Abstract
Purpose
As a substantial part of our concept of a minimally invasive cochlear implant (CI) surgery, we developed an automated insertion tool. Studies on an artificial scala tympani model were performed in order to evaluate force application when using the insertion tool.
Methods
Contour electrodes were automatically inserted into a transparent cochlea model in Advance Off-Stylet technique. Occurring forces were measured by the use of a load cell and correlated with observed intracochlear movement of the electrode carriers.
Results
Mean insertion forces were measured up to 20 mN comparable to previous studies on temporal bones. The most influencing factor is the implant’s 2D curling behaviour in comparison to the 3D helical shape of the cochlea.
Conclusion
The study confirms the functionality and reliability of the automated insertion tool for insertion of preformed CI. Improved insertion strategies considering patient-specific anatomy become possible.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Wilson BS, Dorman MF (2008) Interfacing sensors with the nervous system: Lessons from the development and success of the cochlear implant. IEEE Sens J 8: 131–147. doi:10.1109/JSEN.2007.912917
Lenarz T, Stöver T, Buechner A et al (2006) Temporal bone results and hearing preservation with a new straight electrode. Audiol Neurootol 11(Suppl 1): 34–41. doi:10.1159/000095612
Roland P, Gstöttner W, Adunka O (2005) Method for hearing preservation in cochlear implant surgery. OperativeTech 16(2): 93–100
Gantz BJ, Turner C, Gfeller KE (2006) Acoustic plus electric speech processing: preliminary results of a multicenter clinical trial of the iowa/nucleus hybrid implant. Audiol Neurootol 11(Suppl 1): 63–68. doi:10.1159/000095616
Gantz BJ, Turner C, Gfeller KE et al (2005) Preservation of hearing in cochlear implant surgery: advantages of combined electrical and acoustical speech processing. Laryngoscope 115(5): 796–802. doi:10.1097/01.MLG.0000157695.07536.D2
James C, Albegger K, Battmer R et al (2005) Preservation of residual hearing with cochlear implantation: how and why. Acta Otolaryngol 125(5): 481–491. doi:10.1080/00016480510026197
Roland JT, Zeitler DM, Jethanamest D et al (2008) Evaluation of the short hybrid electrode in human temporal bones. Otol Neurotol 29(4): 482–488. doi:10.1097/MAO.0b013e31816845eb
Turner C, Gantz BJ, Reiss L (2008) Integration of acoustic and electrical hearing. J Rehabil Res Dev 45(5): 769–778. doi:10.1682/JRRD.2007.05.0065
Turner CW, Reiss LAJ, Gantz BJ (2008) Combined acoustic and electric hearing: preserving residual acoustic hearing. Hear Res 242(1–2): 164–171. doi:10.1016/j.heares.2007.11.008
Adunka OF, Pillsbury HC, Kiefer J (2006) Combining perimodiolar electrode placement and atraumatic insertion properties in cochlear implantation—fact or fantasy? Acta Otolaryngol 126(5): 475–482. doi:10.1080/00016480500437393
Adunka OF, Radeloff A, Gstoettner WK et al (2007) Scala tympani cochleostomy. II. Topography and histology. Laryngoscope 117(12): 2195–2200. doi:10.1097/MLG.0b013e3181453a53
Briggs RJS, Tykocinski M, Stidham K et al (2005) Cochleostomy site: implications for electrode placement and hearing preservation. Acta Otolaryngol 125(8): 870–876. doi:10.1080/00016480510031489
Eshraghi AA, Yang NW, Balkany TJ (2003) Comparative study of cochlear damage with three perimodiolar electrode designs. Laryngoscope 113(3): 415–419. doi:10.1097/00005537-200303000-00005
Roland PS, Wright CG (2006) Surgical aspects of cochlear implantation: mechanisms of insertional trauma. Adv Otorhinolaryngol 64: 11–30
Stöver T, Issing P, Graurock G et al (2005) Evaluation of the advance off-stylet insertion technique and the cochlear insertion tool in temporal bones. Otol Neurotol 26(6): 1161–1170. doi:10.1097/01.mao.0000179527.17285.85
Wardrop P, Whinney D, Rebscher SJ et al (2003) A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I. Comparison of Nucleus banded and Nucleus Contour electrodes. Hear Res 203(1–2): 54–67. doi:10.1016/j.heares.2004.11.006
Wardrop P, Whinney D, Rebscher SJ et al (2005) A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. II. Comparison of Spiral Clarion and HiFocus II electrodes. Hear Res 203(1–2): 68–79. doi:10.1016/j.heares.2004.11.007
Schipper J, Klenzner T, Aschendorff A et al (2004) Navigation-controlled cochleostomy. Is an improvement in the quality of results for cochlear implant surgery possible? HNO 52(4): 329–335. doi:10.1007/s00106-004-1057-5
Labadie RF, Shah RJ, Harris SS et al (2005) In vitro assessment of image-guided otologic surgery: Submillimeter accuracy within the region of the temporal bone. Otolaryngol Head Neck Surg 132(3): 435–442. doi:10.1016/j.otohns.2004.09.141
Labadie RF, Chodhury P, Cetinkaya E et al (2005) Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro. Otol Neurotol 26(4): 557–562. doi:10.1097/01.mao.0000178117.61537.5b
Labadie RF, Majdani O, Fitzpatrick JM (2007) Image-guided technique in neurotology. Otolaryngol Clin North Am 40(3): 611–624. doi:10.1016/j.otc.2007.03.006
Majdani O, Bartling SH, Leinung M et al (2008) Image-guided minimal-invasive cochlear implantation—experiments on cadavers. Laryngorhinootologie 87(1): 18–22. doi:10.1055/s-2007-966775
Majdani O, Bartling SH, Leinung M et al (2008) A true minimally invasive approach for cochlear implantation: High accuracy in cranial base navigation through flat-panel-based volume computed tomography. Otol Neurotol 29(2): 120–123. doi:10.1097/mao.0b013e318157f7d8
Baron S, Eilers H, Hornung O et al (2006) Conception of a robot assisted cochleostomy: first experimental results. In: Proceedings of the 7th international workshop on research and education in mechatronics (REM 2006), Stockholm, Schweden
Brett PN, Taylor RP Proops D et al (2007) A surgical robot for cochleostomy. In: Conference proceedings of the IEEE engineering in medicine and biological society, pp 1229–1232
Coulson CJ, Reid AP, Proops DW et al (2007) ENT challenges at the small scale. Int J Med Robot 3: 91–96. doi:10.1002/rcs.132
Leinung M, Baron S, Eilers H et al (2006) Robotic guided minimal invasive cochleostomy: first results. In: Proceedings of the 5th annual conference of CURAC, Hannover, Germany
Labadie RF, Noble JH, Dawant BM et al (2008) Clinical validation of percutaneous cochlear implant surgery: initial report. Laryngoscope 118(6): 1031–1039. doi:10.1097/MLG.0b013e31816b309e
Warren FM, Balachandran R, Fitzpatrick JM et al (2007) Percutaneous cochlear access using bone-mounted, customized drill guides: demonstration of concept in vitro. Otol Neurotol 28(3): 325–329. doi:10.1097/01.mao.0000253287.86737.2e
Hussong A, Rau T, Eilers H et al (2008) Conception and design of an automated insertion tool for cochlear implants. In: Proceedings of the 30th annual international conference of the IEEE engineering in medicine and biology society, EMBC, Vancouver, Canada, pp 5593–5596
Cohen LT, Saunders E, Clark GM (2001) Psychophysics of a prototype peri-modiolar cochlear implant electrode array. Hear Res 155(1–2): 63–81. doi:10.1016/S0378-5955(01)00248-9
Roland JT (2005) A model for cochlear implant electrode insertion and force evaluation: results with a new electrode design and insertion technique. Laryngoscope 115(8): 1325–1339. doi:10.1097/01.mlg.0000167993.05007.35
Lenarz T (2006) Cochlear Implantation. The Hannover Guideline. Endo-Press, Tuttlingen
Fraysse B, Macías AR, Sterkers O et al (2006) Residual hearing conservation and electroacoustic stimulation with the nucleus 24 contour advance cochlear implant. Otol Neurotol 27(5): 624–633. doi:10.1097/01.mao.0000226289.04048.0f
Lehnhardt E (1993) Intracochlear placement of cochlear implant electrodes in soft surgery technique. HNO 41(7): 356–359
Balkany TJ, Connell SS, Hodges AV et al (2006) Conservation of residual acoustic hearing after cochlear implantation. Otol Neurotol 27(8): 1083–1088. doi:10.1097/01.mao.0000244355.34577.85
Di Nardo W, Cantore I, Cianfrone F et al (2007) Residual hearing thresholds in cochlear implantation and reimplantation. Audiol Neurootol 12: 165–169. doi:10.1159/000099019
Gstoettner WK, Helbig S, Maier N et al (2006) Ipsilateral electric acoustic stimulation of the auditory system: results of long-term hearing preservation. Audiol Neurootol 11(Suppl 1): 49–56. doi:10.1159/000095614
Adunka OF, Kiefer J, Unkelbach MH et al (2004) Development and evaluation of an improved cochlear implant electrode design for electric acoustic stimulation. Laryngoscope 114(7): 1237–1241. doi:10.1097/00005537-200407000-00018
Todd CA, Naghdy F, Svehla M (2007) Force application during cochlear implant insertion: An analysis for improvement of surgeon technique. IEEE Biomed Eng 4(7): 1247–1255. doi:10.1109/TBME.2007.891937
Rau TS, Hussong A Leinung M et al (2007) Erfassung des Krümmungsverhaltens von CI-Elektroden für die robotergestützte, minimal-traumatische Insertion. In: Proceedings of the 6th annual conference of CURAC, Karlsruhe, Germany
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rau, T.S., Hussong, A., Leinung, M. et al. Automated insertion of preformed cochlear implant electrodes: evaluation of curling behaviour and insertion forces on an artificial cochlear model. Int J CARS 5, 173–181 (2010). https://doi.org/10.1007/s11548-009-0299-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-009-0299-9