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

Todt, Ingo; Ernst, Arneborg; Mittmann, Philipp

doi:10.1159/000442041

Cited by 27 publications

(39 citation statements)

References 13 publications

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“…Although the measured conditions were artificial, using a model, clinical relevance is highly probable since the measured values are, in comparison with other studies [3–5, 8, 9], by far the highest. Importantly, our mean maximum pressure amplitude values of 933.6 PA up to 1598 PA are above the measured pathologically relevant level in the guinea pig of +700 PA [17].…”

Section: Discussionmentioning

confidence: 89%

“…The development of atraumatic opening of the round window has led to the development of specific opening tools [6]. Insertional factors have been observed experimentally under force aspects [7] and even under the point of pressure occurrence in terms of speed [8], moisturized insertions [4], and tremor aspects [9]. Different studies have shown the clinical relevance of these findings [10–12].…”

Section: Introductionmentioning

confidence: 99%

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Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure

Todt

Karimi

Luger

et al. 2016

BioMed Research International

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Introduction. To achieve a functional atraumatic cochlear implantation, intracochlear pressure changes during the procedure should be minimized. Postinsertional cable movements are assumed to induce intracochlear pressure changes. The aim of this study was to observe intracochlear pressure changes due to postinsertional cable movements. Materials and Methods. Intracochlear pressure changes were recorded in a cochlear model with a micro-pressure sensor positioned in the apical region of the cochlea model to follow the maximum amplitude and pressure gain velocity in intracochlear pressure. A temporal bone mastoid cavity was attached to the model to simulate cable positioning. The compared conditions were (1) touching the unsealed electrode, (2) touching the sealed electrode, (3) cable storage with an unfixed cable, and (4) cable storage with a fixed cable. Results. We found statistically significant differences in the occurrence of maximum amplitude and pressure gain velocity in intracochlear pressure changes under the compared conditions. Comparing the cable storage conditions, a cable fixed mode offers significantly lower maximum pressure amplitude and pressure gain velocity than the nonfixed mode. Conclusion. Postinsertional cable movement led to a significant pressure transfer into the cochlea. Before positioning the electrode cable in the mastoid cavity, fixation of the cable is recommended.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure

Todt

Karimi

Luger

et al. 2016

BioMed Research International

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“…These studies investigated the effects of insertion speed (18), insertion technique (i.e. unsupported, supported, or automated) (19), and size of the opening in the round window (32), each revealing generation of large static pressures (~ 200 Pa, or 140 dB SPL) during the insertion. It is interesting that no transient pressures are reported; however this may be due to the use of a plastic model, compared to cadaveric temporal bones in this study.…”

Section: Discussionmentioning

confidence: 99%

“…A series of recent papers reported intracochlear pressure changes for several speeds of electrode insertions (via a linear actuator) (18), and different insertion techniques (19) in an artificial cochlear model. Mean maximal intracochlear pressures were reported up to 170 Pa, or ~140 dB SPL peak; however, no large transients were observed, possibly because these studies were conducted in an artificial cochlea model.…”

Section: Introductionmentioning

confidence: 99%

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

Greene

Mattingly

Hartl

et al. 2016

Otology &Amp; Neurotology

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Hypothesis Cochlear implant (CI) electrode insertion into the round window induces pressure transients in the cochlear fluid comparable to high intensity sound transients. Background Many patients receiving a CI have some remaining functional hearing at low frequencies, thus devices and surgical techniques have been developed to utilize this residual hearing. To maintain functional acoustic hearing, it is important to retain function of any hair cells and auditory nerve fibers innervating the basilar membrane; however, in a subset of patients, residual low frequency hearing is lost following CI insertion. Here, we test the hypothesis that transient intracochlear pressure spikes are generated during CI electrode insertion, which could cause damage and compromise residual hearing. Methods Human cadaveric temporal bones were prepared with an extended facial recess. Pressures in the scala vestibuli (PSV) and tympani (PST) were measured with fiber-optic pressure sensors inserted into the cochlea near the oval and round windows while CI electrodes (five styles from two manufacturers) were inserted into the cochlea via a round window approach. Results PST tended to be larger in magnitude than PSV, consistent with electrode insertion into the scala tympani. CI electrode insertion produced a range of pressure transients in the cochlea that could occur alone or as part of a train of spikes with equivalent peak sound pressure levels in excess of 170dB SPL. Instances of pressure transients varied with electrode styles. Conclusions Results suggest electrode design, insertion mechanism, and surgical technique affect the magnitude and rate of intracochlear pressure transients during CI electrode insertion. Pressure transients showed intensities similar to those elicited by high level sounds and thus could cause damage to the basilar membrane and/or hair cells.

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“…The significance of intraoperative trauma to the cochlea during hearing preservation implantation is well established, and several mechanical factors, such as insertional force, underwater insertion, the presence of blood or bone dust, and electrode specifications, have been identified as being of significance [Roland, 2005;Bas et al, 2012;Rajan et al, 2013;Anagiotos et al, 2016;Todt et al, 2016a;Eshraghi et al, 2017] [Basta et al, 2007;Mittmann et al, 2014Mittmann et al, , 2016Mittmann et al, , 2017Mittmann et al, , 2018Todt et al, 2014aTodt et al, , b, 2016aTodt et al, , b, 2017a.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

2018

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Aim: To investigate and compare residual hearing preservation between patients based on the presence of intraoperative gusher. Methodology: We retrospectively compared 2 cohorts of cochlear implant recipients significantly distinguished by whether or not they experienced gusher intraoperatively. Patients underwent cochlear implantation using 24-mm lateral wall electrode arrays as well pharmacologic steroid protection. All patients were assessed by a hearing implant MDT. Hearing preservation rates and speech perception outcomes were assessed at 1, 6, 12, 24, 36, 48, and 60 months. Results: The patients with no gusher demonstrated complete hearing preservation. The patients with gusher demonstrated significant postoperative reduction of hearing thresholds, which declined at a significantly higher pace during follow-up. All patients demonstrated significantly better speech performance after cochlear implantation. Conclusion: The present study suggests that intraoperative gusher is associated with a significant drop in residual hearing, both immediately and over time, which may be related to the large change in intracochlear pressure intraoperatively.

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

Cited by 27 publications

References 13 publications

Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure

Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure

Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion

The Effects of Gusher-Related Intracochlear Pressure Changes on Hearing Preservation in Cochlear Implantation: A Comparative Series

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