluate the position of the slim, perimodiolar electrode (SPE), and to study the influence of the SPE position on CI outcome. Methods Twenty-three consecutively implanted, adult SPE candidates were included in this prospective cohort study conducted between December 2016 and April 2019. Mean age at surgery was 59.5 years. Mean preoperative residual hearing was 92.2 dB. Intra-operative fluoroscopy and high-resolution computed tomography scans were performed to evaluate electrode position after insertion using a cochleostomy (CS) approach. Follow-up was 12 months after implantation; residual hearing (6–8 weeks) and speech perception (6–8 weeks and 12 months) were evaluated in relation to the intracochlear SPE position. Results In most patients in whom the SPE was positioned in the scala tympani residual hearing was preserved [mean absolute increase in PTA of 4.4 dB and 77.2% relative hearing preservation (RHP%)]. Translocation into the scala vestibuli occurred in 36% of the insertions, resulting in a mean absolute increase in PTA of 17.9 dB, and a RHP% of 19.2%. Participants with a translocation had poorer speech perception scores at 12-month follow-up. Conclusion Given the incidence of CS-associated translocations with the SPE and the negative effect on outcome, it is advised to insert the SPE using the (extended) round window approach.

Cochlear implant placement: round window approach

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Douglas D. Backous
Keyword(s):  
Clinical Trials ◽  
Surgical Technique ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Round Window ◽  
Hearing Preservation ◽  
Residual Hearing ◽  
Implant Placement ◽  
Single Sided Deafness ◽  
Window Approach

The indications for cochlear implantation continue to extend to patients with increased levels of residual hearing. Single-sided deafness and tinnitus are currently under various clinical trials as even further expansion of the application of cochlear implant device and programming technology is underway. This video details a round window and hearing preservation approach for cochlear implant placement, and incorporates the most recent advances in surgical technique.The video can be found here: http://youtu.be/bDqkbboXrU4.

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