Three-Dimensional Force Profile During Cochlear Implantation Depends on Individual Geometry and Insertion Trauma.

OBJECTIVES: To preserve the acoustic hearing, cochlear implantation has to be as atraumatic as possible. Therefore, understanding the impact of the cochlear geometry on insertion forces and intracochlear trauma might help to adapt and improve the electrode insertion and reduce the probability of intracochlear trauma. DESIGN: The study was conducted on 10 fresh-frozen human temporal bones. The inner ear was removed from the temporal bone. The bony capsule covering the scala vestibuli was removed and the dissected inner ear was mounted on the three-dimensional (3D) force measurement system (Agilent technologies, Nano UTM, Santa Clare, CA). A lateral wall electrode array was inserted, and the forces were recorded in three dimensions with a sensitivity of 2 µN. Afterwards, the bones were scanned using a Skyscan 1173 micro-computed tomography (micro-CT). The obtained 3D force profiles were correlated with the videos of the insertions recorded through the microscope, and the micro-CT images. RESULTS: A correlation was found between intracochlear force profiles measured in three different directions with intracochlear trauma detected with micro-CT imaging. The angle of insertion and the cochlear geometry had a significant impact on the electrode array insertion forces and possible insertion trauma. Intracochlear trauma occurred frequently within the first 180° from the round window, where buckling of the proximal part of the electrode carrier inside the cochlea, and rupturing of the spiral ligament was observed. CONCLUSIONS: The combination of the 3D force measurement system and micro-CT can be used to characterize the mechanical behavior of a CI electrode array and some forms of insertion trauma. Intracochlear trauma does not always correlate with higher force amplitudes, but rather with an abrupt change of force directions.

Feasibility of Monte Carlo simulations in quantitative tissue imaging.

PURPOSE: The feasibility of Monte Carlo simulations as a tool to facilitate quantitative image analysis is investigated by means of simulating light transport in skin phantoms. METHODS: A Monte Carlo tool is used to compare if simulated fluorescent signals show agreement with measured data. The lipophilic fluorescent probe Nile Red and dedicated skin phantoms are also used in simulations to investigate the influence of the optical properties of the skin on the signal. RESULTS: It is shown that the simulated and measured fluorescence signals show linear behavior up to a certain concentration of Nile Red. The simulations of the skin phantoms show the varying influence of single skin layers on the fluorescence signal. A calibration factor for quantitative analysis can be determined for the different skin layers. CONCLUSION: Characterizing the influence of different media on imaging signals is a primary task in developing quantitative analysis methods. Monte Carlo simulations are a useful tool to investigate imaging properties of biological specimen where quantifying signals is important. However, detailed models must be provided.

First Experience With a New Thin Lateral Wall Electrode in Human Temporal Bones.

INTRODUCTION: A modern cochlear implant electrode array design must combine: improved surgical ease of use, structure preservation, particularly important for pediatric application, stable position within the cochlea over time, and a meaningful balance between hearing preservation against addressing sufficient cochlear tissue to support electrical-only hearing. The aim of this study was to investigate a new lateral wall electrode array design from Advanced Bionics on human temporal bones (TBs). METHODS: Ten fresh-frozen TBs were implanted with the SlimJ electrode array via the round window. The electrode array is 23 mm long, with a cross-section varying from 0.25 × 0.55 mm at the most apical contact to 0.6 × 0.8 mm at the proximal marker contact. To assess location of the electrode array, the TBs were postoperatively scanned using cone beam computed tomography, and histology was performed to assess intracochlear trauma (Grades 0-4). RESULTS: All electrode arrays were considered easy to insert. The average insertion depth was 432 degrees measured from the round window with a range from 411 to 450 degrees azimuth. Nine out of 10 electrode arrays were inserted fully (<0.5 mm out of the cochlea), one electrode array was left 1.5 mm out of the cochlea. No translocations were observed in all 10 cochleae, slight touching of the basilar membrane at the distal portion of the array was observed in 50% of the cases. CONCLUSION: The results from the new thin lateral wall electrode array from Advanced Bionics provided consistent scala tympani locations. No translocations were observed and almost all electrode arrays were fully inserted. These results are promising and the new electrode array will be further studied in clinical practice investigating hearing preservation capabilities and speech performance.

Variations in microanatomy of the human cochlea.

The human cochlea shows considerable interindividual variability in size and morphology. In order to develop atraumatic cochlear implant (CI) electrodes, high-precision details of the variability of human anatomy are required. Sixteen human temporal bones were cut around the cochlea in blocks of approximately 3.5 × 3.5 cm. The bones were scanned by using a Skyscan 1173 micro-computed tomography (µCT) device. Mimics software (Materialise, Leuven, Belgium) was used to segment out the scala tympani (ST) from the µCT images. A three-dimensional surface model of the segmented area was generated for each cochlea. Cross-sectional images were taken and analyzed by custom-designed software in MATLAB. Comparison of different STs showed large variability in cross-sectional diameter (CSD), vertical trajectory, and height of the ST. Relative standard deviations of the CSD were between 9 and 15%. Heights measured at the center of the ST exceeded those in the modiolar and lateral regions of the scala. At the lateral region, the height decreased significantly at the beginning of the second turn. In the vertical trajectory, critical anatomic features were observed, such as dips, vertical jumps, and peaks. Rosenthal's canal (RC) extended to between 560 and 650°. We found a correlation between the length of the RC and that of the ST. The ST was segmented and the internal dimensions measured by using µCT. We observed large dimensional variability between different STs. These differences could have considerable implications for approaches to the design of CI arrays, especially in terms of their ability to preserve residual hearing during insertion of the electrode array.