Definition of Metrics to Evaluate Cochlear Array Insertion Forces Performed with Forceps, Insertion Tool, or Motorized Tool in Temporal Bone Specimens

Nguyen, Yann; Kazmitcheff, Guillaume; Seta, Daniele De; Miroir, Mathieu; Ferrary, Évelyne; Sterkers, Olivier

doi:10.1155/2014/532570

Cited by 26 publications

(35 citation statements)

References 14 publications

(19 reference statements)

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“…Since so far microeffects of the insertional procedure were only assumed and described in the literature [Majdani et al, 2010;Nguyen et al, 2014], we tried to objectively quantify those effects in terms of maximum amplitude changes and peak frequency deviation related to ICP. Theoretically it can be assumed that the amplitude of deviation is influenced by the technique (e.g.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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To achieve a functional atraumatic insertion, low intracochlear pressure changes during the procedure are assumed to be important. The aim of this study was to observe intracochlear pressure changes due to different insertion techniques in a cochlear model. Cochlear implant electrode insertions were performed in an artificial cochlear model to record intracochlear pressure changes with a micropressure sensor to evaluate the maximum amplitude and frequency of pressure changes under different insertional conditions. We found statistically significant differences in the occurrence of intracochlear pressure peak changes comparing different techniques. Based on our model results, an insertion should be maximally supported to minimize micromovement-related pressure changes.

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Section: Discussionmentioning

confidence: 99%

“…Comparisons of different insertion techniques are, to our knowledge, limited to the measurements of friction force [Majdani et al, 2010] and were focused on the differences between manual, tool and automated insertion techniques [Nguyen et al, 2014]. However, the variations of how to insert an electrode are quite large.…”

Section: Introductionmentioning

confidence: 99%

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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“…Seven guinea pigs were implanted with the 0.4 electrode array, seven with the 0.4R electrode array and six with the 0.3 electrode array. A linear motorized electrode array insertion tool [ 8 ] carried by a robotic arm [ 11 ] was used to insert the arrays with a constant insertion speed of 0.25 mm/s. The insertion was performed until four electrodes had been placed in the cochlea to ensure a reproducible insertion length (4 mm).…”

Section: Methodsmentioning

confidence: 99%

“…The hammock and frame were designed to decrease respiratory artefacts during measurement of insertion forces. The electrode array was loaded in the insertion tool [ 8 ] which was held by a robotic arm [ 11 ] and was inserted at a constant speed of 0.25 mm/s. The insertion site was sealed with small autologous muscle grafts.…”

Section: Methodsmentioning

confidence: 99%

“…Another line of research to improve residual hearing is to monitor and eventually control frictional forces during electrode array insertion. For example, it has been shown that the use of a motorized insertion tool could change the insertion force profile with less stops and starts compared to manual insertion [ 8 ] and this approach has enhanced preservation of residual hearing in an animal model [ 9 ]. Moreover, some authors have suggested including a force sensor placed at the tip of the electrode array to detect contact with the lateral wall or basilar membrane [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Influence of electrode array stiffness and diameter on hearing in cochlear implanted guinea pig

et al. 2017

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During cochlear implantation, electrode array translocation and trauma should be avoided to preserve residual hearing. The aim of our study was to evaluate the effect of physical parameters of the array on residual hearing and cochlear structures during insertion. Three array prototypes with different stiffnesses or external diameters were implanted in normal hearing guinea pigs via a motorized insertion tool carried on a robot-based arm, and insertion forces were recorded. Array prototypes 0.4 and 0.4R had 0.4 mm external diameter and prototype 0.3 had 0.3 mm external diameter. The axial stiffness was set to 1 for the 0.4 prototype and the stiffnesses of the 0.4R and 0.3 prototypes were calculated from this as 6.8 and 0.8 (relative units), respectively. Hearing was assessed preoperatively by the auditory brainstem response (ABR), and then at day 7 and day 30 post-implantation. A study of the macroscopic anatomy was performed on cochleae harvested at day 30 to examine the scala location of the array. At day 7, guinea pigs implanted with the 0.4R array had significantly poorer hearing results than those implanted with the 0.3 array (26±17.7, 44±23.4, 33±20.5 dB, n = 7, vs 5±8.7, 1±11.6, 12±11.5 dB, n = 6, mean±SEM, respectively, at 8, 16 and 24 kHz, p<0.01) or those implanted with the 0.4 array (44±23.4 dB, n = 7, vs 28±21.7 dB, n = 7, at 16 kHz, p<0.05). Hearing remained stable from day 7 to day 30. The maximal peak of insertion force was higher with the 0.4R array than with the 0.3 array (56±23.8 mN, n = 7, vs 26±8.7 mN, n = 6). Observation of the cochleae showed that an incorrectly positioned electrode array or fibrosis were associated with hearing loss ≥40 dB (at 16 kHz). An optimal position in the scala tympani with a flexible and thin array and prevention of fibrosis should be the primary objectives to preserve hearing during cochlear implantation.

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Effect of a liposomal hyaluronic acid gel loaded with dexamethasone in a guinea pig model after manual or motorized cochlear implantation

Mamelle

Kechai

Granger

et al. 2016

Eur Arch Otorhinolaryngol

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Goals of cochlear implantation have shifted from complete insertion of the cochlear electrode array towards low traumatic insertion with minimally invasive techniques. The aim of this study was first to evaluate, in a guinea pig model of cochlear implantation, the effect of a motorized insertion technique on hearing preservation. The second goal was to study a new gel formulation containing dexamethasone phosphate loaded in liposomes (DEX-P). Guinea pigs had a unilateral cochlear implantation with either a manual technique (n = 12), or a motorized technique (n = 15), with a 0.4 mm diameter and 4 mm long array trough a cochleostomy. At the end of the procedure, hyaluronic acid gel containing drug-free liposomes, or liposomes loaded with DEX-P, was injected into the bulla. Auditory brainstem responses thresholds were recorded before surgery and day 2 and 7 after surgery. All the animals had increased auditory brainstem responses thresholds after the cochlear implantation. Implanted animals with the motorized insertion tool experienced a partial hearing recovery at day 7 but not in those implanted with the manual insertion procedure (p < 0.001). In the manually implanted animals, a partial recovery was observed when DEX-P contained in liposomal gel was locally administrated (p < 0.0001). Finally, no additive effect with the motorized insertion was noticed. The deleterious effect of manual insertion, during cochlear implantation, can be prevented with local DEX-P administration in the bulla at day 7. The use of a motorized tool performed more atraumatic electrode array insertion for postoperative hearing.

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Definition of Metrics to Evaluate Cochlear Array Insertion Forces Performed with Forceps, Insertion Tool, or Motorized Tool in Temporal Bone Specimens

Cited by 26 publications

References 14 publications

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Influence of electrode array stiffness and diameter on hearing in cochlear implanted guinea pig

Effect of a liposomal hyaluronic acid gel loaded with dexamethasone in a guinea pig model after manual or motorized cochlear implantation

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