Ultra-High-Resolution CT to Detect Intracochlear New Bone Formation after Cochlear Implantation

Heutink, Floris; Klabbers, Tim M; Huinck, Wendy J.; Lucev, Federica; Woude, Willem-Jan van der; Mylanus, Emmanuel A. M.; Verbist, Berit M.

doi:10.1148/radiol.219033

Cited by 5 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Human cadaveric temporal bone studies of CI recipients have consistently correlated CI insertion trauma of the OSL, lateral wall, and basilar membrane with new intracochlear tissue growth and neossification (16,39,40), which has been correlated with speech discrimination outcomes and loss of residual hearing after traditional and hearing preservation cochlear implantation, respectively (11,41). Recent high-resolution computed tomographic imaging of hearing preservation CI recipients has corroborated previous cadaveric studies demonstrating that poorer long-term residual hearing preservation after CI is associated with CI-adjacent scala tympani neo-ossification (13). Although multiple other factors likely affect hearing preservation and speech discrimination outcomes after cochlear implantation, the previously stated findings provide rationale to support use of a robotics-assisted CI insertion tool to reduce intracochlear trauma and potentially improve CI outcomes.…”

Section: Discussionmentioning

confidence: 64%

“…The pathophysiologic events resulting in loss of residual acoustic hearing after cochlear implantation are diverse and may involve neural and/or sensory cell degeneration as well as an intracochlear conductive hearing loss resulting from CI-associated fibrosis and neo-ossification (9)(10)(11)(12)(13). Ample evidence suggests that the intracochlear surgical trauma from implantation negatively affects traditional CI outcomes as well as contributing to loss of residual acoustic hearing (1,(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Analysis of Robotics-Assisted and Manual Insertions of Cochlear Implant Electrode Arrays

et al. 2022

View full text Add to dashboard Cite

HypothesisRobotics-assisted cochlear implant (CI) insertions will result in reduced intracochlear trauma when compared with manual, across multiple users.BackgroundWhether intracochlear trauma and translocations are two factors that may contribute to significant variability in CI outcomes remains to be seen. To address this issue, we have developed a robotics-assisted insertion system designed to aid the surgeon in inserting electrode arrays with consistent speeds and reduced variability. This study evaluated the effect of robotics-assisted insertions on the intracochlear trauma as compared with manual insertions in cadaveric cochleae in a simulated operative environment.MethodsTwelve neurotologists performed bilateral electrode insertions into cochleae of full cadaveric heads using both the robotics-assisted system and manual hand insertion. Lateral wall electrodes from three different manufacturers (n = 24) were used and randomized between surgeons. Insertion angle of the electrode and trauma scoring were evaluated using high-resolution three-dimensional x-ray microscopy and compared between robotics-assisted and manual insertions.ResultsThree-dimensional x-ray microscopy provided excellent resolution to characterize the in situ trauma and insertion angle. Robotics-assisted insertions significantly decreased insertional intracochlear trauma as measured by reduced trauma scores compared with manual insertions (average: 1.3 versus 2.2, device versus manual, respectively; p < 0.05). There was no significant difference between insertion angles observed for manual and robotics-assisted techniques (311 ± 131° versus 307 ± 96°, device versus manual, respectively).ConclusionsRobotics-assisted insertion systems enable standardized electrode insertions across individual surgeons and experience levels. Clinical trials are necessary to investigate whether insertion techniques that reduce insertional variability and the likelihood of intracochlear trauma also improve CI auditory outcomes.

show abstract

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Robotics-Assisted and Manual Insertions of Cochlear Implant Electrode Arrays

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Aside from visualizing normal cochlear walls, OCT imaging has the potential to detect other obstacles on the insertion path, such as pathological fibrosis and ossification of the ST. This is particularly important in patients who have previously undergone CI surgery 44,45 , in patients with cochlear otosclerosis 46 and when cochlear hearing loss is related to a meningitis infection 47 . In patients with these pathologies, the outcome can often be complicated by incomplete electrode insertions, electrode translocations and device failures 46 .…”

Section: Discussionmentioning

confidence: 99%

An optically-guided cochlear implant sheath for real-time monitoring of electrode insertion into the human cochlea

Starovoyt

Quirk

Putzeys

et al. 2022

Sci Rep

View full text Add to dashboard Cite

In cochlear implant surgery, insertion of perimodiolar electrode arrays into the scala tympani can be complicated by trauma or even accidental translocation of the electrode array within the cochlea. In patients with partial hearing loss, cochlear trauma can not only negatively affect implant performance, but also reduce residual hearing function. These events have been related to suboptimal positioning of the cochlear implant electrode array with respect to critical cochlear walls of the scala tympani (modiolar wall, osseous spiral lamina and basilar membrane). Currently, the position of the electrode array in relation to these walls cannot be assessed during the insertion and the surgeon depends on tactile feedback, which is unreliable and often comes too late. This study presents an image-guided cochlear implant device with an integrated, fiber-optic imaging probe that provides real-time feedback using optical coherence tomography during insertion into the human cochlea. This novel device enables the surgeon to accurately detect and identify the cochlear walls ahead and to adjust the insertion trajectory, avoiding collision and trauma. The functionality of this prototype has been demonstrated in a series of insertion experiments, conducted by experienced cochlear implant surgeons on fresh-frozen human cadaveric cochleae.

show abstract

“…1E-G), such as intravestibular stapes prosthesis protrusion and intracochlear electrode array position [6,7]. Recently, Heutink, et al [8] reported the first in vivo detection of cochlear neo-ossification after cochlear implantation using U-HRCT, which had been previously described only on postmortem examination.…”

Section: Dear Editormentioning

confidence: 99%

Temporal Bone Imaging Opportunities With Ultra-High-Resolution Computed Tomography

2023

View full text Add to dashboard Cite

Ultra-High-Resolution CT to Detect Intracochlear New Bone Formation after Cochlear Implantation

Abstract: Figure 2 contained an error and has been changed to "Precurved electrode 1 cochleostomy approach (n=80)."This copy is for personal use only. To order printed copies, contact

Cited by 5 publications

References 0 publications

Comparative Analysis of Robotics-Assisted and Manual Insertions of Cochlear Implant Electrode Arrays

Comparative Analysis of Robotics-Assisted and Manual Insertions of Cochlear Implant Electrode Arrays

An optically-guided cochlear implant sheath for real-time monitoring of electrode insertion into the human cochlea

Temporal Bone Imaging Opportunities With Ultra-High-Resolution Computed Tomography

Contact Info

Product

Resources

About