Prolonged Insertion Time Reduces Translocation Rate of a Precurved Electrode Array in Cochlear Implantation.

HYPOTHESIS: Insertion speed during cochlear implantation determines the risk of cochlear trauma. By slowing down insertion speed tactile feedback is improved. This is highly conducive to control the course of the electrode array along the cochlear contour and prevent translocation from the scala tympani to the scala vestibuli. BACKGROUND: Limiting insertion trauma is a dedicated goal in cochlear implantation to maintain the most favorable situation for electrical stimulation of the remaining stimulable neural components of the cochlea. Surgical technique is one of the potential influencers on translocation behavior of the electrode array. METHODS: The intrascalar position of 226 patients, all implanted with a precurved electrode array, aiming a mid-scalar position, was evaluated. One group (n = 113) represented implantation with an insertion time less than 25 seconds (fast insertion) and the other group (n = 113) was implanted in 25 or more seconds (slow insertion). A logistic regression analysis studied the effect of insertion speed on insertion trauma, controlled for surgical approach, cochlear size, and angular insertion depth. Furthermore, the effect of translocation on speech performance was evaluated using a linear mixed model. RESULTS: The translocation rate within the fast and slow insertion groups were respectively 27 and 10%. A logistic regression analysis showed that the odds of dislocation increases by 2.527 times with a fast insertion, controlled for surgical approach, cochlear size, and angular insertion depth (95% CI = 1.135, 5.625). We failed to find a difference in speech recognition between patients with and without translocated electrode arrays. CONCLUSION: Slowing down insertion speed till 25 seconds or longer reduces the incidence of translocation.

High permittivity dielectric pads improve high spatial resolution magnetic resonance imaging of the inner ear at 7 T.

OBJECTIVES: The objective of this study was to evaluate the use of dielectric pads for improving high spatial resolution imaging of the inner ear at 7 T. MATERIALS AND METHODS: Two sets of dielectric pads were designed using electromagnetic simulations and implemented using a deuterated suspension of barium titanate. Their effect on transmit efficiency, contrast homogeneity, and diagnostic image quality was evaluated in vivo (N = 10). In addition, their effect on the specific absorption rate was evaluated numerically. RESULTS: Statistically significant improvements (P < 0.001) in several measures of the image quality were obtained by using dielectric pads. The dielectric pads lead to an increase in the transmit efficiency and uniformity at the location of the inner ear, which is reflected in both an increased contrast homogeneity and an increased diagnostic value. Simulations show that the dielectric pads do not increase the peak local specific absorption rate. CONCLUSIONS: Using geometrically tailored dielectric pads enables high spatial resolution magnetic resonance imaging of the human inner ear at 7 T. The high spatial resolution improves the depiction of the fine inner ear structures, showing the benefit of magnetic resonance imaging at ultrahigh fields.