scholarly journals Clinical investigation of the Nucleus Slim Modiolar Electrode

2017 ◽  
Vol 22 (3) ◽  
pp. 169-179 ◽  
Author(s):  
Antje Aschendorff ◽  
Robert Briggs ◽  
Goetz Brademann ◽  
Silke Helbig ◽  
Joachim Hornung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Temporal Bone ◽  
Clinical Investigation ◽  
Round Window ◽  
Electrode Array ◽  
Lateral Wall ◽  
Scala Tympani ◽  
Flat Panel ◽  
Insertion Depth

Aims: The Nucleus CI532 cochlear implant incorporates a new precurved electrode array, i.e., the Slim Modiolar electrode (SME), which is designed to bring electrode contacts close to the medial wall of the cochlea while avoiding trauma due to scalar dislocation or contact with the lateral wall during insertion. The primary aim of this prospective study was to determine the final position of the electrode array in clinical cases as evaluated using flat-panel volume computed tomography. Methods: Forty-five adult candidates for unilateral cochlear implantation were recruited from 8 centers. Eleven surgeons attended a temporal bone workshop and received further training with a transparent plastic cochlear model just prior to the first surgery. Feedback on the surgical approach and use of the SME was collected via a questionnaire for each case. Computed tomography of the temporal bone was performed postoperatively using flat-panel digital volume tomography or cone beam systems. The primary measure was the final scalar position of the SME (completely in scala tympani or not). Secondly, medial-lateral position and insertion depth were evaluated. Results: Forty-four subjects received a CI532. The SME was located completely in scala tympani for all subjects. Pure round window (44% of the cases), extended round window (22%), and inferior and/or anterior cochleostomy (34%) approaches were successful across surgeons and cases. The SME was generally positioned close to the modiolus. Overinsertion of the array past the first marker tended to push the basal contacts towards the lateral wall and served only to increase the insertion depth of the first electrode contact without increasing the insertion depth of the most apical electrode. Complications were limited to tip fold-overs encountered in 2 subjects; both were attributed to surgical error, with both reimplanted successfully. Conclusions: The new Nucleus CI532 cochlear implant with SME achieved the design goal of producing little or no trauma as indicated by consistent scala tympani placement. Surgeons should be carefully trained to use the new deployment method such that tip fold-overs and over insertion may be avoided.

Flat-Panel Volume Computed Tomography for Cochlear Implant Electrode Array Examination in Isolated Temporal Bone Specimens

2006 ◽  
Vol 27 (4) ◽  
pp. 491-498 ◽  
Author(s):  
Soenke H. Bartling ◽  
Rajiv Gupta ◽  
Attila Torkos ◽  
Christian Dullin ◽  
Grabbe Eckhardt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Temporal Bone ◽  
Electrode Array ◽  
Flat Panel ◽  
Volume Computed Tomography

scholarly journals Evaluation of the Relationship between the NRT-Ratio, Cochlear Anatomy, and Insertions Depth of Perimodiolar Cochlear Implant Electrodes

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Philipp Mittmann ◽  
Grit Rademacher ◽  
Sven Mutze ◽  
Frederike Hassepass ◽  
Arneborg Ernst ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Array ◽  
Scala Tympani ◽  
Flat Panel ◽  
Insertion Depth ◽  
Tomography System ◽  
Neural Response Telemetry ◽  
Auditory Performance ◽  
The Relationship ◽  
Scala Vestibuli

The position of the cochlear implant electrode array within the scala tympani is essential for an optimal postoperative hearing benefit. If the electrode array changes in between the scalae intracochlearly (i.e., from scala tympani to scala vestibuli), a reduced auditory performance can be assumed. We established a neural response telemetry-ratio (NRT-ratio) which corresponds with the scalar position of the electrodes but shows within its limits a variability. The aim of this study was to determine if insertion depth angle or cochlea size influences the NRT-ratio. The intraoperative electrophysiological NRT data of 26 patients were evaluated. Using a flat panel tomography system, the position of the electrode array was evaluated radiologically. The insertion depth angle of the electrode, the cochlea size, and the NRT-ratio were calculated postoperatively. The radiological results were compared with the intraoperatively obtained electrophysiological data (NRT-ratio) and statistically evaluated. In all patients the NRT-ratio, the insertion depth angle, and the cochlea size could be determined. A significant correlation between insertional depth, cochlear size, and the NRT-ratio was not found. The NRT-ratio is a reliable electrophysiological tool to determine the scalar position of a perimodiolar electrode array. The NRT-ratio can be applied independent from insertion depth and cochlear size.

Flat-Panel Volume Computed Tomography for Cochlear Implant Electrode Array Examination in Isolated Temporal Bone Specimens

2006 ◽  
Vol 27 (4) ◽  
pp. 491-498 ◽  
Author(s):  
Soenke H. Bartling ◽  
Rajiv Gupta ◽  
Attila Torkos ◽  
Christian Dullin ◽  
Grabbe Eckhardt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Temporal Bone ◽  
Electrode Array ◽  
Flat Panel ◽  
Volume Computed Tomography

scholarly journals Computed-tomography estimates of interaural mismatch in insertion depth and scalar location in bilateral cochlear-implant users

2021 ◽  
Author(s):  
Matthew J Goupell ◽  
Jack H Noble ◽  
Sandeep A Phatak ◽  
Elizabeth Kolberg ◽  
Miranda Cleary ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Superior Olivary Complex ◽  
Negative Consequences ◽  
Scala Tympani ◽  
Insertion Depth ◽  
Binaural Processing ◽  
Bilateral Cochlear Implant ◽  
Interaural Differences

Hypothesis: We hypothesized that the bilateral cochlear-implant (BI-CI) users would have a range of interaural insertion-depth mismatch because of different physical placements or characteristics of the arrays, but less than half of electrodes would have less than 75° or 3 mm of interaural insertion-depth mismatch. We also hypothesized that interaural insertion-depth mismatch would be more prevalent nearer the apex, when electrodes were located outside of scala tympani (i.e., possible interaural scalar mismatch), and when the arrays were a mix of pre-curved and straight types. Background: Brainstem neurons in the superior olivary complex are exquisitely sensitive to interaural differences, the cues to sound localization. These binaurally sensitive neurons rely on interaurally place-of-stimulation-matched inputs at the periphery. BI-CI users may have interaural differences in insertion depth and scalar location, causing interaural place-of-stimulation mismatch that impairs binaural abilities. Methods: Insertion depths and scalar locations were calculated from temporal-bone computed-tomography (CT) scans of 107 BI-CI users (27 Advanced Bionics, 62 Cochlear, and 18 Med-El). Each subject had either both pre-curved, both straight, or one of each type of array (mixed). Results: The median interaural insertion-depth mismatch was 23.4° or 1.3 mm. Relatively large interaural insertion-depth mismatch sufficient to disrupt binaural processing occurred for about 15% of electrode pairs [defined as >75° (13.0% of electrode pairs) or >3 mm (19.0% of electrode pairs)]. There was a significant three-way interaction of insertion depth, scalar location, and array type. Interaural insertion-depth mismatch was most prevalent when electrode pairs were more apically located, electrode pairs had interaural scalar mismatch (i.e., one in Scala Tympani, one in Scala Vestibuli), and when the arrays were both pre-curved. Conclusion: Large interaural insertion-depth mismatch can occur in BI-CI users. For new BI-CI users, improved surgical techniques to avoid interaural insertion-depth and scalar mismatch is recommended. For existing BI-CI users with interaural insertion-depth mismatch, interaural alignment of clinical frequency allocation tables by an audiologist might remediate any negative consequences to spatial-hearing abilities.

In Vivo Measurements of the Insertion Depth of Cochlear Implant Arrays Using Flat-Panel Volume Computed Tomography

2011 ◽  
Vol 32 (1) ◽  
pp. 152-157 ◽  
Author(s):  
Annett Trieger ◽  
Anja Schulze ◽  
Matthias Schneider ◽  
Thomas Zahnert ◽  
Dirk Mürbe
Keyword(s):  
Computed Tomography ◽  
Cochlear Implant ◽  
Flat Panel ◽  
Insertion Depth ◽  
In Vivo Measurements ◽  
Volume Computed Tomography

Incidence of Complete Insertion in Cochlear Implant Recipients of Long Lateral Wall Arrays

2021 ◽  
pp. 019459982098745
Author(s):  
Michael W. Canfarotta ◽  
Margaret T. Dillon ◽  
Kevin D. Brown ◽  
Harold C. Pillsbury ◽  
Matthew M. Dedmon ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Electrode Array ◽  
Lateral Wall ◽  
Electrode Arrays ◽  
Tertiary Referral ◽  
Insertion Depth ◽  
Future Studies ◽  
Tertiary Referral Center ◽  
Cochlear Duct Length ◽  
Cochlear Morphology

Objective High rates of partial insertion have been reported for cochlear implant (CI) recipients of long lateral wall electrode arrays, presumably caused by resistance encountered during insertion due to cochlear morphology. With recent advances in long-electrode array design, we sought to investigate (1) the incidence of complete insertions among patients implanted with 31.5-mm flexible arrays and (2) whether complete insertion is limited by cochlear duct length (CDL). Study Design Retrospective review. Setting Tertiary referral center. Methods Fifty-one adult CI recipients implanted with 31.5-mm flexible lateral wall arrays underwent postoperative computed tomography to determine the rate of complete insertion, defined as all contacts being intracochlear. CDL and angular insertion depth (AID) were compared between complete and partial insertion cohorts. Results Most cases had a complete insertion (96.1%, n = 49). Among the complete insertion cohort, the median CDL was 33.6 mm (range, 30.3-37.9 mm), and median AID was 641° (range, 533-751°). Two cases of partial insertion had relatively short CDL (31.8 mm and 32.3 mm) and shallow AID (542° and 575°). Relatively shallow AID for the 2 cases of partial insertion fails to support the idea that CDL alone prevents a complete insertion. Conclusion Complete insertion of a 31.5-mm flexible array is feasible in most cases and does not appear to be limited by the range of CDL observed in this cohort. Future studies are needed to estimate other variations in cochlear morphology that could predict resistance and failure to achieve complete insertion with long arrays.

Comparison of the HiFocus Mid-Scala and HiFocus 1J Electrode Array: Angular Insertion Depths and Speech Perception Outcomes

2016 ◽  
Vol 21 (5) ◽  
pp. 316-325 ◽  
Author(s):  
M. Annerie van der Jagt ◽  
Jeroen J. Briaire ◽  
Berit M. Verbist ◽  
Johan H.M. Frijns
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Electrode Array ◽  
Lateral Wall ◽  
Neural Stimulation ◽  
Insertion Depth ◽  
Optimal Distance ◽  
Frequency Mismatch ◽  
The Mean

The HiFocus Mid-Scala (MS) electrode array has recently been introduced onto the market. This precurved design with a targeted mid-scalar intracochlear position pursues an atraumatic insertion and optimal distance for neural stimulation. In this study we prospectively examined the angular insertion depth achieved and speech perception outcomes resulting from the HiFocus MS electrode array for 6 months after implantation, and retrospectively compared these with the HiFocus 1J lateral wall electrode array. The mean angular insertion depth within the MS population (n = 96) was found at 470°. This was 50° shallower but more consistent than the 1J electrode array (n = 110). Audiological evaluation within a subgroup, including only postlingual, unilaterally implanted, adult cochlear implant recipients who were matched on preoperative speech perception scores and the duration of deafness (MS = 32, 1J = 32), showed no difference in speech perception outcomes between the MS and 1J groups. Furthermore, speech perception outcome was not affected by the angular insertion depth or frequency mismatch.

Electrode Migration in Patients with Perimodiolar Cochlear Implant Electrodes

2015 ◽  
Vol 20 (6) ◽  
pp. 349-353 ◽  
Author(s):  
Philipp Mittmann ◽  
Grit Rademacher ◽  
Sven Mutze ◽  
Arneborg Ernst ◽  
Ingo Todt
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Lateral Wall ◽  
Electrode Arrays ◽  
Insertion Depth ◽  
Lower Extent ◽  
Uncommon Complication

Migration of a cochlear implant electrode is a hitherto uncommon complication. So far, array migration has only been observed in lateral wall electrodes. Between 1999 and 2014, a total of 27 patients received bilateral perimodiolar electrode arrays at our institution. The insertion depth angle was estimated on the initial postoperative scans and compared with the insertion depth angle of the postoperative scans performed after contralateral cochlear implantation. Seven (25.93%) patients were found to have an electrode array migration of more than 15°. Electrode migration in perimodiolar electrodes seems to be less frequent and to occur to a lower extent than in lateral wall electrodes. Electrode migration was clinically asymptomatic in all cases.

scholarly journals Refined Surgical Technique for Insertion of Banded Electrode Array

1987 ◽  
Vol 96 (1_suppl) ◽  
pp. 15-17 ◽  
Author(s):  
B. K-H. G. Franz ◽  
G. M. Clark
Keyword(s):  
Surgical Technique ◽  
Cochlear Implant ◽  
Round Window ◽  
Electrode Array ◽  
Scala Tympani ◽  
Insertion Technique ◽  
Electrode Insertion ◽  
The Right

A refined electrode insertion technique is presented for the multichannel cochlear implant. It comprises two basic steps. The first step is the removal of the anteroinferior overhang of the round window and crista fenestrae, or alternatively an opening drilled into the scala tympani anteroinferior to the round window. The second is rotation of the electrode during insertion, counterclockwise in the right ear and clockwise in the left ear.

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