Insertion forces and intracochlear trauma in temporal bone specimens implanted with a straight atraumatic electrode array.

The aim of the study was to evaluate insertion forces during manual insertion of a straight atraumatic electrode in human temporal bones, and post-implantation histologic evaluation of the samples to determine whether violation of intracochlear structures is related to insertion forces. In order to minimize intracochlear trauma and preserve residual hearing during cochlear implantation, knowledge of the insertion forces is necessary. Ten fresh frozen human temporal bones were prepared with canal wall down mastoidectomy. All samples were mounted on a one-axis force sensor. Insertion of a 16-mm straight atraumatic electrode was performed from different angles to induce "traumatic" insertion. Histologic evaluation was performed in order to evaluate intracochlear trauma. In 4 of 10 samples, dislocation of the electrode into scala vestibuli was observed. The mean insertion force for all 10 procedures was 0.003 ± 0.005 N. Insertion forces measured around the site of dislocation to scala vestibuli in 3 of 4 samples were significantly higher than insertion forces at the same location of the cochleae measured in samples without trauma (p < 0.04). Mean force during the whole insertion process of the straight atraumatic electrode is lower than reported by other studies using longer electrodes. Based on our study, insertion forces leading to basilar membrane trauma may be lower than the previously reported direct rupture forces.

Cochlear implant insertion forces in microdissected human cochlea to evaluate a prototype array.

Cochlear implant array insertion forces are potentially related to cochlear trauma. We compared these forces between a standard (Digisonic SP; Neurelec, Vallauris, France) and an array prototype (Neurelec) with a smaller diameter. The arrays were inserted by a mechatronic tool in 23 dissected human cochlea specimens exposing the basilar membrane. The array progression under the basilar membrane was filmed together with dynamic force measurements. Insertion force profiles and depth of insertion were compared. The recordings showed lower insertion forces beyond 270° of insertion and deeper insertions with the thin prototype array. This will potentially allow larger cochlear coverage with less trauma.

A Brownian energy depot model of the basilar membrane oscillation with a braking mechanism.

High auditory sensitivity, sharp frequency selectivity, and spontaneous otoacoustic emissions are signatures of active amplification of the cochlea. The human ear can also detect very large amplitude sounds without being damaged, as long as the exposed time is not too long. The outer hair cells are believed to be the best candidate for the active force generator of the mammalian cochlea. In this paper, we propose a new model for the basilar membrane oscillation which describes both an active and a protective mechanism by employing an energy depot concept and a critical velocity of the basilar membrane. The compressive response of the basilar membrane at the characteristic frequency and the dynamic response to the stimulation are consistent with the experimental results. Although our model displays a Hopf bifurcation, our braking mechanism results in a hyper-compressive response to intense stimuli which is not generically observed near a Hopf bifurcation. Asymmetry seen in experimental recordings between the onset and the offset of the basilar membrane response to a sound burst is also observed in this model.

Damage to inner ear structure during cochlear implantation: Correlation between insertion force and radio-histological findings in temporal bone specimens.

Cochlear implant insertion should be as least traumatic as possible in order to reduce trauma to the cochlear sensory structures. The force applied to the cochlea during array insertion should be controlled to limit insertion-related damage. The relationship between insertion force and histological traumatism remains to be demonstrated. Twelve freshly frozen cadaveric temporal bones were implanted with a long straight electrodes array through an anterior extended round window insertion using a motorized insertion tool with real-time measurement of the insertion force. Anatomical parameters, measured on a pre-implantation cone beam CT scan, position of the array and force metrics were correlated with post-implantation scanning electron microscopy images and histological damage assessment. An atraumatic insertion occurred in six cochleae, a translocation in five cochleae and a basilar membrane rupture in one cochlea. The translocation always occurred in the 150- to 180-degree region. In the case of traumatic insertion, different force profiles were observed with a more irregular curve arising from the presence of an early peak force (30 ± 18.2 mN). This corresponded approximately to the first point of contact of the array with the lateral wall of the cochlea. Atraumatic and traumatic insertions had significantly different force values at the same depth of insertion (p < 0.001, two-way ANOVA), and significantly different regression lines (y = 1.34x + 0.7 for atraumatic and y = 3.37x + 0.84 for traumatic insertion, p < 0.001, ANCOVA). In the present study, the insertion force was correlated with the intracochlear trauma. The 150- to 180-degree region represented the area at risk for scalar translocation for this straight electrodes array. Insertion force curves with different sets of values were identified for traumatic and atraumatic insertions; these values should be considered during motorized insertion of an implant so as to be able to modify the insertion parameters (e.g axis of insertion) and facilitate preservation of endocochlear structures.

Impact of electrode insertion depth on intracochlear trauma.

OBJECTIVE: To assess the effect of cochlear implant (CI) insertion depth and surgical technique on intracochlear trauma. STUDY DESIGN AND SETTING: Twenty-one fresh human temporal bones were implanted with CI electrodes and underwent histologic processing and evaluation. Specimens were grouped into 3 categories: 1) soft implantation technique and standard electrode; 2) soft implantation technique and flexible prototype array; 3) forceful implantations and standard electrode. Based on the grading system (1 to 4), 2 numeric values were calculated indicating the overall severity of cochlear damage (trauma indices). RESULTS: Mean trauma index values were 13.8, 36.3, and 59.2 for group 1, 2, and 3, respectively. Differences in cochlear trauma (trauma index) were nonsignificant between specimens in groups 1 and 2 but were significant between groups 1 and 3. CONCLUSION: This study gives evidence that intracochlear trauma increases with deep insertions. Thus, in cases where cochlear integrity might be important, limited insertions should be achieved.

Combining perimodiolar electrode placement and atraumatic insertion properties in cochlear implantation -- fact or fantasy?

CONCLUSIONS: Except for basal cochlear traumatization, all specimens implanted into scala tympani showed atraumatic insertion properties and good perimodiolar electrode positioning. Cochleostomy preparation and placement can have a significant impact on levels of basal cochlear trauma. OBJECTIVE: In the past, perimodiolar cochlear implant electrodes increased the risk for intracochlear traumatization when compared to free-fitting arrays. Recently, however, clinical evidence for atraumatic perimodiolar implantations with preservation of residual hearing has been described. The aim of this paper was to histologically evaluate a perimodiolar cochlear implant array for its insertion properties in cadaver human temporal bones. Surgical and electrode factors, as well as preparation artifacts influencing intracochlear trauma, were considered in the evaluation. MATERIALS AND METHODS: Sixteen human temporal bones were harvested up to 24 hours post mortem and implanted immediately with the Nucleus 24 Contour Advance cochlear implant electrode array. Implantations were either performed using a regular caudal approach cochleostomy or through the round window membrane. After implantation, all bones underwent special histological processing, which allowed sectioning of undecalcified bone. Insertion properties were evaluated according to a grading system. RESULTS: Fourteen specimens were implanted into scala tympani and only two exhibited basal trauma attributable to electrode insertion characteristics. Two bones were implanted into scala vestibuli after causing trauma in the region of the cochleostomy. Insertion depths ranged from 180 degrees to 400 degrees. All bones showed good perimodiolar electrode positioning. Basal trauma due to surgical issues and histological artifacts was present in 10 of 16 bones.

[The influence of glucocorticoids on the view of chicken's inner ear damage after exposure to wide-band-noise]. / Wplyw glikokortykoidów na obraz zniszczen komórek rzesatych ucha wewnetrznego kurczat poddanych ekspozycji na halas szerokopasmowy.

The aim of the study was to assess the influence of glucocorticoids on the view of hair cell regeneration process being in the chicken's inner ear (basilar papilla - BP) after exposure to wide-band noise at the level 120 dB (A) for 48 hours. We found that glucocorticoids given during and/or after exposure to the noise have a cytoprotective activity to the hair cells, they limitate the extensiveness and decrease the dynamics of hair cells injury. We observed that new "young" hair cells reappeared at the sensory epithelium on the 7th day after the end of exposure. Regenerated hair cells have immature, short and thick cilia and small apical surface area.

[Pathological changes of temporal bone after cochlear implantation and the countermeasures].

Cochlear implant (CI) is an artificial electronic device which can provide a sense of sound to a patient with severe or profound hearing loss. Pathological changes have been observed after CI surgery, which might influence the effectiveness of the CI procedure. In this review, we divided the postoperative pathological changes of the temporal bone into two categories according to different stages: immediate trauma and delayed side effects. Immediate trauma might arise from traumatic insertion of the electrode during CI surgery, which included trauma at cochleostomy site, lateral wall trauma, basilar membrane injury, osseous lamina fracture and modiolar injury. Delayed side effects arised from the host response against the inserted electrode, which involved a tissue reaction consisting of fibrotic and osseous changes in the cochlea, intracochlear inflammatory response to the electrode, changes in spiral ganglion cells number, pathological changes outside the cochlea and pathological changes after reimplantation. Published data suggested that the effectiveness of the surgery would be affected in many ways by postoperative pathological changes, and individuals with these changes would have an increased risk of the surgical failure. Therefore, subsequent countermeasures need to be taken to reduce the damages.

Evaluation of the advance off-stylet insertion technique and the cochlear insertion tool in temporal bones.

OBJECTIVE: The concept and design of new cochlear implant electrodes is a challenging process. To evaluate new electrode designs, we present a study that uses a microgrinding procedure to evaluate damage to the microstructures of the cochlea resulting from the insertion procedure. In this study, we compared different insertion techniques with the Contour electrode with Softip for placement inside the cochlea and any resulting damage. METHODS: Twenty-five fresh frozen human temporal bones were used to compare electrode insertion characteristics with three insertion techniques (i.e., conventional insertion, Advance Off-Stylet performed manually, and Advance Off-Stylet performed with insertion tool) and two prototype variants of the Contour electrode with Softip (referred as Softip I and Softip II in this article). Five temporal bones were used for each arm of the study: Softip I electrode and conventional insertion; Softip I electrode and manual Advance Off-Stylet insertion; Softip I electrode and Advance Off-Stylet insertion with an early experimental insertion tool; Softip II prototype electrode and manual Advance Off-Stylet insertion; and Softip II prototype and Advance Off-Stylet insertion with a prototype insertion tool. The temporal bones were dehydrated and embedded in epoxy and used for the microgrinding procedure. Resulting images were documented and compared with conventional radiographic images. RESULTS: Our results showed that, especially when using the conventional insertion technique with Softip I electrode arrays, basilar membrane perforations were observable. Using the prototype insertion tool, good placement of the electrode array but also two basilar membrane perforations (one with each type of electrode) were observed. In contrast, the Advance Off-Stylet insertion technique did not show basilar membrane perforation with Softip I and II electrodes and resulted in reliable perimodiolar placement of the arrays. CONCLUSION: Using microgrinding of temporal bones, the Advance Off-Stylet insertion technique was proven to enable more atraumatic insertions of Contour electrodes with Softip and to provide very reliable perimodiolar placements.

Cochleostomy site: implications for electrode placement and hearing preservation.

CONCLUSIONS: With recent increased interest in minimizing intracochlear trauma and preserving residual hearing during cochlear implantation, increased attention must be paid to the cochleostomy site. The results of this paper demonstrate that the cochleostomy must be made inferior, rather than anterior, to the round window to ensure scala tympani insertion and to decrease the likelihood of insertion-induced intracochlear damage during electrode insertion. OBJECTIVE: To describe the complex anatomy of the hook region of the cochlea, specifically in relation to the optimal placement of the cochleostomy for cochlear implant electrode insertion to potentially achieve hearing preservation. The authors believe that previous industry recommendations and described surgical techniques have resulted in cochleostomies being placed in anatomical positions that possibly result in electrode insertions that damage the basilar membrane and/or other cochlear structures. MATERIAL AND METHODS: The results of a number of temporal bone studies were reviewed with attention being paid to the anatomical relationship of the basilar membrane and spiral ligament to the round window membrane. For different cochleostomy sites the potential for damage to intracochlear structures, particularly the basilar membrane and organ of Corti, was assessed. RESULTS: The review of electrode insertion studies into human temporal bones, as well as a post-mortem anatomical study of implanted temporal bones, showed an increased risk of scala vestibuli insertions and insertion-induced damage to intracochlear structures when the cochleostomy was performed more anterior to the round window. These results were endorsed by studies detailing the anatomy of the hook region of the cochlea.

Blast overpressure induced structural and functional changes in the auditory system.

Blast overpressure of sufficient intensity can produce injury to various organ systems. Unprotected ears result in the auditory system being the most susceptible. The injuries to the auditory system include: rupture of the tympanic membrane, dislocation or fracture of the ossicular chain, and damage to the sensory structures on the basilar membrane. All these injuries can be characterized as a form of mechanical damage to the affected structure. Injury to the sensory structures on the basilar membrane leads to temporary and permanent loss of hearing sensitivity. The temporary component of the hearing loss shows a time course after removal from the noise which frequently will include an initial increase in hearing loss followed by a recovery period during which threshold may return to preexposure levels or stabilize at a higher level which represents a permanent loss of hearing sensitivity. This type of recovery function suggests that there are damage processes which continue after the traumatic event and that intervention might mitigate some of the damage and hearing loss.

Recovery of auditory function following intense sound exposure in the neonatal chick.

We report the changes in auditory function that occurred at selected intervals following exposure to an intense pure-tone stimulus. One day old chicks were exposed to a 0.9 kHz tone for 48 h at 120 dB. At 0, 1, 3, 6, 9, 12 and 15 days after exposure, cochlear nucleus sound-evoked potentials were used to assess threshold sensitivity and frequency selectivity. Immediately after removal from the pure tone a threshold shift of 60 dB relative to age-matched controls was measured. The sharpness of tuning curves, as measured by Q10 dB, decreased by over 50%. By post-exposure day 15, near complete recovery of function was seen, with the greatest recovery occurring within the first three days. We relate these results to recent reports of structural recovery on the basilar papilla of the chick.

Regeneration after tall hair cell damage following severe acoustic trauma in adult pigeons: correlation between cochlear morphology, compound action potential responses and single fiber properties in single animals.

The time course of recovery of compound action potential (CAP) thresholds was observed in individual adult pigeons after severe acoustic trauma. Pigeons were overstimulated with a tone of 0.7 kHz and 136-142 dB SPL presented to one ear for 1 h under general anesthesia. Recovery of CAP audiograms was monitored at regular intervals after trauma. A new semi-stereotaxic approach to the peripheral part of the auditory nerve was developed. This permitted activity from single auditory nerve fibers to be recorded over a wide range of characteristic frequencies (CFs), including high CFs, without having to open the inner ear. Single unit recordings were made after three weeks and after 4 or more months of recovery. The time course of recovery, the single unit properties, and the morphological status of the basilar papilla were correlated. The CAP was abolished in all animals after overstimulation. Three groups of animals were identified according to the functional recovery of the CAP thresholds recorded at regular intervals with implanted electrodes: Group 1: Fast functional recovery starting immediately after trauma, followed by recovery to pre-exposure values within 3 weeks. Group 2: Slow functional recovery of threshold starting 1-2 weeks after trauma and ending 4-5 weeks after trauma. A mean residual hearing loss of 26.3 dB at 2 kHz remained. Group 3: No recovery of CAP thresholds up to 8 months after trauma. Three weeks after trauma, very few responsive neurons were found in groups 2 and 3. Tuning curves were very broad and sometimes irregular in shape. Thresholds were very high, around 120 dB SPL. Spontaneous firing rate was much reduced, especially in neurons with high CFs. After 4 or more months of recovery, the response properties of single units in group 1 had only partially recovered. Thresholds and sharpness of tuning of many single units were normal: however, in general they were still poorer than in control animals. Spontaneous firing rate was comparable to control animals. Neurons from animals in group 2 showed less recovery, especially at frequencies above the exposure frequency. Thresholds and sharpness of tuning were normal at frequencies below the exposure frequency, but were much poorer at frequencies above the exposure. Spontaneous firing rate was much reduced in fibers with high CFs. The basilar papilla in animals without recovery showed total loss of the sensory epithelium. The basal lamina of the basilar membrane, however, remained intact and was covered with cuboidal cells. In fast recovering animals, the papilla was repopulated with hair cells after 4 months. In slow recovering animals, short (abneural) hair cells were still missing over large parts of the papilla after 4 months of recovery. Residual short (abneural) hair cell loss was largest at two areas, one more basal and the other more apical to the characteristic place of the traumatizing frequency. The results show that functional recovery from severe damage to both short (abneural) and tall (neural) hair cells occurs in adult birds. However, the onset of recovery is delayed and the time course is slower than after destruction of short (abneural) hair cells alone. Furthermore recovery is incomplete, both functionally and morphologically. There are residual permanent hearing losses and regeneration of short (abneural) hair cells is incomplete.

Secretion of a new basal layer of tectorial membrane following gentamicin-induced hair cell loss.

Scanning electron microscopy (SEM) and video-enhanced DIC light microscopy were used to assess morphological changes in the chick tectorial membrane (TM) following gentamicin-induced hair cell loss. Gentamicin was administered (100 mg/kg/day for 3 days) and isolated and in-situ TMs were examined in both fixed and unfixed preparations at days 5 and 10 after the initial injection. Although this protocol induced hair cell damage extending up to 75% of the length of the basilar papilla, there was no apparent damage to the TM itself. However, the ejection of damaged hair cells appeared to sever the filamentous attachments between the TM and the apical surface of the basilar papilla. In SEM preparations this detachment caused the TM to shrink back toward the superior edge. Interestingly, despite the lack of TM damage, gentamicin treatment did reveal the secretion of a new basal layer of TM. Secretion of this new basal layer had begun by day 5 and it was well organized by day 10. This new layer formed attachments to both the recovering basilar papilla and the overlying original TM, a step thought to be necessary for the restoration of auditory function in the regenerating cochlea.

Avian cochlear hair cell regeneration: stereological analyses of damage and recovery from a single high dose of gentamicin.

Hair cell regeneration after acoustic trauma has been conclusively documented in birds. Previous studies of aminoglycoside ototoxicity have typically used 5-10 day courses of drug to damage the cochlea and trigger regeneration. This long-term lesion prevented analysis of the early events of regeneration. We set out to determine how much damage would occur and how recovery would proceed after a single high-dose injection of the aminoglycoside gentamicin. White Leghorn chicks were given a single high dose of gentamicin (100 mg/kg). Three post-injection survival groups with age-matched controls were studied: short-term (3-5 days), intermediate-term (2 weeks) and long-term (5 weeks). After sacrifice, cochleae were dissected and processed for scanning electron microscopy. Using stereological techniques, a quantitative analysis of cochlear hair cell counts along the proximal 50% of the cochlea was performed from scanning electron micrographs on 4-7 chicks from each group. Variable degrees of damage were seen 3-5 days after the drug injection. All hair cells were lost from the proximal 20% of the cochlea in all chicks. This complete hair cell loss could extend to 50% of the cochlea. Immature appearing hair cells could be first identified by their immature stereocilia at 3 days. Immature appearing hair cells were present in greatest number in regions which had been denuded of native hair cells and in regions where partial loss occurred. Interestingly, immature appearing hair cells also occasionally appeared in adjacent areas in which there was no apparent loss of native hair cells. Two-week survivors showed an elevation in hair cell number compared to controls in regions which had sustained damage and immediately adjacent regions. This elevation implies that an overproduction of hair cells might occur as part of the regeneration response. By 5 weeks after damage hair cell numbers approximated controls.

Potential role of bFGF and retinoic acid in the regeneration of chicken cochlear hair cells.

Messenger RNAs (mRNA) of several growth factor receptors and relate genes were examined with reverse transcriptase polymerase chain reaction (RT-PCR) in normal and noise-damaged chicken basilar papillae (BP). Analysis of the amplification products indicated the presence of mRNAs for epidermal growth factor receptor (EGFR), fibroblast factor receptor (FGFR), insulin-like growth factor receptor (IGFR), insulin receptor (IR), retinoic acid receptor beta (RAR beta), retinoic acid receptor gamma (RXR gamma), and basic fibroblast growth factor (BFGF) in both normal and noise-damaged BP. The RT-PCR products generated were characterized by size and sequencing analysis to confirm the identities of the target molecules. The subcellular localization of the mature protein analogs for EGFR, FGFR, IGFR, RAR beta, and BFGF were identified using fluorescence immunocytochemistry and confocal laser scanning microscopy. These experiments indicated that EGFR is present in the stereociliary bundles in the hair cells, IGFR is not present in the cells of the BP, BFGF localizes in the nuclei of supporting cells in the BP, but not hair cells or hyaline cells, and that RAR beta localizes in the perinuclear regions of hair cells. The subcellular distributions of these proteins were consistent in both noise-damaged and control BP. FGFR, in contrast, changed its distribution in the tissue after noise damage. In normal BP, FGFR is concentrated in the stereocilia of hair cells. However, in damaged regions of noise-exposed chick cochleae, FGFR is heavily expressed in the expanded apical regions of the supporting cells. These findings suggest that BFGF and retinoic acid may potentially play a role in the mechanisms which regulate the regeneration of chicken cochlear hair cells.

Sound damage and gentamicin treatment produce different patterns of damage to the efferent innervation of the chick cochlea.

Both sound exposure and gentamicin treatment cause damage to sensory hair cells in the peripheral chick auditory organ, the basilar papilla. This induces a regeneration response which replaces hair cells and restores auditory function. Since functional recovery requires the re-establishment of connections between regenerated hair cells and the central nervous system, we have investigated the effects of sound damage and gentamicin treatment on the neuronal elements within the cochlea. Whole-mount preparations of basilar papillae were labeled with phalloidin to label the actin cytoskeleton and antibodies to neurofilaments, choline acetyltransferase, and synapsin to label neurons; and examined by confocal laser scanning microscopy. When chicks are treated with gentamicin or exposed to acoustic overstimulation, the transverse nerve fibers show no changes from normal cochleae assayed in parallel. Efferent nerve terminals, however, disappear from areas depleted of hair cells following acoustic trauma. In contrast, efferent nerve endings are still present in the areas of hair cell loss following gentamicin treatment, although their morphological appearance is greatly altered. These differences in the response of efferent nerve terminals to sound exposure versus gentamicin treatment may account, at least in part, for the discrepancies reported in the time of recovery of auditory function.

The Nucleus Contour electrode array: a radiological and histological study.

OBJECTIVES: To evaluate the handling and insertion trauma of the recently developed Nucleus perimodiolar Contour electrode array (Cochlear Ltd., Pty, Lane Cove, New South Wales, Australia) in human temporal bones compared with the Nucleus standard straight electrode array. STUDY DESIGN: E-perimental control group. METHODS: Twenty-nine fresh-frozen bones were implanted with different electrode arrays by an experienced cochlear implant surgeon, and evaluated both radiologically and histologically. RESULTS: Intracochlear insertion of the standard Nucleus straight electrode array was found to be atraumatic, confirming previous findings in the literature. Insertion of the Nucleus Contour electrode array resulted in instances of localized basilar membrane penetration causing the electrode array to move from the scala tympani into the scala vestibuli. However, this trauma did not result in any observable damage to the osseous spiral lamina or the modiolus. Basilar membrane penetration was observed in six of eight cochlear bones when a standard cochleostomy size (approximately 0.8 mm) and site (anterior and superior to the round window) were used. However, when the surgical technique was modified to use a slightly larger cochleostomy ( approximately 1.8 mm) situated closer to the round window and employ a partial stylet withdrawal technique during electrode insertion, the frequency of penetrations was restricted to two of seven bones. This trauma rate is comparable to that observed with other cochlear implants designs. CONCLUSIONS: Following our results, the design of the Nucleus Contour electrode appears to fulfill the safety requirements for an intracochlear electrode array, provided that the surgical insertion technique is modified in the manner outlined.

Comparative study of cochlear damage with three perimodiolar electrode designs.

OBJECTIVE: To describe intracochlear insertion trauma caused by three perimodiolar cochlear implant electrodes. STUDY DESIGN: Descriptive histological study of 15 human cadaver temporal bones. METHODS: Fifteen cadaver temporal bones underwent surface preparation and were implanted with one of the following perimodiolar electrode arrays: Combi 40+PM (MedEl Corporation), HiFocus II (Advanced Bionics Corporation), or Contour (Cochlear Corporation). A cryosectioning technique was used to study horizontal sections at 200 microm intervals with the electrode in place. Image-enhanced videofluoroscopy and computer-assisted morphometrics were used to assess the mechanism of insertion trauma and to determine electrode position within the modiolus. RESULTS: Histological examination revealed varying degrees of damage to the spiral ligament, basilar membrane, and osseous spiral lamina. Using a novel grading system for electrode trauma, there was no statistically significant difference among the three electrodes. A literature search of histological studies of a commonly used "standard" electrode showed damage equal to or greater than that seen in the current study. CONCLUSIONS: Insertion trauma caused by periomodiolar electrodes occurs to an acceptable degree. Refinement of electrodes based on mechanisms of trauma may be able to further reduce damage.

Multichannel intracochlear electrodes: mechanism of insertion trauma.

Cochlear damage from electrode insertion, a potential cause of further neural degeneration, is a major concern in the use of intracochlear electrodes. A study was undertaken to evaluate mechanisms by which damage may occur. Fresh human temporal bone preparations were created to allow direct intracochlear observation during round window insertion of a free-fitting multichannel intracochlear electrode array. The path taken by the electrode, point of first resistance, and any resulting damage were documented. Tips of study electrodes in this preparation tended to embed in the outer wall of the scala tympani. The integrity of the basilar partition was largely maintained during insertion when this was stopped at the point of first resistance. However, insertion beyond the point of first resistance typically resulted in widespread damage to intracochlear structures.