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Tomaz A, Peron KA, Suzuki FADB, Monteiro SRG, Chandrasekhar SS, Penido NO. Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health. Otol Neurotol 2024; 45:e366-e375. [PMID: 38511269 DOI: 10.1097/mao.0000000000004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL). STUDY DESIGN Prospective, cohort study. SETTING Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS). RESULTS Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness. CONCLUSION Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.
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Affiliation(s)
- Andreza Tomaz
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Kelly Abdo Peron
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Flavia Alencar de Barros Suzuki
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Silvia Roberta Gesteira Monteiro
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | | | - Norma Oliveira Penido
- Department of Otolaryngology Head and Neck Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
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Brown A, Zhu M, Rohani A, Ladak H, Agrawal SK, Stankovic KM, Welling DB. Surgical Considerations in Inner Ear Gene Therapy from Human Temporal Bone Anatomy. Laryngoscope 2024; 134:2879-2888. [PMID: 38197496 DOI: 10.1002/lary.31259] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE(S) Recently directed methods of inner ear drug delivery underscore the necessity for understanding critical anatomical dimensions. This study examines anatomical measurements of the human middle and inner ear relevant for inner ear drug delivery studied with three different imaging modalities. METHODS Post-mortem human temporal bones were analyzed using human temporal bone histopathology (N = 24), micro computerized tomography (μCT; N = 4), and synchrotron radiation phase-contrast imaging (SR-PCI; N = 7). Nine measurements involving the oval and round windows were performed when relevant anatomical structures were visualized for subsequent age-controlled analysis, and comparisons were made between imaging methods. RESULTS Combined human temporal bone histopathology showed the mean distance to the saccule from the center of the stapes footplate (FP) was 2.07 ± 0.357 mm and the minimum distance was 1.23 mm. The mean distance from the round window membrane (RWM) to the osseous spiral lamina (OSL) was 1.75 ± 0.199 mm and the minimum distance was 1.43 mm. Instruments inserted up to 1 mm past the center of the FP are unlikely to cause saccular damage, provided there are no endolymphatic hydrops. Similarly, instruments inserted up to 1 mm through the RWM in the trajectory toward the OSL are unlikely to cause OSL damage. CONCLUSION The combined analyses of inner-ear dimensions of age-controlled groups and imaging modalities demonstrate critical dimensions of importance to consider when inserting delivery vehicles into the human cochlea. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2879-2888, 2024.
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Affiliation(s)
- Alyssa Brown
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
| | - MengYu Zhu
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Otopathology Laboratory, Boston, Massachusetts, U.S.A
| | - Alireza Rohani
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hanif Ladak
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Konstantina M Stankovic
- Department of Otolaryngology Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - D Bradley Welling
- Department of Otolaryngology-Head and Neck Surgery and Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, U.S.A
- Division of Otology and Neurotology, Harvard Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, Massachusetts, U.S.A
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Micuda A, Li H, Rask-Andersen H, Ladak HM, Agrawal SK. Morphologic Analysis of the Scala Tympani Using Synchrotron: Implications for Cochlear Implantation. Laryngoscope 2024; 134:2889-2897. [PMID: 38189807 DOI: 10.1002/lary.31263] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To use synchrotron radiation phase-contrast imaging (SR-PCI) to visualize and measure the morphology of the entire cochlear scala tympani (ST) and assess cochlear implant (CI) electrode trajectories. METHODS SR-PCI images were used to obtain geometric measurements of the cochlear scalar diameter and area at 5-degree increments in 35 unimplanted and three implanted fixed human cadaveric cochleae. RESULTS The cross-sectional diameter and area of the cochlea were found to decrease from the base to the apex. This study represents a wide variability in cochlear morphology and suggests that even in the smallest cochlea, the ST can accommodate a 0.4 mm diameter electrode up to 720°. Additionally, all lateral wall array trajectories were within the anatomically accommodating insertion zone. CONCLUSION This is the first study to use SR-PCI to visualize and quantify the entire ST morphology, from the round window to the apical tip, and assess the post-operative trajectory of electrodes. These high-resolution anatomical measurements can be used to inform the angular insertion depth that can be accommodated in CI patients, accounting for anatomical variability. LEVEL OF EVIDENCE N/A. Laryngoscope, 134:2889-2897, 2024.
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Affiliation(s)
- Ashley Micuda
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Hao Li
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Helge Rask-Andersen
- Department of Surgical Sciences, Otorhinolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Hanif M Ladak
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Sumit K Agrawal
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
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Dalbert A, Weder S. [Application of extra- and intracochlear electrocochleography during and after cochlear implantation]. HNO 2024:10.1007/s00106-024-01481-4. [PMID: 38761228 DOI: 10.1007/s00106-024-01481-4] [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] [Accepted: 03/19/2024] [Indexed: 05/20/2024]
Abstract
Electrocochleography (ECochG) represents a promising approach for monitoring cochlear function during cochlear implantation and for investigating the causes of residual cochlear function loss after implantation. This paper provides an overview of the current research and application status of ECochG, both during and after cochlear implantation. Intraoperative ECochG can be conducted either via the implant itself or an extracochlear measuring electrode. Postoperative ECochG recordings are also feasible via the implant. Various studies have demonstrated that a significant decrease in ECochG amplitude during electrode insertion correlates with an increased risk of losing residual cochlear function, with critical cochlear events occurring primarily towards the end of the insertion. Postoperative data suggest that the loss of cochlear function mainly occurs in the early postoperative phase. Future research directions include the automation and objectification of signal analysis, as well as a more in-depth investigation into the underlying mechanisms of these signal changes.
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Affiliation(s)
- Adrian Dalbert
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Stefan Weder
- Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie Inselspital, Universitätsspital Bern, Freiburgstrasse 20, 3012, Bern, Schweiz.
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Dhanasingh A, Nielsen SB, Beal F, Schilp S, Hessler R, Jolly C, Hochmair I. Cochlear implant electrode design for safe and effective treatment. Front Neurol 2024; 15:1348439. [PMID: 38756216 PMCID: PMC11096578 DOI: 10.3389/fneur.2024.1348439] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
The optimal placement of a cochlear implant (CI) electrode inside the scala tympani compartment to create an effective electrode-neural interface is the base for a successful CI treatment. The characteristics of an effective electrode design include (a) electrode matching every possible variation in the inner ear size, shape, and anatomy, (b) electrically covering most of the neuronal elements, and (c) preserving intra-cochlear structures, even in non-hearing preservation surgeries. Flexible electrode arrays of various lengths are required to reach an angular insertion depth of 680° to which neuronal cell bodies are angularly distributed and to minimize the rate of electrode scalar deviation. At the time of writing this article, the current scientific evidence indicates that straight lateral wall electrode outperforms perimodiolar electrode by preventing electrode tip fold-over and scalar deviation. Most of the available literature on electrode insertion depth and hearing outcomes supports the practice of physically placing an electrode to cover both the basal and middle turns of the cochlea. This is only achievable with longer straight lateral wall electrodes as single-sized and pre-shaped perimodiolar electrodes have limitations in reaching beyond the basal turn of the cochlea and in offering consistent modiolar hugging placement in every cochlea. For malformed inner ear anatomies that lack a central modiolar trunk, the perimodiolar electrode is not an effective electrode choice. Most of the literature has failed to demonstrate superiority in hearing outcomes when comparing perimodiolar electrodes with straight lateral wall electrodes from single CI manufacturers. In summary, flexible and straight lateral wall electrode type is reported to be gentle to intra-cochlear structures and has the potential to electrically stimulate most of the neuronal elements, which are necessary in bringing full benefit of the CI device to recipients.
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Müller-Graff FT, Spahn B, Herrmann DP, Kurz A, Voelker J, Hagen R, Rak K. [Comprehensive literature review on the application of the otological-surgical planning software OTOPLAN® for cochlear implantation. German version]. HNO 2024:10.1007/s00106-024-01461-8. [PMID: 38587661 DOI: 10.1007/s00106-024-01461-8] [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] [Accepted: 11/28/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND The size of the human cochlear, measured by the diameter of the basal turn, varies between 7 and 11 mm. For hearing rehabilitation with cochlear implants (CI), the size of the cochlear influences the individual frequency map and the choice of electrode length. OTOPLAN® (CAScination AG [Bern, Switzerland] in cooperation with MED-EL [Innsbruck, Austria]) is a software tool with CE marking for clinical applications in CI treatment which allows for precise pre-planning based on cochlear size. This literature review aims to analyze all published data on the application of OTOPLAN®. MATERIALS AND METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to identify relevant studies published in the PubMed search engine between January 2015 and February 2023 using the search terms "otoplan" [title/abstract] OR "anatomy-based fitting" [title/abstract] OR "otological software tool" [title/abstract] OR "computed tomography-based software AND cochlear" [title/abstract]. RESULTS The systematic review of the literature identified 32 studies on clinical use of OTOPLAN® in CI treatment. Most studies were reported from Germany (7 out of 32), followed by Italy (5), Saudi Arabia (4), the USA (4), and Belgium (3); 2 studies each were from Austria and China, and 1 study from France, India, Norway, South Korea, and Switzerland. In the majority of studies (22), OTOPLAN® was used to assess cochlear size, followed by visualizing the electrode position using postoperative images (5), three-dimensional segmentation of temporal bone structures (4), planning the electrode insertion trajectory (3), creating a patient-specific frequency map (3), planning of a safe drilling path through the facial recess (3), and measuring of temporal bone structures (1). CONCLUSION To date, OTOPLAN® is the only DICOM viewer with CE marking in the CI field that can process pre-, intra-, and postoperative images in the abovementioned applications.
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Affiliation(s)
- Franz-Tassilo Müller-Graff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - Björn Spahn
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - David P Herrmann
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Anja Kurz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Johannes Voelker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Kristen Rak
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Russo S, Carnovalini F, Calignano G, Arfé B, Rodà A, Valenza E. Linking vestibular, tactile, and somatosensory rhythm perception to language development in infancy. Cognition 2024; 243:105688. [PMID: 38101080 DOI: 10.1016/j.cognition.2023.105688] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
First experiences with rhythm occur in the womb, with different rhythmic sources being available to the human fetus. Among sensory modalities, vestibular, tactile, and somatosensory perception plays a crucial role in early processing. However, a limited number of studies so far have specifically focused on VTS rhythms in language development. The present work investigated VTS rhythmic abilities and their role in language acquisition through two experiments with 45 infants (21 females, sex assigned at birth; M age = 661.6 days, SD = 192.6) with middle/high socioeconomic status. Specifically, 37 infants from the original sample completed Experiment 1, assessing VTS rhythmic abilities through a vibrotactile tool for music perception. In Experiment 2, linguistic abilities were evaluated in 40 participants from the same cohort, specifically testing phonological and prosodic processing. Discrimination abilities for rhythmic and linguistic stimuli were inferred from changes in pupil diameter to contingent visual stimuli over time, through a Tobii X-60 eye-tracker. The predictive effect of VTS rhythmic abilities on linguistic processing and the developmental changes occurring across ages were explored in the 32 infants who completed both Experiments 1 and 2 by means of generalized, additive and linear, mixed-effect models. Results are discussed in terms of cross-sensory (i.e., haptic to hearing) and cross-domain (i.e., music to language) effects of rhythm on language acquisition, with implications for typical and atypical development.
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Affiliation(s)
- Sofia Russo
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy.
| | - Filippo Carnovalini
- Department of Department of Information Engineering, University of Padua, Padova, Italy.
| | - Giulia Calignano
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy.
| | - Barbara Arfé
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy.
| | - Antonio Rodà
- Department of Department of Information Engineering, University of Padua, Padova, Italy.
| | - Eloisa Valenza
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy.
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Alahmadi A, Abdelsamad Y, Thabet EM, Hafez A, Alghamdi F, Badr KM, Alghamdi S, Hagr A. Advancing Cochlear Implant Programming: X-ray Guided Anatomy-Based Fitting. Otol Neurotol 2024; 45:107-113. [PMID: 38206059 DOI: 10.1097/mao.0000000000004069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Anatomy-based fitting (ABF) is a new research area in the field of cochlear implants (CIs). Despite the reported benefits and acceptable levels of ABF among CI recipients, some limitations remain, like the postoperative computed tomography (CT) scan, which is preferred for confirming electrode array insertion. OBJECTIVE This study aimed to investigate the feasibility of using plain film radiography (X-ray) for postoperative electrode detection and for building ABF as an alternative to CT. METHODS A total of 53 ears with CI were studied. All cases had routine post-insertion X-rays in the cochlear view and additionally underwent postoperative CT. The insertion angles and center frequencies measured by two independent observers were compared for each imaging modality. The angular insertion depth and center frequencies resulting from the X-ray and CT scans were then compared. RESULTS No significant differences were observed between the X-ray- and CT-measured angles for the electrode contacts. Radiographic measurements between the two readers showed an almost perfect (≥0.8) or substantial (0.71) intraclass correlation coefficient along the electrode contacts. X-ray images showed a mean difference of 4.7 degrees from CT. The mean semitone deviation of the central frequency between the CT and X-ray images was 0.6. CONCLUSIONS X-ray imaging provides a valid and easy-to-perform alternative to CT imaging, with less radiation exposure and lower costs. The radiographs showed excellent concordance with the CT-measured angular insertion depth and consequently with the central frequency for most electrode contacts. Therefore, plain X-ray could be a viable alternative in building ABF for the CI recipients.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | | | | | - Ahmed Hafez
- Electrophysiology Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | | | | | | | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
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Aljazeeri IA, Hagr A. Application of anatomy-based spacing of electrode contacts for achieving a uniform semitonal resolution: A novel concept in cochlear implant electrode design. Sci Rep 2024; 14:2645. [PMID: 38302541 PMCID: PMC10834526 DOI: 10.1038/s41598-024-53070-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
Using anatomy-based fitting, we can determine the place-specific map with individualized center frequencies for each electrode contact that is a closer match to the natural pitch-place of the cochlea. The primary objective of this study is to evaluate the tonal presentation across the electrode array and to calculate the semitone difference between each adjacent pair of contacts according to their anatomy-based map. The secondary objective is to determine the distancing of the contacts that would result in an equal semitone difference with a uniform tonal presentation. A total of 167 ears were included in this retrospective study. The frequencies across the electrode arrays were found to be unequally presented. The semitonal condensations were higher in the apical inter-contact spaces compared to the basal inter-contact spaces, being 3.0-2.3 semitones/mm (Kruskal Wallis test, p < 0.000). The anatomy-based spacing of the electrode contacts was larger in the basal inter-contact spaces compared to the apical inter-contact spaces, ranging from 1.92 to 1.48 mm. In conclusion, the current electrode designs do not have uniform tonal representation throughout the electrode array. There is a more condensed tonal presentation in the apical electrodes than in the basal electrodes, resulting in a lower tonal resolution in the apical region.
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Affiliation(s)
- Isra Ali Aljazeeri
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, PO Box 245, 11411, Riyadh, Saudi Arabia.
- Otolaryngology and Ophthalmology Specialized Aljaber Hospital, Ministry of Health, Ahsa, Saudi Arabia.
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, PO Box 245, 11411, Riyadh, Saudi Arabia
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Gatto A, Tofanelli M, Costariol L, Rizzo S, Borsetto D, Gardenal N, Uderzo F, Boscolo-Rizzo P, Tirelli G. Otological Planning Software-OTOPLAN: A Narrative Literature Review. Audiol Res 2023; 13:791-801. [PMID: 37887851 PMCID: PMC10603892 DOI: 10.3390/audiolres13050070] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
The cochlear implant (CI) is a widely accepted option in patients with severe to profound hearing loss receiving limited benefit from traditional hearing aids. CI surgery uses a default setting for frequency allocation aiming to reproduce tonotopicity, thus mimicking the normal cochlea. One emerging instrument that may substantially help the surgeon before, during, and after the surgery is a surgical planning software product developed in collaboration by CASCINATION AG (Bern, Switzerland) and MED-EL (Innsbruck Austria). The aim of this narrative review is to present an overview of the main features of this otological planning software, called OTOPLAN®. The literature was searched on the PubMed and Web of Science databases. The search terms used were "OTOPLAN", "cochlear planning software" "three-dimensional imaging", "3D segmentation", and "cochlear implant" combined into different queries. This strategy yielded 52 publications, and a total of 31 studies were included. The review of the literature revealed that OTOPLAN is a useful tool for otologists and audiologists as it improves preoperative surgical planning both in adults and in children, guides the intraoperative procedure and allows postoperative evaluation of the CI.
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Affiliation(s)
- Annalisa Gatto
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Ludovica Costariol
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Serena Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Francesco Uderzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
| | - Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, 34149 Trieste, Italy; (A.G.); (N.G.); (G.T.)
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Liebscher T, Hornung J, Hoppe U. Electrically evoked compound action potentials in cochlear implant users with preoperative residual hearing. Front Hum Neurosci 2023; 17:1125747. [PMID: 37850038 PMCID: PMC10577430 DOI: 10.3389/fnhum.2023.1125747] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Residual hearing in cochlear implant (CI) candidates requires the functional integrity of the nerve in particular regions of the cochlea. Nerve activity can be elicited as electrically evoked compound action potentials (ECAP) after cochlear implantation. We hypothesize that ECAP thresholds depend on preoperative residual hearing ability. Materials and methods In a retrospective study, we analyzed 84 adult cochlear implant users who had received a Nucleus® CI632 Slim Modiolar Electrode and who preoperatively had had residual hearing. Inclusion criteria were severe to profound hearing loss with preoperative measurable hearing in the ear to receive the implant, postlingual hearing loss, German as native language and correct placement of the electrode, inserted completely into the scala tympani. Electrically evoked compound action potential (ECAP) was recorded intraoperatively. The angular insertion was measured for each electrode contact from postoperative computed tomography to estimate the corresponding spiral ganglion frequency. Pure-tone audiometry and allocated ECAP thresholds were tested to investigate possible correlation. Results The average of hearing thresholds, tested at 0.5, 1, 2, and 4 kHz (4FPTA) was 82 ± 18 (range 47-129) dB HL. The success rate for recording ECAP thresholds was 96.9%. For all comparable pure-tone frequencies (1, 2, 4, and 8 kHz), there was significant correlation between preoperative hearing levels and intraoperative ECAP thresholds (p < 0.001). Higher hearing thresholds are associated with increased ECAP thresholds. Conclusion In CI candidates with adequate residual hearing, intraoperative electrophysiological measurement records lower thresholds. This outcome may be explained by the neural survival density of the peripheral system, with less neural degeneration.
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Affiliation(s)
- Tim Liebscher
- ENT-Clinic, Department of Audiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Swords C, Geerardyn A, Zhu M, O'Malley JT, Wu P, Arenberg JG, Podury A, Brassett C, Bance M, Quesnel AM. Incomplete Partition Type II Cochlear Malformations: Delineating the Three-Dimensional Structure from Digitized Human Histopathological Specimens. Otol Neurotol 2023; 44:881-889. [PMID: 37621122 PMCID: PMC10803064 DOI: 10.1097/mao.0000000000003999] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
HYPOTHESIS There are clinically relevant differences in scalae anatomy and spiral ganglion neuron (SGN) quantity between incomplete partition type II (IP-II) and normal cochleae. BACKGROUND IP-II is a commonly implanted cochlear malformation. Detailed knowledge of intracochlear three-dimensional (3D) morphology may assist with cochlear implant (CI) electrode selection/design and enable optimization of audiologic programming based on SGN maps. METHODS IP-II (n = 11) human temporal bone histological specimens were identified from the National Institute on Deafness and Other Communication Disorders National Temporal Bone Registry and digitized. The cochlear duct, scalae, and surgically relevant anatomy were reconstructed in 3D. A machine learning algorithm was applied to map the location and number of SGNs. RESULTS 3D scalae morphology of the basal turn was normal. Scala tympani (ST) remained isolated for 540 degrees before fusing with scala vestibuli. Mean ST volume reduced below 1 mm 2 after the first 340 degrees. Scala media was a distinct endolymphatic compartment throughout; mean ± standard deviation cochlear duct length was 28 ± 3 mm. SGNs were reduced compared with age-matched norms (mean, 48%; range, 5-90%). In some cases, SGNs failed to ascend Rosenthal's canal, remaining in an abnormal basalward modiolar location. Two forms of IP-II were seen: type A and type B. A majority (98-100%) of SGNs were located in the basal modiolus in type B IP-II, compared with 76 to 85% in type A. CONCLUSION Hallmark features of IP-II cochleae include the following: 1) fusion of the ST and scala vestibuli at a mean of 540 degrees, 2) highly variable and overall reduced SGN quantity compared with normative controls, and 3) abnormal SGN distribution with cell bodies failing to ascend Rosenthal's canal.
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Affiliation(s)
| | | | | | | | | | | | | | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Manohar Bance
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Schaeper JJ, Liberman MC, Salditt T. Imaging of excised cochleae by micro-CT: staining, liquid embedding, and image modalities. J Med Imaging (Bellingham) 2023; 10:053501. [PMID: 37753271 PMCID: PMC10519431 DOI: 10.1117/1.jmi.10.5.053501] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Assessing the complex three-dimensional (3D) structure of the cochlea is crucial to understanding the fundamental aspects of signal transduction in the inner ear and is a prerequisite for the development of novel cochlear implants. X-ray phase-contrast computed tomography offers destruction-free 3D imaging with little sample preparation, thus preserving the delicate structure of the cochlea. The use of heavy metal stains enables higher contrast and resolution and facilitates segmentation of the cochlea. Approach For μ-CT of small animal and human cochlea, we explore the heavy metal osmium tetroxide (OTO) as a radiocontrast agent and delineate laboratory μ - CT from synchrotron CT. We investigate how phase retrieval can be used to improve the image quality of the reconstructions, both for stained and unstained specimens. Results Image contrast for soft tissue in an aqueous solution is insufficient under the in-house conditions, whereas the OTO stain increases contrast for lipid-rich tissue components, such as the myelin sheaths in nervous tissue, enabling contrast-based rendering of the different components of the auditory nervous system. The overall morphology of the cochlea with the three scalae and membranes is very well represented. Further, the image quality of the reconstructions improves significantly when a phase retrieval scheme is used, which is also suitable for non-ideal laboratory μ - CT settings. With highly brilliant synchrotron radiation (SR), we achieve high contrast for unstained whole cochleae at the cellular level. Conclusions The OTO stain is suitable for 3D imaging of small animal and human cochlea with laboratory μ - CT , and relevant pathologies, such as a loss of sensory cells and neurons, can be visualized. With SR and optimized phase retrieval, the cellular level can be reached even for unstained samples in aqueous solution, as demonstrated by the high visibility of single hair cells and spiral ganglion neurons.
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Affiliation(s)
- Jannis Justus Schaeper
- University of Göttingen, Institute for X-ray Physics, Göttingen, Germany
- University of Göttingen, Cluster of Excellence “Multiscale Bioimaging: Molecular Machines to Networks of Excitable Cells,” Göttingen, Germany
| | - Michael Charles Liberman
- Massachusetts Eye and Ear Infirmary, Eaton-Peabody Laboratories, Boston, Massachusetts, United States
- Harvard Medical School, Department of Otolaryngology, Head and Neck Surgery, Boston, Massachusetts, United States
| | - Tim Salditt
- University of Göttingen, Institute for X-ray Physics, Göttingen, Germany
- University of Göttingen, Cluster of Excellence “Multiscale Bioimaging: Molecular Machines to Networks of Excitable Cells,” Göttingen, Germany
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Schuerch K, Wimmer W, Rummel C, Caversaccio MD, Weder S. Objective evaluation of intracochlear electrocochleography: repeatability, thresholds, and tonotopic patterns. Front Neurol 2023; 14:1181539. [PMID: 37621854 PMCID: PMC10446839 DOI: 10.3389/fneur.2023.1181539] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Intracochlear electrocochleography (ECochG) is increasingly being used to measure residual inner ear function in cochlear implant (CI) recipients. ECochG signals reflect the state of the inner ear and can be measured during implantation and post-operatively. The aim of our study was to apply an objective deep learning (DL)-based algorithm to assess the reproducibility of longitudinally recorded ECochG signals, compare them with audiometric hearing thresholds, and identify signal patterns and tonotopic behavior. Methods We used a previously published objective DL-based algorithm to evaluate post-operative intracochlear ECochG signals collected from 21 ears. The same measurement protocol was repeated three times over 3 months. Additionally, we measured the pure-tone thresholds and subjective loudness estimates for correlation with the objectively detected ECochG signals. Recordings were made on at least four electrodes at three intensity levels. We extracted the electrode positions from computed tomography (CT) scans and used this information to evaluate the tonotopic characteristics of the ECochG responses. Results The objectively detected ECochG signals exhibited substantial repeatability over a 3-month period (bias-adjusted kappa, 0.68; accuracy 83.8%). Additionally, we observed a moderate-to-strong dependence of the ECochG thresholds on audiometric and subjective hearing levels. Using radiographically determined tonotopic measurement positions, we observed a tendency for tonotopic allocation with a large variance. Furthermore, maximum ECochG amplitudes exhibited a substantial basal shift. Regarding maximal amplitude patterns, most subjects exhibited a flat pattern with amplitudes evenly distributed over the electrode carrier. At higher stimulation frequencies, we observed a shift in the maximum amplitudes toward the basal turn of the cochlea. Conclusions We successfully implemented an objective DL-based algorithm for evaluating post-operative intracochlear ECochG recordings. We can only evaluate and compare ECochG recordings systematically and independently from experts with an objective analysis. Our results help to identify signal patterns and create a better understanding of the inner ear function with the electrode in place. In the next step, the algorithm can be applied to intra-operative measurements.
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Affiliation(s)
- Klaus Schuerch
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Weller T, Timm ME, Lenarz T, Büchner A. Cochlear coverage with lateral wall cochlear implant electrode arrays affects post-operative speech recognition. PLoS One 2023; 18:e0287450. [PMID: 37437046 DOI: 10.1371/journal.pone.0287450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The goal was to investigate the relationship between the insertion angle/cochlear coverage of cochlear implant electrode arrays and post-operative speech recognition scores in a large cohort of patients implanted with lateral wall electrode arrays. METHODS Pre- and post-operative cone beam computed tomography scans of 154 ears implanted with lateral wall electrode arrays were evaluated. Traces of lateral wall and electrode arrays were combined into a virtual reconstruction of the implanted cochlea. This reconstruction was used to measure insertion angles and proportional cochlear coverage. Word recognition scores and sentence recognition scores measured 12 months after implantation using electric-only stimulation were used to examine the relationship between cochlear coverage/insertion angle and implantation outcomes. RESULTS Post-operative word recognition scores and the difference between post- and pre-operative word recognition scores were positively correlated with both cochlear coverage and insertion angle, however sentence recognition scores were not. A group-wise comparison of word recognition scores revealed that patients with cochlear coverage below 70% performed significantly worse than patients with coverage between 79%-82% (p = 0.003). Performance of patients with coverage above 82% was on average poorer than between 79%-82, although this finding was not statistically significant (p = 0.84). Dividing the cohort into groups based on insertion angle quadrants revealed that word recognition scores were highest above 450° insertion angle, sentence recognition scores were highest between 450° and 630° and the difference between pre- and post-operative word recognition scores was largest between 540° and 630°, however none of these differences reached statistical significance. CONCLUSIONS The results of this study show that cochlear coverage has an effect on post-operative word recognition abilities and the benefit patients receive from their implant. Generally, higher coverage led to better outcomes, however there were results indicating that insertion past 82% cochlear coverage may not provide an additional benefit for word recognition. These findings can be useful for choosing the optimal electrode array and thereby improving cochlear implantation outcomes on a patient-individual basis.
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Affiliation(s)
- Tobias Weller
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover, Germany
- Cluster of Excellence "Hearing4All", Oldenburg, Germany
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Kurz A, Herrmann D, Hagen R, Rak K. Using Anatomy-Based Fitting to Reduce Frequency-to-Place Mismatch in Experienced Bilateral Cochlear Implant Users: A Promising Concept. J Pers Med 2023; 13:1109. [PMID: 37511722 PMCID: PMC10381201 DOI: 10.3390/jpm13071109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/27/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°-620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps' self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users.
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Affiliation(s)
- Anja Kurz
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - David Herrmann
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Head & Neck Surgery, Comprehensive Hearing Center, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
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Schraivogel S, Aebischer P, Weder S, Caversaccio M, Wimmer W. Cochlear implant electrode impedance subcomponents as biomarker for residual hearing. Front Neurol 2023; 14:1183116. [PMID: 37288065 PMCID: PMC10242064 DOI: 10.3389/fneur.2023.1183116] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction and objectives Maintaining the structural integrity of the cochlea and preserving residual hearing is crucial for patients, especially for those for whom electric acoustic stimulation is intended. Impedances could reflect trauma due to electrode array insertion and therefore could serve as a biomarker for residual hearing. The aim of this study is to evaluate the association between residual hearing and estimated impedance subcomponents in a known collective from an exploratory study. Methods A total of 42 patients with lateral wall electrode arrays from the same manufacturer were included in the study. For each patient, we used data from audiological measurements to compute residual hearing, impedance telemetry recordings to estimate near and far-field impedances using an approximation model, and computed tomography scans to extract anatomical information about the cochlea. We assessed the association between residual hearing and impedance subcomponent data using linear mixed-effects models. Results The progression of impedance subcomponents showed that far-field impedance was stable over time compared to near-field impedance. Low-frequency residual hearing demonstrated the progressive nature of hearing loss, with 48% of patients showing full or partial hearing preservation after 6 months of follow-up. Analysis revealed a statistically significant negative effect of near-field impedance on residual hearing (-3.81 dB HL per kΩ; p < 0.001). No significant effect of far-field impedance was found. Conclusion Our findings suggest that near-field impedance offers higher specificity for residual hearing monitoring, while far-field impedance was not significantly associated with residual hearing. These results highlight the potential of impedance subcomponents as objective biomarkers for outcome monitoring in cochlear implantation.
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Affiliation(s)
- Stephan Schraivogel
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Aebischer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of ENT—Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Paouris D, Kunzo S, Goljerová I. Validation of Automatic Cochlear Measurements Using OTOPLAN ® Software. J Pers Med 2023; 13:jpm13050805. [PMID: 37240975 DOI: 10.3390/jpm13050805] [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: 04/06/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Electrode length selection based on case-related cochlear parameters is becoming a standard pre-operative step for cochlear implantation. The manual measurement of the parameters is often time-consuming and may lead to inconsistencies. Our work aimed to evaluate a novel, automatic measurement method. MATERIALS AND METHODS A retrospective evaluation of pre-operative HRCT images of 109 ears (56 patients) was conducted, using a development version of the OTOPLAN® software. Inter-rater (intraclass) reliability and execution time were assessed for manual (surgeons R1 and R2) vs. automatic (AUTO) results. The analysis included A-Value (Diameter), B-Value (Width), H-Value (Height), and CDLOC-length (Cochlear Duct Length at Organ of Corti/Basilar membrane). RESULTS The measurement time was reduced from approximately 7 min ± 2 (min) (manual) to 1 min (AUTO). Cochlear parameters in mm (mean ± SD) for R1, R2 and AUTO, respectively, were A-value: 9.00 ± 0.40, 8.98 ± 0.40 and 9.16 ± 0.36; B-value: 6.81 ± 0.34, 6.71 ± 0.35 and 6.70 ± 0.40; H-value: 3.98 ± 0.25, 3.85 ± 0.25 and 3.76 ± 0.22; and the mean CDLoc-length: 35.64 ± 1.70, 35.20 ± 1.71 and 35.47 ± 1.87. AUTO CDLOC measurements were not significantly different compared to R1 and R2 (H0: Rx CDLOC = AUTO CDLOC: p = 0.831, p = 0.242, respectively), and the calculated intraclass correlation coefficient (ICC) for CDLOC was 0.9 (95% CI: 0.85, 0.932) for R1 vs. AUTO; 0.90 (95% CI: 0.85, 0.932) for R2 vs. AUTO; and 0.893 (95% CI: 0.809, 0.935) for R1 vs. R2. CONCLUSIONS We observed excellent inter-rater reliability, a high agreement of outcomes, and reduced execution time using the AUTO method.
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Affiliation(s)
- Dimitrios Paouris
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
| | - Samuel Kunzo
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
| | - Irina Goljerová
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty, National Institute of Children's Diseases, Comenius University, 83340 Bratislava, Slovakia
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Rader T, Nachtigäller P, Linke T, Weißgerber T, Baumann U. Exponential fitting of spread of excitation response measurements in cochlear implants. J Neurosci Methods 2023; 391:109854. [PMID: 37031765 DOI: 10.1016/j.jneumeth.2023.109854] [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: 12/12/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Hearing performance in cochlear implant (CI) users is variable. An objective measure which can allow a prediction of this performance is desirable. Spread of neural excitation (SoE) curves are an objective measure that can be obtained using the fitting software of cochlear implants and might be able to be used as a predictor. A novel method to interpret SoE curves is presented. New Method Spread of excitation measurements for three recording sites were fitted using two exponential functions. An asymmetric width measure was developed, defined as the distance in mm to the point, where 25% or 50% of peak normalized amplitude was reached, for each half of the SoE separately. Also, a novel population of subjects with MED-EL CIs is used. Furthermore, speech perception (speech reception threshold, SRT) was evaluated using a matrix sentence test in a multi-source noise field. RESULTS SoE width was narrowest for the basal recording site and widest for the apical recording site. Fitted SoE exponential functions were most asymmetric for the apical recording site. A significant positive correlation between sentence test SRT and SoE width at the apical recording site was found. Comparison with Existing Methods The use of an asymmetric width measure correlated strongly and positively with speech perception for apical recording sites, unlike the symmetric width measure used in previous studies. Presumably, longer electrodes allow stimulation of a more apical part of the cochlear. At the apical part of the cochlea, dendrites from a large region of the basilar membrane map to a narrow portion on the spiral ganglion, which might explain the observed asymmetry. CONCLUSIONS For subjects implanted with long electrode arrays, an asymmetric width measure correlates positively with apical SoE distance. However, due to lack of a sufficient amount of data, the results are currently less conclusive and need to be consolidated in a larger cohort of subjects.
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Affiliation(s)
- Tobias Rader
- Division of Audiology, Department for Otorhinolaryngology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pascal Nachtigäller
- Division of Audiology, Department for Otorhinolaryngology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Theresa Linke
- Dermatology Bad Soden, Bad Soden, Germany; Division of Audiological Acoustics, Department for Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Weißgerber
- Division of Audiological Acoustics, Department for Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany.
| | - Uwe Baumann
- Division of Audiological Acoustics, Department for Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
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Lewis MA, Juliano A, Robson C, Clement E, Nash R, Rajput K, D'Arco F. The spectrum of cochlear malformations in CHARGE syndrome and insights into the role of the CHD7 gene during embryogenesis of the inner ear. Neuroradiology 2023; 65:819-834. [PMID: 36715725 DOI: 10.1007/s00234-023-03118-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE We reviewed the genotypes and the imaging appearances of cochleae in CHARGE patients from two large tertiary centres and analysed the observed cochlear anomalies, providing detailed anatomical description and a grading system. The goal was to gain insight into the spectrum of cochlear anomalies in CHARGE syndrome, and thus, in the role of the CHD7 gene in otic vesicle development. METHODS We retrospectively reviewed CT and/or MR imaging of CHARGE patients referred to our institutions between 2005 and 2022. Cochlear morphology was analysed and, when abnormal, divided into 3 groups in order of progressive severity. Other radiological findings in the temporal bone were also recorded. Comparison with the existing classification system of cochlear malformation was also attempted. RESULTS Cochlear morphology in our CHARGE cohort ranged from normal to extreme hypoplasia. The most common phenotype was cochlear hypoplasia in which the basal turn was relatively preserved, and the upper turns were underdeveloped. All patients in the cohort had absent or markedly hypoplastic semicircular canals and small, misshapen vestibules. Aside from a stenotic cochlear aperture (fossette) being associated with a hypoplastic or absent cochlear nerve, there was no consistent relationship between cochlear nerve status (normal, hypoplasia, or aplasia) and cochlear morphology. CONCLUSION Cochlear morphology in CHARGE syndrome is variable. Whenever the cochlea was abnormal, it was almost invariably hypoplastic. This may shed light on the role of CHD7 in cochlear development. Accurate morphological description of the cochlea contributes to proper clinical diagnosis and is important for planning surgical treatment options.
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Affiliation(s)
- Martin A Lewis
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St. London, London, WC1N3JH, UK
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Caroline Robson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emma Clement
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Robert Nash
- Department of Audiological Medicine, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Kaukab Rajput
- Department of Audiological Medicine, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St. London, London, WC1N3JH, UK. felice.d'
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK. felice.d'
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Del Rio J, Taszus R, Nowotny M, Stoessel A. Variations in cochlea shape reveal different evolutionary adaptations in primates and rodents. Sci Rep 2023; 13:2235. [PMID: 36754991 DOI: 10.1038/s41598-023-29478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The presence of a coiled cochlea is a unique feature of the therian inner ear. While some aspects of the cochlea are already known to affect hearing capacities, the full extent of the relationships between the morphology and function of this organ are not yet understood-especially when the effect of body size differences between species is minimized. Here, focusing on Euarchontoglires, we explore cochlear morphology of 33 species of therian mammals with a restricted body size range. Using μCT scans, 3D models and 3D geometric morphometrics, we obtained shape information of the cochlea and used it to build phylogenetically corrected least square models with 12 hearing variables obtained from the literature. Our results reveal that different taxonomic groups differ significantly in cochlea shape. We further show that these shape differences are related to differences in hearing capacities between these groups, despite of similar cochlear lengths. Most strikingly, rodents with good low-frequency hearing display "tower-shaped" cochleae, achieved by increasing the degree of coiling of their cochlea. In contrast, primates present relatively wider cochleae and relative better high frequency hearing. These results suggest that primates and rodents increased their cochlea lengths through different morpho-evolutionary trajectories.
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Moatti A, Li C, Sivadanam S, Cai Y, Ranta J, Piedrahita JA, Cheng AG, Ligler FS, Greenbaum A. Ontogeny of cellular organization and LGR5 expression in porcine cochlea revealed using tissue clearing and 3D imaging. iScience 2022; 25:104695. [PMID: 35865132 DOI: 10.1016/j.isci.2022.104695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Over 11% of the world's population experience hearing loss. Although there are promising studies to restore hearing in rodent models, the size, ontogeny, genetics, and frequency range of hearing of most rodents' cochlea do not match that of humans. The porcine cochlea can bridge this gap as it shares many anatomical, physiological, and genetic similarities with its human counterpart. Here, we provide a detailed methodology to process and image the porcine cochlea in 3D using tissue clearing and light-sheet microscopy. The resulting 3D images can be employed to compare cochleae across different ages and conditions, investigate the ontogeny of cochlear cytoarchitecture, and produce quantitative expression maps of LGR5, a marker of cochlear progenitors in mice. These data reveal that hair cell organization, inner ear morphology, cellular cartography in the organ of Corti, and spatiotemporal expression of LGR5 are dynamic over developmental stages in a pattern not previously documented.
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Weber L, Kwok P, Picou EM, Wendl C, Bohr C, Marcrum SC. [Measuring the cochlea using a tablet-based software package: influence of imaging modality and rater background]. HNO 2022. [PMID: 35970933 DOI: 10.1007/s00106-022-01208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cochlear duct length (CDL) is subject to significant individual variation. In the context of cochlear implantation, adapting the electrode array length to the CDL is of potential interest, as it has been associated with improvements in both speech recognition and sound quality. Using a tablet-based software package, it is possible to measure CDL at the level of the organ of Corti (CDLOC) to select appropriate electrode array lengths based on individual cochlear anatomy. OBJECTIVE To identify effects of imaging modality and rater background on CDL estimates. METHODS Magnetic resonance imaging (MRI) and flat-panel volume CT (fpVCT) scans of 10 patients (20 cochleae) were analyzed using the OTOPLAN software package (MED-EL, Innsbruck, Austria). Raters were an otorhinolaryngology (ORL) specialist, an ORL resident, and an audiologist. To analyze effects of rater background and imaging modality on CDL measurements, linear mixed models were constructed. RESULTS Measurements showed mean CDLOC(fpVCT) = 36.69 ± 1.78 mm and CDLOC(MRI) = 36.81 ± 1.87 mm. Analyses indicated no significant effect of rater background (F(2, 105) = 0.84; p = 0.437) on CDL estimates. Imaging modality, on the other hand, significantly affected CDL (F (1, 105) = 20.70; p < 0.001), whereby estimates obtained using MRI were 0.89 mm larger than those obtained using fpVCT. CONCLUSION No effect of rater background on CDL estimates could be identified, suggesting that comparable measurements could be obtained by personnel other than specially trained neurootologists. While imaging modality (fpVCT vs. MRI) did impact CDL results, the difference was small and of questionable clinical significance.
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O'Toole Bom Braga G, Zboray R, Parrilli A, Bulatović M, Caversaccio MD, Wagner F. Otosclerosis under microCT: New insights into the disease and its anatomy. Front Radiol 2022; 2:965474. [PMID: 37492684 PMCID: PMC10365283 DOI: 10.3389/fradi.2022.965474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/13/2022] [Indexed: 07/27/2023]
Abstract
Purpose Otospongiotic plaques can be seen on conventional computed tomography (CT) as focal lesions around the cochlea. However, the resolution remains insufficient to enable evaluation of intracochlear damage. MicroCT technology provides resolution at the single micron level, offering an exceptional amplified view of the otosclerotic cochlea. In this study, a non-decalcified otosclerotic cochlea was analyzed and reconstructed in three dimensions for the first time, using microCT technology. The pre-clinical relevance of this study is the demonstration of extensive pro-inflammatory buildup inside the cochlea which cannot be seen with conventional cone-beam CT (CBCT) investigation. Materials and Methods A radiological and a three-dimensional (3D) anatomical study of an otosclerotic cochlea using microCT technology is presented here for the first time. 3D-segmentation of the human cochlea was performed, providing an unprecedented view of the diseased area without the need for decalcification, sectioning, or staining. Results Using microCT at single micron resolution and geometric reconstructions, it was possible to visualize the disease's effects. These included intensive tissue remodeling and highly vascularized areas with dilated capillaries around the spongiotic foci seen on the pericochlear bone. The cochlea's architecture as a morphological correlate of the otosclerosis was also seen. With a sagittal cut of the 3D mesh, it was possible to visualize intense ossification of the cochlear apex, as well as the internal auditory canal, the modiolus, the spiral ligament, and a large cochleolith over the osseous spiral lamina. In addition, the oval and round windows showed intense fibrotic tissue formation and spongiotic bone with increased vascularization. Given the recently described importance of the osseous spiral lamina in hearing mechanics and that, clinically, one of the signs of otosclerosis is the Carhart notch observed on the audiogram, a tonotopic map using the osseous spiral lamina as region of interest is presented. An additional quantitative study of the porosity and width of the osseous spiral lamina is reported. Conclusion In this study, structural anatomical alterations of the otosclerotic cochlea were visualized in 3D for the first time. MicroCT suggested that even though the disease may not appear to be advanced in standard clinical CT scans, intense tissue remodeling is already ongoing inside the cochlea. That knowledge will have a great impact on further treatment of patients presenting with sensorineural hearing loss.
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Affiliation(s)
| | - Robert Zboray
- Center for X-ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf, Switzerland
| | - Annapaola Parrilli
- Center for X-ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf, Switzerland
| | - Milica Bulatović
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
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Van de Heyning PH, Dazert S, Gavilan J, Lassaletta L, Lorens A, Rajan GP, Skarzynski H, Skarzynski PH, Tavora-Vieira D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Polak M. Systematic Literature Review of Hearing Preservation Rates in Cochlear Implantation Associated With Medium- and Longer-Length Flexible Lateral Wall Electrode Arrays. Front Surg 2022; 9:893839. [PMID: 36034377 PMCID: PMC9407249 DOI: 10.3389/fsurg.2022.893839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe last two decades have demonstrated that preoperative functional acoustic hearing (residual hearing) can be preserved during cochlear implant (CI) surgery. However, the relationship between the electrode array length and postoperative hearing preservation (HP) with lateral wall flexible electrode variants is still under debate.Aims/ObjectivesThis is a systematic literature review that aims to analyze the HP rates of patients with residual hearing for medium-length and longer-length lateral wall electrodes.MethodA systematic literature review methodology was applied following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations to evaluate the HP rates of medium-length and longer-length lateral wall electrodes from one CI manufacturer (medium length FLEX 24, longer length FLEX 28 and FLEX SOFT, MED-EL, Innsbruck, Austria). A search using search engine PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) was performed using the search terms “hearing preservation” or “residual hearing” and “cochlear implant” in “All fields.” Articles published only in English between January 01, 2009 and December 31, 2020 were included in the search.ResultsThe HP rate was similar between medium-length (93.4%–93.5%) and longer (92.1%–86.8%) electrodes at 4 months (p = 0.689) and 12 months (p = 0.219). In the medium-length electrode group, patients under the age of 45 years had better HP than patients above the age of 45 years.ConclusionsBoth medium-length and longer electrode arrays showed high hearing preservation rates. Considering the hearing deterioration over time, implanting a longer electrode at primary surgery should be considered, thus preventing the need for future reimplantation.
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Affiliation(s)
- Paul H Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Correspondence: Paul H Van de Heyning
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
- Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos, III, (CIBERER-U761), Madrid, Spain
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
| | - Dayse Tavora-Vieira
- Otolaryngology, Head & Neck Surgery, Division of Surgery, Medical School University of Western Australia, Perth, Australia
- Audiology Department, Fiona Stanley Fremantle Hospitals Group, Perth, WA, Australia
| | - Vedat Topsakal
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Brussels, Vrije Universiteit Brussel, Brussels Health Campus, Belgium
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Marek Polak
- Department of Electrophysiology, R&D, MED-EL, Innsbruck, Austria
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Müller-Graff FT, Rak K. [Cochlear Implantation: Evaluation of Cochlear Duct Length (CDL)]. Laryngorhinootologie 2022; 101:428-441. [PMID: 35500581 DOI: 10.1055/a-1742-5254] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Personalized care in the context of cochlear implantation is becoming increasingly important. Choosing the right electrode could improve speech understanding. The measurement of the cochlear length plays an important role: preoperatively, in order to select a suitable electrode length; postoperatively, on the one hand to check the correct electrode position, on the other hand to enable anatomically based fitting of the electrode contacts. Of the various possible localizations of the CDL measurements within the cochlear turns, the one on the organ of Corti (CDLOC) is the most frequently used and clinically most important. In the CDL measurement, a direct and indirect evaluation can be distinguished. There is also the possibility of reconstructing and measuring the CDL in 3D and calculating it mathematically, e.g. using spiral equations. In this context, measurements based on radiological imaging are gaining increasing importance. Therefore, if there is the possibility of performing higher-resolution imaging, this should be strived preoperatively in order to enable the most precise possible procedure and thus a good outcome. Otological planning software can help to create an interface between new findings regarding CDL measurement and higher-resolution imaging for an individualized cochlear implantation.
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Affiliation(s)
- Franz-Tassilo Müller-Graff
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg
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Van de Heyning P, Roland P, Lassaletta L, Agrawal S, Atlas M, Baumgartner WD, Brown K, Caversaccio M, Dazert S, Gstoettner W, Hagen R, Hagr A, Jablonski GE, Kameswaran M, Kuzovkov V, Leinung M, Li Y, Loth A, Magele A, Mlynski R, Mueller J, Parnes L, Radeloff A, Raine C, Rajan G, Schmutzhard J, Skarzynski H, Skarzynski PH, Sprinzl G, Staecker H, Stöver T, Tavora-Viera D, Topsakal V, Usami SI, Van Rompaey V, Weiss NM, Wimmer W, Zernotti M, Gavilan J. Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events. Front Surg 2022; 9:823219. [PMID: 35402479 PMCID: PMC8987358 DOI: 10.3389/fsurg.2022.823219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. Methods A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. Results A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4–6.6%) of ETFO, 28.6% (26.6–30.6%) of ESD, and 0.53% (0.2–1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1–1.3%), 11% (9.2–13.0%), and 3.2% (2.5–3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. Conclusion Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.
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Affiliation(s)
- Paul Van de Heyning
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- *Correspondence: Paul Van de Heyning
| | - Peter Roland
- Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luis Lassaletta
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marcus Atlas
- Ear Sciences Institute Australia, Lions Hearing Clinic, Perth, WA, Australia
| | | | - Kevin Brown
- UNC Ear and Hearing Center at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Marco Caversaccio
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Stefan Dazert
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | | | - Rudolf Hagen
- Würzburg ENT University Hospital, Würzburg, Germany
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology & Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Vladislav Kuzovkov
- St. Petersburg ENT and Speech Research Institute, St. Petersburg, Russia
| | - Martin Leinung
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Andreas Loth
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Magele
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery, “Otto Körner” Rostock University Medical Center, Rostock, Germany
| | - Joachim Mueller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Andreas Radeloff
- Division of Oto-Rhino-Laryngology, Evangelisches Krankenhaus Oldenburg, Research Center of Neurosensory Sciences, University Oldenburg, Oldenburg, Germany
| | - Chris Raine
- Bradford Royal Infirmary Yorkshire Auditory Implant Center, Bradford, United Kingdom
| | - Gunesh Rajan
- Department of Otolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Medical Sciences Department of Health Sciences and Medicine. University of Lucerne, Luzern, Switzerland. Otolaryngology, Head & Neck Surgery, Medical School University of Western Australia, Perth, WA, Australia
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Henryk Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Piotr H. Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Georg Sprinzl
- Ear, Nose and Throat Department, University Clinic St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria
| | - Hinrich Staecker
- Kansas University Center for Hearing and Balance Disorders, Kansas City, KS, United States
| | - Timo Stöver
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Vedat Topsakal
- Department of ENT HNS, University Hospital Brussels, Brussels, Belgium
| | - Shin-Ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Nora M. Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth University Hospital Bochum, Bochum, Germany
| | - Wilhelm Wimmer
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - Mario Zernotti
- Catholic University of Córdoba and National University of Córdoba, Córdoba, Argentina
| | - Javier Gavilan
- Hospital Universitario La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain
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Pietsch M, Schurzig D, Salcher R, Warnecke A, Erfurt P, Lenarz T, Kral A. Variations in microanatomy of the human modiolus require individualized cochlear implantation. Sci Rep 2022; 12:5047. [PMID: 35322066 DOI: 10.1038/s41598-022-08731-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
Cochlear variability is of key importance for the clinical use of cochlear implants, the most successful neuroprosthetic device that is surgically placed into the cochlear scala tympani. Despite extensive literature on human cochlear variability, few information is available on the variability of the modiolar wall. In the present study, we analyzed 108 corrosion casts, 95 clinical cone beam computer tomographies (CTs) and 15 µCTs of human cochleae and observed modiolar variability of similar and larger extent than the lateral wall variability. Lateral wall measures correlated with modiolar wall measures significantly. ~ 49% of the variability had a common cause. Based on these data we developed a model of the modiolar wall variations and related the model to the design of cochlear implants aimed for perimodiolar locations. The data demonstrate that both the insertion limits relevant for lateral wall damage (approximate range of 4–9 mm) as well as the dimensions required for optimal perimodiolar placement of the electrode (the point of release from the straightener; approximate range of 2–5mm) are highly interindividually variable. The data demonstrate that tip fold-overs of preformed implants likely result from the morphology of the modiolus (with radius changing from base to apex), and that optimal cochlear implantation of perimodiolar arrays cannot be guaranteed without an individualized surgical technique.
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Vogl C, Neef J, Wichmann C. Methods for multiscale structural and functional analysis of the mammalian cochlea. Mol Cell Neurosci 2022; 120:103720. [DOI: 10.1016/j.mcn.2022.103720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 01/11/2023] Open
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Canfarotta MW, Dillon MT, Brown KD, Pillsbury HC, Dedmon MM, O'Connell BP. Insertion Depth and Cochlear Implant Speech Recognition Outcomes: A Comparative Study of 28- and 31.5-mm Lateral Wall Arrays. Otol Neurotol 2022; 43:183-189. [PMID: 34772886 PMCID: PMC8752482 DOI: 10.1097/mao.0000000000003416] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES 1) To compare speech recognition outcomes between cochlear implant (CI) recipients of 28- and 31.5-mm lateral wall electrode arrays, and 2) to characterize the relationship between angular insertion depth (AID) and speech recognition. STUDY DESIGN Retrospective review. SETTING Tertiary academic referral center. PATIENTS Seventy-five adult CI recipients of fully inserted 28-mm (n = 28) or 31.5-mm (n = 47) lateral wall arrays listening with a CI-alone device. INTERVENTIONS Cochlear implantation with postoperative computed tomography. MAIN OUTCOME MEASURES Consonant-nucleus-consonant (CNC) word recognition assessed with the CI-alone at 12 months postactivation. RESULTS The mean AID of the most apical electrode contact for the 31.5-mm array recipients was significantly deeper than the 28-mm array recipients (628° vs 571°, p < 0.001). Following 12 months of listening experience, mean CNC word scores were significantly better for recipients of 31.5-mm arrays compared with those implanted with 28-mm arrays (59.5% vs 48.3%, p = 0.004; Cohen's d = 0.70; 95% CI [0.22, 1.18]). There was a significant positive correlation between AID and CNC word scores (r = 0.372, p = 0.001), with a plateau in performance observed around 600°. CONCLUSIONS Cochlear implant recipients implanted with a 31.5-mm array experienced better speech recognition than those with a 28-mm array at 12 months postactivation. Deeper insertion of a lateral wall array appears to confer speech recognition benefit up to ∼600°, with a plateau in performance observed thereafter. These data provide preliminary evidence of the insertion depth necessary to optimize speech recognition outcomes for lateral wall electrode arrays among CI-alone users.
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Affiliation(s)
- Michael W Canfarotta
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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31
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Mahmood AF, Mahmood SW. Cough/X-ray/CT (CXC) website for testing COVID-19 and auto-informing results. Rev Sci Instrum 2022; 93:013705. [PMID: 35104981 DOI: 10.1063/5.0076314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Despite the development of vaccines and the emergence of various treatments for COVID-19, the number of confirmed cases of the coronavirus disease (COVID-19) is increasing worldwide, and it is unlikely that the disease will ever disappear completely. Having a non-contact remote testing system can improve the workload of health-care centers and contribute to reducing the infection by recommending early self-isolation for those who suffer from a cough. In the proposed system, patients can upload an audio cough recording via mobile phones through the suggested Cough/X-ray/CT website and then receive the diagnosis within seconds on the same phone. Moreover, in the case of infection, the health center and the community are informed in addition to automatically calling the mobile phones of the injured cases. The higher proposed accuracy with deep cough training was achieved on the ResNet152v2 model after converting the cough signal into an image using the Mel-spectrogram, where the accuracy was 99.95%, the sensitivity was 100%, and the specificity was 99%.
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Affiliation(s)
| | - Saja Waleed Mahmood
- Computer Engineering, College of Engineering, University of Mosul, Mosul, Iraq
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Aljazeeri I, Hamed N, Abdelsamad Y, Sharif T, Al-Momani M, Hagr A. Anatomy-Based Frequency Allocation in Cochlear Implantation: The Importance of Cochlear Coverage. Laryngoscope 2021; 132:2224-2231. [PMID: 34967457 DOI: 10.1002/lary.30004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/12/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to compare the predicted anatomy-based frequency allocation of cochlear implant electrodes with the default standard frequencies. STUDY DESIGN Retrospective study. METHODS A retrospective analysis was performed using computed tomography (CT) images of patients who received cochlear implants at a tertiary referral center. Patients were excluded if they had any congenital or acquired cochlear anatomical anomalies. The CT images of the patients were uploaded to the surgical planning software. Two independent reviewers allocated the anatomical parameters of the cochlea. The software then used these parameters to calculate the frequency allocation for each electrode according to the type of electrode and the length of the organ of Corti (OC) in each patient. These anatomy-based frequency allocations were compared with the default frequency settings. MAIN OUTCOME MEASURE Frequency-to-place mismatch in semitones. RESULTS A total of 169 implanted ears in 102 patients were included in this study. The readings of the two reviewers were homogenous, with a Cronbach's alpha of 0.98. The mean anatomy-based frequency allocation was 487.3 ± 202.9 Hz in electrode 1; 9,298.6 ± 490.6 Hz in electrode 12. The anatomy-based frequency allocations were found to be significantly higher than the frequencies of the default frequencies for each corresponding electrode (one-sample t-test, P < .001). The frequency-to-place mismatch was negatively correlated with cochlear coverage and positively correlated with the cochlear duct length (Pearson correlation > 0.65, P < .003). CONCLUSIONS The anatomy-based frequency allocation of each electrode is significantly different from the default frequency setting. This frequency-to-place mismatch was affected mainly by the cochlear coverage. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Isra Aljazeeri
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia.,Aljaber Ophthalmology and Otolaryngology Specialized Hospital, Ministry of Health, Ahsa, Saudi Arabia
| | - Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | | | - Tahir Sharif
- Research Department, MED-EL GmbH, Riyadh, Saudi Arabia
| | - Murad Al-Momani
- ENT Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
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Neves CA, Tran ED, Cooperman SP, Blevins NH. Fully Automated Measurement of Cochlear Duct Length From Clinical Temporal Bone Computed Tomography. Laryngoscope 2021; 132:449-458. [PMID: 34536238 DOI: 10.1002/lary.29869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/20/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present and validate a novel fully automated method to measure cochlear dimensions, including cochlear duct length (CDL). STUDY DESIGN Cross-sectional study. METHODS The computational method combined 1) a deep learning (DL) algorithm to segment the cochlea and otic capsule and 2) geometric analysis to measure anti-modiolar distances from the round window to the apex. The algorithm was trained using 165 manually segmented clinical computed tomography (CT). A Testing group of 159 CTs were then measured for cochlear diameter and width (A- and B-values) and CDL using the automated system and compared against manual measurements. The results were also compared with existing approaches and historical data. In addition, pre- and post-implantation scans from 27 cochlear implant recipients were studied to compare predicted versus actual array insertion depth. RESULTS Measurements were successfully obtained in 98.1% of scans. The mean CDL to 900° was 35.52 mm (SD, 2.06; range, [30.91-40.50]), the mean A-value was 8.88 mm (0.47; [7.67-10.49]), and mean B-value was 6.38 mm (0.42; [5.16-7.38]). The R2 fit of the automated to manual measurements was 0.87 for A-value, 0.70 for B-value, and 0.71 for CDL. For anti-modiolar arrays, the distance between the imaged and predicted array tip location was 0.57 mm (1.25; [0.13-5.28]). CONCLUSION Our method provides a fully automated means of cochlear analysis from clinical CTs. The distribution of CDL, dimensions, and cochlear quadrant lengths is similar to those from historical data. This approach requires no radiographic experience and is free from user-related variation. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Caio A Neves
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Emma D Tran
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Shayna P Cooperman
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Nikolas H Blevins
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Hochmair I. Translational research around five categories of CI. Acta Otolaryngol 2021; 141:178-184. [PMID: 33818266 DOI: 10.1080/00016489.2021.1888516] [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] [Indexed: 10/21/2022]
Abstract
Five categories of cochlear implants are introduced: The 'classic CI', the 'combined CI' - which can be combining a CI based on electric stimulation with acoustic stimulation (EAS) or with mechanical stimulation (EMS) or with electrical stimulation of the vestibular system (VICI) -, the 'individualised CI', the 'augmented CI' and the 'totally implantable CI'. The translational research activities leading to and within these categories have been, are and will be numerous and are the subject of the compendium for which this paper is the concluding chapter. Early translational research has resulted in the 'classic CI' in 1994. From then on translational research enabled the developments respectively the new indications and reimbursement of CI-systems for bilateral CIs, CI in single sided deafness, the auditory brainstem implant, speech coding and signal processing advances, electrophysiologic measurements for evaluation of cochlear health, all within the classic CI category. Starting points for the four newer categories of CI are either ideas of professionals treating hearing loss or of CI developers. The translational research performed also triggered research that led and leads to improved understanding of the fundamental mechanisms of hearing.
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Affiliation(s)
- Ingeborg Hochmair
- MED-EL Elektromedizinische Geraete Gesellschaft m.b.H., Innsbruck, Austria
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