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Eichler T, Lakomek A, Waschkies L, Meyer M, Sadok N, Lang S, Arweiler-Harbeck D. Two different methods to digitally visualize continuous electrocochleography potentials during cochlear implantation: a first description of feasibility. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-023-08400-3. [PMID: 38170210 DOI: 10.1007/s00405-023-08400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The study explores the potential of real-time electrocochleographic potentials (ECochG) visualization during electrode insertion using digital microscopes such as RoboticScope (BHS®). Collaborative software development of the MAESTRO Software (MED-EL®) offers continuous ECochG monitoring during implantation and postoperative hearing evaluation, addressing previous time constraints. The study aims to assess software applicability and the impact of real-time visualization on long-term residual hearing preservation. METHODS Eight patients with residual hearing underwent cochlear implantation with Flex26 or Flex28 electrode according to the Otoplan evaluation. ECochG responses were measured and visualized during electrode insertion, with insertion times recorded. Two randomized display methods (graph and arrows) tracked ECochG potentials. Postoperative behavioral thresholds determined hearing preservation. Successful real-time intraoperative ECochG visualization was achieved in all cases, enabling surgeon adaptation. Mean electrode insertion time was 114 s, with postoperative thresholds comparable to preoperative values. Visualization did not affect surgeon workload. ECochG amplitudes differed between patients with and without residual hearing. CONCLUSION The study demonstrates effective implementation of advanced ECochG software combined with real-time visualization, enabling residual hearing preservation during CI. Visualization had no apparent effect on surgeon performance or workload. Future investigation involving a larger population will assess the long-term impact of ECochG on hearing threshold and structure preservation.
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Affiliation(s)
- Theda Eichler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.
| | - Antonia Lakomek
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Laura Waschkies
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Moritz Meyer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Nadia Sadok
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Stephan Lang
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
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Andonie RR, Wimmer W, Wildhaber RA, Caversaccio M, Weder S. Real-Time Feature Extraction From Electrocochleography With Impedance Measurements During Cochlear Implantation Using Linear State-Space Models. IEEE Trans Biomed Eng 2023; 70:3137-3146. [PMID: 37195836 DOI: 10.1109/tbme.2023.3276993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Electrocochleography (ECochG) is increasingly used to monitor the inner ear function of cochlear implant (CI) patients during surgery. Current ECochG-based trauma detection shows low sensitivity and specificity and depends on visual analysis by experts. Trauma detection could be improved by including electric impedance data recorded simultaneously with the ECochG. However, combined recordings are rarely used because the impedance measurements produce artifacts in the ECochG. In this study, we propose a framework for automated real-time analysis of intraoperative ECochG signals using Autonomous Linear State-Space Models (ALSSMs). We developed ALSSM based algorithms for noise reduction, artifact removal, and feature extraction in ECochG. Feature extraction includes local amplitude and phase estimations and a confidence metric over the presence of a physiological response in a recording. We tested the algorithms in a controlled sensitivity analysis using simulations and validated them with real patient data recorded during surgeries. The results from simulation data show that the ALSSM method provides improved accuracy in the amplitude estimation together with a more robust confidence metric of ECochG signals compared to the state-of-the-art methods based on the fast Fourier transform (FFT). Tests with patient data showed promising clinical applicability and consistency with the findings from the simulations. We showed that ALSSMs are a valid tool for real-time analysis of ECochG recordings. Removal of artifacts using ALSSMs enables simultaneous recording of ECochG and impedance data. The proposed feature extraction method provides the means to automate the assessment of ECochG. Further validation of the algorithms in clinical data is needed.
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Tessler I, Gecel NA, Glicksberg BS, Shivatzki S, Shapira Y, Zimlichman E, Alon EE, Klang E, Wolfovitz A. A Five-Decade Text Mining Analysis of Cochlear Implant Research: Where We Started and Where We Are Heading. Medicina (Kaunas) 2023; 59:1891. [PMID: 38003940 PMCID: PMC10673015 DOI: 10.3390/medicina59111891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Since its invention in the 1970s, the cochlear implant (CI) has been substantially developed. We aimed to assess the trends in the published literature to characterize CI. Materials and Methods: We queried PubMed for all CI-related entries published during 1970-2022. The following data were extracted: year of publication, publishing journal, title, keywords, and abstract text. Search terms belonged to the patient's age group, etiology for hearing loss, indications for CI, and surgical methodological advancement. Annual trends of publications were plotted. The slopes of publication trends were calculated by fitting regression lines to the yearly number of publications. Results: Overall, 19,428 CIs articles were identified. Pediatric-related CI was the most dominant sub-population among the age groups, with the highest rate and slope during the years (slope 5.2 ± 0.3, p < 0.001), while elderly-related CIs had significantly fewer publications. Entries concerning hearing preservation showed the sharpest rise among the methods, from no entries in 1980 to 46 entries in 2021 (slope 1.7 ± 0.2, p < 0.001). Entries concerning robotic surgery emerged in 2000, with a sharp increase in recent years (slope 0.5 ± 0.1, p < 0.001). Drug-eluting electrodes and CI under local-anesthesia have been reported only in the past five years, with a gradual rise. Conclusions: Publications regarding CI among pediatrics outnumbered all other indications, supporting the rising, pivotal role of CI in the rehabilitation of children with sensorineural hearing loss. Hearing-preservation publications have recently rapidly risen, identified as the primary trend of the current era, followed by a sharp rise of robotic surgery that is evolving and could define the next revolution.
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Affiliation(s)
- Idit Tessler
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
- ARC Innovation Center, Sheba Medical Center, Ramat Gan 52621, Israel; (E.Z.); (E.K.)
| | - Nir A. Gecel
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
| | - Benjamin S. Glicksberg
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shaked Shivatzki
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
| | - Yisgav Shapira
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
| | - Eyal Zimlichman
- ARC Innovation Center, Sheba Medical Center, Ramat Gan 52621, Israel; (E.Z.); (E.K.)
| | - Eran E. Alon
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
| | - Eyal Klang
- ARC Innovation Center, Sheba Medical Center, Ramat Gan 52621, Israel; (E.Z.); (E.K.)
- Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amit Wolfovitz
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Ramat Gan 52621, Israel (S.S.); (Y.S.); (E.E.A.); (A.W.)
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杨 军, 金 玉, 陈 建, 张 青, 段 茂. [To address on the refined and individualized comprehensive evaluation of inner ear function]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:651-658;664. [PMID: 36036063 PMCID: PMC10127629 DOI: 10.13201/j.issn.2096-7993.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Auditory and vestibular function detection technology is the premise and key to the diagnosis and management for inner ear diseases. Concurrent damage to the auditory and vestibular system occurs in many inner ear diseases. The general points and issues on hearing and vestibular function tests, as well as the clinical significance of refined and individualized comprehensive evaluation of inner ear function are described in this paper.
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Affiliation(s)
- 军 杨
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 玉莲 金
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 建勇 陈
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 青 张
- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科 上海交通大学医学院耳科学研究所 上海耳鼻疾病转化医学重点实验室(上海,200092)Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Jiaotong University School of Medicine Ear Institute; Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, 200092, China
| | - 茂利 段
- 瑞典斯德哥尔摩卡罗林斯卡大学医院创伤与修复医学耳鼻咽喉病区Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- 瑞典斯德哥尔摩卡罗林斯卡医学院临床科学干预及技术系耳鼻咽喉头颈外科Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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Herrmann DP, Müller-Graff FT, Kaulitz S, Cebulla M, Kurz A, Hagen R, Neun T, Rak K. Application of intentional facial nerve stimulation during cochlear implantation as an electrophysiological tool to estimate the intracochlear electrode position. Sci Rep 2022; 12:13426. [PMID: 35927465 PMCID: PMC9352782 DOI: 10.1038/s41598-022-17732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI). Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric current pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCTSECO). During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion.
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Affiliation(s)
- David P Herrmann
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Franz-Tassilo Müller-Graff
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Stefan Kaulitz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Mario Cebulla
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Anja Kurz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Tilmann Neun
- Department of Diagnostic and Interventional Neuroradiology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany.
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Skarżyński PH, Lorens A, Walkowiak A, Polak M, Skarżyński H. Multi-Frequency Intraoperative Monitoring of Hearing Preservation during Cochlear Implantation. Life (Basel) 2022; 12:life12050636. [PMID: 35629304 PMCID: PMC9143534 DOI: 10.3390/life12050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Current indications for cochlear implants (CIs) have expanded to include patients with appreciable low-frequency hearing. However, longitudinal results indicate that only one-third of these recipients retain full hearing preservation. In another words, the remaining two-thirds lose this facility either partially or fully. This points to the need to better understand the impact of cochlear implantation on cochlear integrity. Intracochlear electrocochleography (ECochG) involves the recording of electrical potentials generated in the inner ear in response to acoustic stimuli, and previous studies have shown that these potentials give an indication of residual inner ear function. Aim of the research: The aim is to monitor intracochlear ECochG during CI surgery and gain a better understanding of how the implant impacted inner ear function. A newly developed SPL Chirp was used for stimulation. (2) Methods: Intracochlear ECochG signals were measured in a subject with residual preoperative low-frequency hearing, while an electrode array was introduced into the cochlea and was continued until the round window was sealed. Afterwards, surgical events were reviewed with the surgeon; preoperative and postoperative radiological data and hearing thresholds were also evaluated. (3) Conclusions: Real-time intraoperative monitoring, with multifrequency evaluation and video recording, has the potential to allow surgeons and audiologists to continuously assess cochlear function. ECochG monitoring may be a useful tool during cochlear implantation to gain frequency-specific information on the status of the patient’s hearing, assisting surgeons to lower hearing trauma during the operation.
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Affiliation(s)
- Piotr Henryk Skarżyński
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (A.L.); (A.W.); (H.S.)
- Institute of Sensory Organs, 05-830 Kajetany, Poland
- Center of Hearing and Speech Medincus, 05-830 Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Second Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
- Correspondence:
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (A.L.); (A.W.); (H.S.)
| | - Adam Walkowiak
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (A.L.); (A.W.); (H.S.)
| | - Marek Polak
- R&D Med-El, Furstenweg 77A, 6020 Innsbruck, Austria;
| | - Henryk Skarżyński
- World Hearing Center, Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (A.L.); (A.W.); (H.S.)
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