The Nucleus Double Array Cochlear Implant: A New Concept for the Obliterated Cochlea

Lenarz, Thomas; Lesinski‐Schiedat, Anke; Weber, Benno; Issing, P. R.; Frohne, C.; Büchner, Andreas; Battmer, R. D.; Parker, John E.; Wallenberg, Ernst von

doi:10.1097/00129492-200101000-00006

Cited by 53 publications

(37 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Special electrodes are available for malformations and for ossified cochleas (double or split array, Figure 27). Those arrays distribute the electrode contacts on 2 electrode carriers that are inserted into the first and second turns via 2 cochleostomies [7]. Compressed arrays are shortened electrode carriers with a normal number of stimulus contacts that are placed into the drilled initial part of the basal turn.…”

Section: Electrode Systemsmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

View full text Add to dashboard Cite

Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

show abstract

Section: Electrode Systemsmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

View full text Add to dashboard Cite

show abstract

“…Among these changes in candidacy are: the age of the candidate [Balkany et al, 2002;van den Broek et al, 1995;Hehar et al, 2002;Uziel et al, 1993;Waltzman and Cohen, 1998], presence of residual hearing [Barbara et al, 2000;von Ilberg et al, 1999], our willingness to implant patients with major cochlear malformations [Au and Gibson, 1999;Fishman and Holliday, 2000;Fishman et al, 2003;Ito et al, 1999;Marangos and Aschendorff, 1997;Weber et al, 1995Weber et al, , 1998] and other abnormalities [Balkany et al, 1991;Camilleri et al, 1999;Formanek et al, 1998;Temple et al, 1999], other handicaps concurrent with hearing loss [Ramsden et al, 1993;Lesinski et al, 1995;Saeed et al, 1998;Waltzman et al, 2000], new cochlear implant hardware and improved software [Balkany et al, 1999;Lenarz et al, 2001;Cohen et al, 2002] and the interest in bilateral implantation [Gantz et al, , 2002Van Hoesel and Clark, 1995].…”

Section: Candidacymentioning

confidence: 99%

Cochlear Implant Candidacy and Surgical Considerations

Cohen¹

2004

Audiol Neurotol

View full text Add to dashboard Cite

Numerous changes continue to occur in regard to cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound rather the prior requirement of a bilateral profound loss. In addition, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. New hardware, such as the behind-the-ear speech processors, require modification of existing implant surgery. Similarly, the new perimodiolar electrodes require special insertion techniques. Bilateral implantation clearly requires modification of the surgical techniques used for unilateral implantation. The surgery remains mostly the same, but takes almost twice as long, and requires some modification since at a certain point, when the first device is in contact with the body, the monopolar cautery may no longer be used. Research has already begun on the development of the totally implantable cochlear implant (TICI). This will clearly require a modification of the surgical technique currently used for the present semi-implantable devices. In addition to surgically burying the components of the present cochlear implant, we will also have to develop techniques for implanting a rechargeable power supply and a microphone for the TICI. The latter will be a challenge, since it must be placed where it is capable of great sensitivity, yet not exposed to interference or the risk of extrusion. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. We anticipate further changes in the foreseeable future, for which there will likely be surgical problems to solve.

show abstract

“…6 It is known that total or partial obliteration of the initial portion of the cochlear basal turn prevents the complete insertion of the electrodes used in conventional cochlear implants. 13 This represents a major problem, because studies based on data from 327 patients have proven that the greater the insertion, and consequently the higher the number of electrodes connected, better is the speech recognition index. 14 Thus, many techniques have been used and tested in order to deeply implant increasingly more electrodes in ossified cochleas.…”

Section: Introductionmentioning

confidence: 99%

“…However, for such a risky procedure, this description is very inaccurate. Lenarz et al 13 estimated the distance from the first cochleostomy all the way to the anterior cochlear wall in the basal turn to be of 8 to 11mm. Now, the distance from the second cochleostomy, again to the second cochlear turn is of 5 to 6mm.…”

Section: Introductionmentioning

confidence: 99%

Estudo anatômico da cóclea para confecção de instrumental para a cirurgia de implante coclear com 2 feixes de eletrodos em cócleas ossificadas

Bogar¹,

Bento

Tsuji

2008

Rev. Bras. Otorrinolaringol.

View full text Add to dashboard Cite

Cochl ear ossification, mainly secondary to meningitis, prevents the complete conventional cochlear implant insertion. Implants with two electrode bundles shorter than the conventional ones were specifically developed for ossified cochleas. However, during surgery there is a high risk of damaging the internal carotid artery (ICA). Therefore, measuring cochleostomy depth in order to insert the two electrode bundles would greatly increase the procedure's safety. Aims: 1) Find the distances between cochleostomies and ICA in cadaver temporal bones. 2) Design an instrument that can be used in cochlear implant surgery to introduce an implant with two bundles of electrodes. Study Design: Experimental prospective. Materials and Methods: In 21 temporal bones from cadavers we performed: 1) canal wall down mastoidectomy; 2) cochleostomy in the cochlear basal and middle turns; 3) ICA identification; 4) Length determination between the cochleostomies and the artery. Results: the average distance ± standard deviation obtained for the upper tunnel was of 8.2 ± 1.1 mm and for the lower tunnel it was of 8.1± 1.3 mm. The shortest distance found was of 6.5 mm for the upper tunnel and 6.0 mm for the lower tunnel. Conclusion: Despite the values calculated, we concluded that the best value to be considered in creating a surgical instrument are the minimum lengths obtained for each one of the cochlear turns, because this is the safest way to avoid damaging the ICA, that can be fatal.

show abstract

The Nucleus Double Array Cochlear Implant: A New Concept for the Obliterated Cochlea

Abstract: In patients with a totally obliterated cochlea, the number of intracochlear electrodes can be increased by use of the Nucleus double array implant. As a result, patients achieve significantly better auditory results.

Cited by 53 publications

References 7 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

Cochlear Implant Candidacy and Surgical Considerations

Estudo anatômico da cóclea para confecção de instrumental para a cirurgia de implante coclear com 2 feixes de eletrodos em cócleas ossificadas

Contact Info

Product

Resources

About