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.

Visualization of Different Types of Cochlear Implants in Postoperative Cone-Beam CT Imaging

2021 ◽  
Author(s):  
Iris Burck ◽  
Franziska Drath ◽  
Moritz H. Albrecht ◽  
Tommaso D´Angelo ◽  
Hanns Ackermann ◽  
...  
Keyword(s):  
Cochlear Implants ◽  
Cone Beam Ct ◽  
Ct Imaging ◽  
Cone Beam ◽  
Different Types

scholarly journals Imaging anatomy of the retrotympanum: variants and their surgical implications

2020 ◽  
Vol 93 (1105) ◽  
pp. 20190677 ◽  
Author(s):  
Christian Burd ◽  
Irumee Pai ◽  
Stephen Connor
Keyword(s):  
Cone Beam Ct ◽  
Cone Beam ◽  
Middle Ear Surgery ◽  
Anatomical Landmarks ◽  
Ear Surgery ◽  
Complex Anatomy ◽  
Pictorial Review ◽  
Operative Planning ◽  
Ct Technology ◽  
Temporal Bone Imaging

The retrotympanic anatomy is complex and variable but has received little attention in the radiological literature. With advances in CT technology and the application of cone beam CT to temporal bone imaging, there is now a detailed depiction of the retrotympanic bony structures. With the increasing use of endoscopes in middle ear surgery, it is important for the radiologist to appreciate the nomenclature of the retrotympanic compartments in order to aid communication with the surgeon. For instance, in the context of cholesteatoma, clear imaging descriptions of retrotympanic variability and pathological involvement are valuable in pre-operative planning. The endoscopic anatomy has recently been described and the variants classified. The retrotympanum is divided into medial and lateral compartments with multiple described potential sinuses separated by bony crests. This pictorial review will describe the complex anatomy and variants of the retrotympanum. We will describe optimum reformatting techniques to demonstrate the structures of the retrotympanum and illustrate the associated anatomical landmarks and variants with CT. The implications of anatomical variants with regards to otologic surgery will be discussed.

scholarly journals Radiological evaluation of a new straight electrode array compared to its precursors

2020 ◽  
Author(s):  
Manuel Christoph Ketterer ◽  
A. Aschendorff ◽  
S. Arndt ◽  
I. Speck ◽  
A. K. Rauch ◽  
...  
Keyword(s):  
Round Window ◽  
Electrode Array ◽  
Lateral Wall ◽  
Study Groups ◽  
Cone Beam ◽  
Special Focus ◽  
Electrode Arrays ◽  
Academic Center ◽  
Cochlear Morphology ◽  
Array Position

Abstract Objective The aim of this study is to examine electrode array coverage, scalar position and dislocation rate in straight electrode arrays with special focus on a new electrode array with 26 mm in lengths. Study design Retrospective study. Setting Tertiary academic center. Patients 201 ears implanted between 2013 and 2019. Main outcome measures We conducted a comparative analysis of patients implanted with lateral wall electrode arrays of different lengths (F24 = MED-EL Flex24, F26 = MED-EL Flex26, F28 = MED-EL Flex28 and F31.5 = MED-EL FlexSoft). Cone beam computed tomography was used to determine electrode array position (scala tympani (ST) versus scala vestibuli (SV), intracochlear dislocation, position of dislocation and insertion angle). Results Study groups show no significant differences regarding cochlear size which excludes influences by cochlear morphology. As expected, the F24 showed significant shorter insertion angles compared to the longer electrode arrays. The F26 electrode array showed no signs of dislocation or SV insertion. The electrode array with the highest rate of ST dislocations was the F31.5 (26.3%). The electrode array with the highest rates of SV insertions was the F28 (5.75%). Most of the included electrode arrays dislocate between 320° and 360° (mean: 346.4°; range from 166° to 502°). Conclusion The shorter F24 and the new straight electrode array F26 show less or no signs of scalar dislocation, neither for round window nor for cochleostomy insertion than the longer F28 and the F31.5 array. As expected, the cochlear coverage is increasing with length of the electrode array itself but with growing risk for scalar dislocation and with the highest rates of dislocation for the longest electrode array F31.5. Position of intracochlear dislocation is in the apical cochlear part in the included lateral wall electrode arrays.

Effects of Electrode Array Length on Frequency-Place Mismatch and Speech Perception with Cochlear Implants

2015 ◽  
Vol 20 (2) ◽  
pp. 102-111 ◽  
Author(s):  
Frederic Venail ◽  
Caroline Mathiolon ◽  
Sophie Menjot de Champfleur ◽  
Jean Pierre Piron ◽  
Marielle Sicard ◽  
...  
Keyword(s):  
Speech Perception ◽  
Cochlear Implants ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Electrode Arrays ◽  
Frequency Map

Frequency-place mismatch often occurs after cochlear implantation, yet its effect on speech perception outcome remains unclear. In this article, we propose a method, based on cochlea imaging, to determine the cochlear place-frequency map. We evaluated the effect of frequency-place mismatch on speech perception outcome in subjects implanted with 3 different lengths of electrode arrays. A deeper insertion was responsible for a larger frequency-place mismatch and a decreased and delayed speech perception improvement by comparison with a shallower insertion, for which a similar but slighter effect was noticed. Our results support the notion that selecting an electrode array length adapted to each individual's cochlear anatomy may reduce frequency-place mismatch and thus improve speech perception outcome.

scholarly journals Toward steerable electrodes. An overview of concepts and current research.

2017 ◽  
Vol 3 (2) ◽  
pp. 765-769 ◽  
Author(s):  
Thomas S. Rau ◽  
Silke Hügl ◽  
Thomas Lenarz ◽  
Omid Majdani
Keyword(s):  
Inner Ear ◽  
Cochlear Implants ◽  
Basilar Membrane ◽  
Clinical Success ◽  
Electrode Array ◽  
Surrounding Tissue ◽  
Clinical Implementation ◽  
The Past ◽  
The Individual ◽  
Insertion Process

AbstractRestoration of hearing is a demanding surgical task which requires the insertion of a cochlear implant electrode array into the inner ear while preserving the delicate basilar membrane inside the cochlea for an atraumatic insertion. Already shortly after the first clinical success with early versions of cochlear implants the desire for a controlled insertion of the electrode array arose. Such a steerable electrode should be in its shape adaptable to the individual path of the helical inner ear in order to avoid any contact between the implant and the surrounding tissue. This article provides a short overview of concepts and actuator mechanisms investigated in the past and present with the objective of developing a steerable electrode array for an individualized insertion process. Although none of these concepts has reached clinical implementation, there are promising experimental results indicating that insertion forces can be reduced up to 60% compared to straight and not steerable electrodes. Finally, related research topics are listed which require considerable further improvements until steerable electrodes will reach clinical applicability.

scholarly journals Intraoperative use of cone-beam computed tomography in a cadaveric ossified cochlea model

2009 ◽  
Vol 140 (5) ◽  
pp. 697-702 ◽  
Author(s):  
Emma Barker ◽  
Keith Trimble ◽  
Harley Chan ◽  
James Ramsden ◽  
Sajendra Nithiananthan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Temporal Bone ◽  
Cone Beam Computed Tomography ◽  
Intraoperative Imaging ◽  
Electrode Array ◽  
Cone Beam ◽  
Electrode Placement ◽  
Electrode Arrays ◽  
Labyrinthitis Ossificans ◽  
Conventional Ct

Objectives: To describe a cadaveric temporal bone model of labyrinthitis ossificans and investigate the utility of intraoperative cone-beam computed tomography (CBCT) in the facilitating cochlear implantation. Design: Cadaveric temporal bone study. Methods: Five cadaveric heads had cement introduced into the 10 cochleas. CBCT and a conventional CT scan were compared to assess the extent of cochlear obliteration. The cement was drilled-out (under CBCT guidance, if required) and cochlear implant electrode arrays (from 3 different manufacturers) inserted. Results: CBCT images demonstrated temporal bone anatomy and the extent of cochlear obliteration as clearly as conventional CT in all cases. Intraoperative CBCT guided drilling and facilitated electrode placement in two of five heads (3 of 10 ears). Streak-artifact from the electrodes of two devices partially obscured image clarity. Conclusions: The obliterated cochlear model reproduced a disease-ossified cochlear both radiographically and surgically. CBCT is useful for intraoperative imaging to facilitate electrode array placement in the obliterated or congenitally abnormal cochlea.

scholarly journals Histological evaluation of a cochlear implant electrode array with electrically activated shape change for perimodiolar positioning

2018 ◽  
Vol 4 (1) ◽  
pp. 145-148
Author(s):  
Thomas S. Rau ◽  
N.úha Suzaly ◽  
Nick Pawsey ◽  
Silke Hügl ◽  
Lenarz Majdani ◽  
...  
Keyword(s):  
Shape Memory ◽  
Inner Ear ◽  
Shape Change ◽  
Round Window ◽  
Small Diameter ◽  
Electrode Array ◽  
Electrical Heating ◽  
Histological Evaluation ◽  
Electrode Arrays ◽  
Nitinol Wire

AbstractFor the treatment of deafness or severe hearing loss cochlear implants (CI) are used to stimulate the auditory nerve of the inner ear. In order to produce an electrode array which is both atraumatic and reaches a perimodiolar final position a design featuring shape memory effect was proposed. A Nitinol wire with a diameter of 100 μm was integrated in a state of the art lateral wall electrode array. The wire serves as an actuator after it has been ‘trained’ to adopt the spiral shape of an average human cochlea. Three small diameter platinum-iridium wires (each 20 μm) were crimped to the Nitinol wire in order to produce thermal energy. An insertion test was pursued using a human temporal bone specimen. The prototype electrode array was cooled down by means of immersion in ice water and freeze spray to enable sufficient straightening. Thereafter, insertion into the cochlea through the round window as performed. Insertion was feasible but difficult as premature curling of the electrode occurred during the movement towards the inner ear while passing the middle ear cavity. Therefore, the insertion had to be performed faster than usual. The shape memory actuator was subsequently activated with 450mA current at 5V for 3 seconds. After insertion the specimen was embedded in epoxy resin, microgrinded and all histological slices were assessed for trauma. Perimodiolar position was achieved. No insertion trauma was observed and there were no indications of thermal damage caused by the electrical heating. To the best of our knowledge, this is the first histological evaluation of the insertion trauma caused by an electrically activated shape memory electrode array. These promising results support further research on shape memory CI electrode arrays.

scholarly journals Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

2021 ◽  
Vol 8 ◽  
Author(s):  
Renato Torres ◽  
Hannah Daoudi ◽  
Ghizlene Lahlou ◽  
Olivier Sterkers ◽  
Evelyne Ferrary ◽  
...  
Keyword(s):  
Speech Perception ◽  
Cochlear Implantation ◽  
High Frequency ◽  
Pure Tone ◽  
Free Field ◽  
Electrode Array ◽  
Electrode Arrays ◽  
Robot Assisted ◽  
Deaf Adults ◽  
Post Implantation

Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot.Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot (RobOtol®, Collin, Bagneux, France) with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250–500–750 Hz, 500–1,000–2,000–3,000 Hz, and 3,000–4,000–8,000 Hz for low, mid, and high frequencies, respectively.Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies (p &lt; 0.0001; Adjusted R2 = 0.64, polynomial non-linear regression). Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion (p = 0.018; Fisher's exact test).Conclusion: The restoration of high-frequency thresholds (3,000–4,000–8,000 Hz) by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced after a robot-assisted insertion.

Preservation of residual hearing following cochlear implantation: comparison between three surgical techniques

2007 ◽  
Vol 122 (3) ◽  
pp. 246-252 ◽  
Author(s):  
S Berrettini ◽  
F Forli ◽  
S Passetti
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Lateral Wall ◽  
Hearing Preservation ◽  
Acoustic Stimulation ◽  
Residual Hearing ◽  
Electrode Arrays ◽  
Electrode Insertion

AbstractThe preservation of residual hearing is becoming a high priority in cochlear implant surgery. It allows better speech understanding and ensures long-lasting and stable performance; it also allows the possibility, in selected cases, of combining electro-acoustic stimulation in the same ear.We present the results of a retrospective study of the conservation of residual hearing in three different groups of patients who had undergone cochlear implantation using three different cochlear implant electrode arrays, combined with three different surgical techniques for the cochleostomy. The study aimed to evaluate which approach allowed greater preservation of residual hearing.The best residual hearing preservation results (i.e. preservation in 81.8 per cent of patients) were achieved with the Contour Advance electrode array, using the Advance Off-Stylet technique and performing a modified anterior inferior cochleostomy; this combination enabled reduced trauma to the lateral wall of the cochlea during electrode insertion.

Cone-beam computed tomography in children with cochlear implants: The effect of electrode array position on ECAP

2017 ◽  
Vol 92 ◽  
pp. 27-31 ◽  
Author(s):  
Marine Lathuillière ◽  
Fanny Merklen ◽  
Jean-Pierre Piron ◽  
Marielle Sicard ◽  
Françoise Villemus ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cochlear Implants ◽  
Cone Beam Computed Tomography ◽  
Electrode Array ◽  
Cone Beam ◽  
Array Position
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