Surgical Techniques to Avoid Complications of Cochlear Implants in Children

1997 ◽  
pp. 161-163 ◽  
Author(s):  
N.L. Cohen
Keyword(s):  
Cochlear Implants ◽  
Surgical Techniques

The Use of a Robot to Insert an Electrode Array of Cochlear Implants in the Cochlea: A Feasibility Study and Preliminary Results

2021 ◽  
pp. 1-7
Author(s):  
Sébastien Barriat ◽  
Nicolas Peigneux ◽  
Unal Duran ◽  
Severine Camby ◽  
Philippe P. Lefebvre
Keyword(s):  
Inner Ear ◽  
Cochlear Implants ◽  
Pure Tone ◽  
Cone Beam Ct ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Pure Tone Audiometry ◽  
Cone Beam ◽  
Middle Ear Surgery ◽  
Electrode Arrays

<b><i>Introduction:</i></b> Cochlear implants (CIs) are commonly used for the rehabilitation of profound bilateral hearing loss. However, patients with substantial residual acoustic hearing are potential CI candidates. Because of both improvements in technology and advancements in surgical techniques, it may be possible to preserve hearing to some extent. For more than a decade, it has been suggested that robots are used to perform middle ear surgery. We evaluated the use of the RobOtol® otologic robot specifically to insert CI electrodes into the inner ear. <b><i>Methods:</i></b> CI surgery with the conventional approach was performed under general anesthesia. The MED-El Flex 24-electrode array was inserted using RobOtol®. Video recordings were used to calculate the speed of insertion. The positions of the electrodes were evaluated using a cone beam CT. All subjects underwent pure-tone audiometry tests before and after surgery, and the pure-tone average (PTA) was calculated from 250 to 4,000 Hz. <b><i>Results:</i></b> The robot inserted implants in 5 patients, and complete insertion of the electrode array was achieved. The speed of insertion of the electrode array was 0.88 ± 0.12 mm/s. The mean loss of the PTA for 5 frequencies (250, 500, 1,000, 2,000, and 4,000 Hz) was 13.60 ± 7.70 dB. Only 1 patient showed a loss of the PTA by &#x3e;20 dB. For these 5 patients, the cone beam CT findings showed that all the electrode arrays were in the tympanic ramp and had a grade of 0. The results were compared with those obtained from a cohort of 17 patients who underwent manual implantation of a MED-El Flex 24-electrode array. <b><i>Conclusion:</i></b> To minimize disturbance to the cochlea while atraumatic electrode arrays are inserted, electrodes can be inserted at a constant, slow speed in the inner ear with the assistance of the RobOtol® robot in a normal clinical surgical setting.

scholarly journals Histopathologic Assessment of Fibrosis and nEw Bone Formation in Implanted Human Temporal Bones Using 3D Reconstruction

2009 ◽  
Vol 141 (2) ◽  
pp. 247-252 ◽  
Author(s):  
Jose N. Fayad ◽  
Andres O. Makarem ◽  
Fred H. Linthicum
Keyword(s):  
Bone Formation ◽  
3D Reconstruction ◽  
Temporal Bone ◽  
Cochlear Implants ◽  
Surgical Techniques ◽  
Hearing Preservation ◽  
Surgical Trauma ◽  
Tissue Formation ◽  
New Bone Formation ◽  
Temporal Bones

OBJECTIVE: To evaluate new bone formation and fibrosis in implanted human temporal bones and relate that to neurosensory elements preservation. STUDY DESIGN: Human temporal bone histopathology study. SETTING: Temporal bone laboratory. SUBJECTS AND METHODS: Ten human temporal bones from eight patients with multichannel cochlear implants and one single-electrode implant were examined under light microscopy and reconstructed with AMIRA 4.1 3D reconstruction software. Volumes of new bone formation, fibrosis, and patent area were calculated in each bone. RESULTS: The amount of fibrosis and new bone formation postimplantation varied among bones. There were no statistically significant relationships between age at implantation or duration of implantation and the overall amount of new tissue in the implanted ear. There was a relationship between total amount of new tissue and preservation of neurosensory elements only in segment I of the cochlea (Rho = −0.75, P < 0.013). Most of the new tissue was located in segments I and II, segment III had little to no new tissue formation, and segment IV was clear in all of the subjects. CONCLUSION: New tissue formation postimplantation was related to preservation of neurosensory elements primarily in segment I of the cochlea. In an era of hearing preservation surgery and hybrid cochlear implants, soft surgical techniques are advocated as a means to decrease surgical trauma.

scholarly journals Comparison of Cochlear Implant Magnets and Their MRI Artifact Size

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
I. Todt ◽  
R. Guerkov ◽  
H. B. Gehl ◽  
H. Sudhoff
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Surgical Techniques ◽  
Visual Assessment ◽  
In Vivo Measurement ◽  
Implant Positioning ◽  
Recent Developments ◽  
Mri Scans ◽  
Mri Artifact

Introduction. Recent developments regarding cochlear implant magnets (e.g., a bipolar diametral magnet) and refined surgical techniques (e.g., implant positioning) have had a significant impact on the relation between cochlear implants and MRIs, making the reproducible visibility of cochlea and IAC possible. MRI scanning has changed from a contraindication to a diagnostic tool. Magnet artifact size plays a central role in the visual assessment of the cochlea and IAC. Objective. The aim of this study is to compare the CI magnet-related maximum artifact sizes of various cochlea implant systems. Materials and Methods. We performed an in vivo measurement of MRI artifacts at 1.5 and 3 Tesla with three cochlear implant magnet systems (AB 3D, Medel Synchrony, and Oticon ZTI). The implant, including the magnet, was positioned with a head bandage 7.0 cm and 120° from the nasion, external auditory canal. We used a TSE T2w MRI sequence on the axial and coronal plains and compared the artifacts in two volunteers for each tesla strength. Results. Intraindividual artifact size differences between the three magnets are smaller than interindividual maximum artifact size differences. 3 T MRI scans, in comparison to 1.5 T MRI scans, show a difference between soft artifact areas. Conclusion. We observed no major difference between maximum implant magnet artifact sizes of the three implant magnet types.

Surgical Techniques in Cochlear Implants

2012 ◽  
Vol 45 (1) ◽  
pp. 69-80 ◽  
Author(s):  
Brannon Mangus ◽  
Alejandro Rivas ◽  
Betty S. Tsai ◽  
David S. Haynes ◽  
J. Thomas Roland
Keyword(s):  
Cochlear Implants ◽  
Surgical Techniques

Effects of Fundamental Frequency Contours on Sentence Recognition in Mandarin-Speaking Children With Cochlear Implants

2020 ◽  
Vol 63 (11) ◽  
pp. 3855-3864
Author(s):  
Wanting Huang ◽  
Lena L. N. Wong ◽  
Fei Chen ◽  
Haihong Liu ◽  
Wei Liang
Keyword(s):  
Cochlear Implants ◽  
Fundamental Frequency ◽  
Signal To Noise Ratio ◽  
Lexical Tone ◽  
Signal To Noise ◽  
Sentence Recognition ◽  
Test Conditions ◽  
Age Appropriate ◽  
F0 Contour ◽  
Appropriate Sentences

Purpose Fundamental frequency (F0) is the primary acoustic cue for lexical tone perception in tonal languages but is processed in a limited way in cochlear implant (CI) systems. The aim of this study was to evaluate the importance of F0 contours in sentence recognition in Mandarin-speaking children with CIs and find out whether it is similar to/different from that in age-matched normal-hearing (NH) peers. Method Age-appropriate sentences, with F0 contours manipulated to be either natural or flattened, were randomly presented to preschool children with CIs and their age-matched peers with NH under three test conditions: in quiet, in white noise, and with competing sentences at 0 dB signal-to-noise ratio. Results The neutralization of F0 contours resulted in a significant reduction in sentence recognition. While this was seen only in noise conditions among NH children, it was observed throughout all test conditions among children with CIs. Moreover, the F0 contour-induced accuracy reduction ratios (i.e., the reduction in sentence recognition resulting from the neutralization of F0 contours compared to the normal F0 condition) were significantly greater in children with CIs than in NH children in all test conditions. Conclusions F0 contours play a major role in sentence recognition in both quiet and noise among pediatric implantees, and the contribution of the F0 contour is even more salient than that in age-matched NH children. These results also suggest that there may be differences between children with CIs and NH children in how F0 contours are processed.

Age at Full-Time Use Predicts Language Outcomes Better Than Age of Surgery in Children Who Use Cochlear Implants

2019 ◽  
Vol 28 (4) ◽  
pp. 986-992 ◽  
Author(s):  
Lisa R. Park ◽  
Erika B. Gagnon ◽  
Erin Thompson ◽  
Kevin D. Brown
Keyword(s):  
Cochlear Implants ◽  
Time Use ◽  
Expressive Language ◽  
Normal Hearing ◽  
Full Time ◽  
Language Outcomes ◽  
Age At Surgery ◽  
Device Placement ◽  
Device Use ◽  
Better Than

Purpose The aims of this study were to (a) determine a metric for describing full-time use (FTU), (b) establish whether age at FTU in children with cochlear implants (CIs) predicts language at 3 years of age better than age at surgery, and (c) describe the extent of FTU and length of time it took to establish FTU in this population. Method This retrospective analysis examined receptive and expressive language outcomes at 3 years of age for 40 children with CIs. Multiple linear regression analyses were run with age at surgery and age at FTU as predictor variables. FTU definitions included 8 hr of device use and 80% of average waking hours for a typically developing child. Descriptive statistics were used to describe the establishment and degree of FTU. Results Although 8 hr of daily wear is typically considered FTU in the literature, the 80% hearing hours percentage metric accounts for more variability in outcomes. For both receptive and expressive language, age at FTU was found to be a better predictor of outcomes than age at surgery. It took an average of 17 months for children in this cohort to establish FTU, and only 52.5% reached this milestone by the time they were 3 years old. Conclusions Children with normal hearing can access spoken language whenever they are awake, and the amount of time young children are awake increases with age. A metric that incorporates the percentage of time that children with CIs have access to sound as compared to their same-aged peers with normal hearing accounts for more variability in outcomes than using an arbitrary number of hours. Although early FTU is not possible without surgery occurring at a young age, device placement does not guarantee use and does not predict language outcomes as well as age at FTU.

Overview of Current Approaches to Aural Rehabilitation for Adults With Cochlear Implants

2020 ◽  
Vol 5 (5) ◽  
pp. 1175-1187
Author(s):  
Rachel Glade ◽  
Erin Taylor ◽  
Deborah S. Culbertson ◽  
Christin Ray
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Cochlear Implants ◽  
Practice Patterns ◽  
The United States ◽  
Care Providers ◽  
Aural Rehabilitation ◽  
Starting Point ◽  
Clinical Models ◽  
Hearing Health

Purpose This clinical focus article provides an overview of clinical models currently being used for the provision of comprehensive aural rehabilitation (AR) for adults with cochlear implants (CIs) in the Unites States. Method Clinical AR models utilized by hearing health care providers from nine clinics across the United States were discussed with regard to interprofessional AR practice patterns in the adult CI population. The clinical models were presented in the context of existing knowledge and gaps in the literature. Future directions were proposed for optimizing the provision of AR for the adult CI patient population. Findings/Conclusions There is a general agreement that AR is an integral part of hearing health care for adults with CIs. While the provision of AR is feasible in different clinical practice settings, service delivery models are variable across hearing health care professionals and settings. AR may include interprofessional collaboration among surgeons, audiologists, and speech-language pathologists with varying roles based on the characteristics of a particular setting. Despite various existing barriers, the clinical practice patterns identified here provide a starting point toward a more standard approach to comprehensive AR for adults with CIs.

Selecting the Optimal FM System for Children With Cochlear Implants

2008 ◽  
Vol 18 (1) ◽  
pp. 19-24
Author(s):  
Erin C. Schafer
Keyword(s):  
Speech Recognition ◽  
Cochlear Implants ◽  
Empirical Research ◽  
Background Noise ◽  
Signal To Noise Ratio ◽  
Evidence Based ◽  
Signal To Noise ◽  
Speech Processor ◽  
System Input ◽  
Optimal Type

Children who use cochlear implants experience significant difficulty hearing speech in the presence of background noise, such as in the classroom. To address these difficulties, audiologists often recommend frequency-modulated (FM) systems for children with cochlear implants. The purpose of this article is to examine current empirical research in the area of FM systems and cochlear implants. Discussion topics will include selecting the optimal type of FM receiver, benefits of binaural FM-system input, importance of DAI receiver-gain settings, and effects of speech-processor programming on speech recognition. FM systems significantly improve the signal-to-noise ratio at the child's ear through the use of three types of FM receivers: mounted speakers, desktop speakers, or direct-audio input (DAI). This discussion will aid audiologists in making evidence-based recommendations for children using cochlear implants and FM systems.

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