Objective: To investigate the effect of insertion technique and electrode array type on the insertion force of electrode array, and to provide a basis for further optimizing electrode design and facilitating mini-invasive electrode insertion. Methods: Three types of electrode array from Nurotron (Standard Electrode, Slim-medium Electrode, Slim-long Electrode) were studied. from July 2019 to December 2019. These electrode arrays were inserted into the phantom models of the cochlea, manually or robot-assisted(medium speed and low speed). The real-time force during electrode array insertion was recorded by ATI Nano 17 Ti sensors and was analyzed by accessory software. Origin 2020b software was used for statistical processing. Results: The insertion force of all electrode arrays progressively increased with the insertion depth. With the manual technique, the peak force of slim-medium electrode insertion was significantly smaller than that of the standard electrode insertion((71.0±16.6) mN vs (140.9±52.7) mN, Z=3.683, P<0.01), and the peak force of the slim-long electrode insertion was between the peak force of standard electrode and slim-medium electrode(P>0.05). No difference was found in the force variation of insertion among the three electrodes(P>0.05). With medium-speed and low-speed robotic assistance, the peak force characteristics of three electrodes were similar to those with the manual technique, but the force variation of standard electrode insertion ((83.9±9.7) mN/s) at medium speed was significantly larger than that of the slim-long electrode insertion ((69.2±4.0)mN/s), and the force variation of the standard electrode insertion at low speed was significantly greater than the other two electrodes. For the same electrode, robot-assisted insertion presented significantly lower peak force and force variation than manual insertion for each type of electrode array. But there was no difference in the peak force and force variation between two-speed levels of robot assistance (P>0.05). Conclusions: The insertion force of the electrode array will be lower when a slim electrode array or robot technique is applied. Long electrode array might make manual insertion difficult or less precise. Robot assistance has advantage on force control during electrode array insertion.
Cochlea/surgery* ; Cochlear Implantation ; Cochlear Implants ; Electrodes, Implanted ; Humans ; Robotics

OBJECTIVETo develop a new method for REZ-1 cochlear implant electrode array insertion.

METHODSREZ-1 cochlear implant electrode array was implanted in 22 human temporal bone specimens. Cochlear diameters were measured from spiral CT scan before implantation. Cochlear views were taken before and after pullback technique. Modiolus-electrode distances were measured and compared. The diameters of sixty normal cochleae were measured.

RESULTSIn 3 cases, 27 electrode rings were inserted into the cochlea, while in others, all 28 electrode rings were inserted into the cochlea. After pullback of the electrode array, No. 12 to No. 19 electrode rings were closer to the modiolus in 17 cases (paired t test, P<0.01). The cochlear diameters in the 17 cases were smaller than 9.50 mm, while in the other 5 cases, the cochlear diameters were at least 9.60 mm. The cochlear diameters in the 17 cases were 9.11 (0.57) mm, while the cochlear diameters in the 5 cases were 9.78 (0.28) mm (Mann-Whitney test, P<0.001). The diameters of normal cochleae were (9.04 +/- 0.45) mm, with 90% larger than 9.50 mm.

CONCLUSIONSIn cases whose cochlear diameter is smaller than 9.50 mm, pullback technique can help some electrode rings be closer to the modiolus. Measurement of the cochlear diameter can help the surgeon to have a better choice in the selection of REZ-1 cochlear implantation methods.

Cochlear implantation has gradually been accepted as an effective treatment for many patients with severe to pround sensorineural hearing loss. The traditional cochlear implantation does not exist up to expectations in some respects. With the soft surgery technique brought forward, the idea of minimally invasive cochlear implantation is deely rooted among the people. Now many institutions are carring out a series of clinical researches and practices to improve the results of cochlear implantation surgery and reduce the complications around the world. It includes minimally invasive approach, cochleostomy and electrode insertion techniques, especially the latter two affect the preservation of residual hearing. This article is a review of the advances in minimally invasive cochlear implantation from the above three aspects.
Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Hearing ; Humans ; Minimally Invasive Surgical Procedures ; methods

OBJECTIVE: To study the effect of binaural bi-modal fitting (one cochlear implant and a contralateral hearing aid) on speech recognition of cochlear implant recipients with low frequency electrodes incompletely implanted. METHOD: A total of 15 cochlear implant(CI) users who have low residual hearing (250 Hz 45-90 dBHL, 500 Hz 75 - 100 dBHL) of their non surgery ears. We closed the top three electrodes to simulate the state of low-frequency electrodes incompletely implanted by fitting software. (1) The same tester received twice speech recognition tests in incompletely implanted state, one test used single CI model and the other used binaural bi-modal fitting model. (2)The same tester received above twice speech recognition tests again, but in completely implanted state. Then we compared the results of tests. RESULT: The CI users used binaural bi-modal fitting have higher speech recognition score than the same users used unilateral cochlear implant model in low-frequency electrodes incompletely implanted state(P<0. 05). The gap between the scores of the tests by using two usage patterns in low frequency electrodes incompletely implanted state was more than that in completely implanted state (P<0. 05). CONCLUSION Binaural bi-modal fitting can help CI users to improve their speech recognition ability in low-frequency electrodes incompletely implanted state.
Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Hearing ; Hearing Aids ; Hearing Tests ; Humans ; Speech ; Speech Perception

Electrode array misplacement is a rare complication of cochlear implant. This article reports an 11-year-old boy who was mistakenly implanted the cochlear electrode array into the superior semicircular canal during the initial cochlear implant. After the diagnosis was confirmed, he underwent a second cochlear implant and the electrode array were successfully implanted into the cochlea. This article conducted a systematic review of the literature on electrode array misplacement, and the causes of electrode array misplacement were analyzed from different implantation position.
Male ; Humans ; Child ; Electrodes, Implanted ; Reoperation ; Cochlea ; Cochlear Implantation ; Cochlear Implants/adverse effects* ; Semicircular Canals/surgery*

Treatments of choice for cardiac implantable electronic device (CIED) infections are the removal of the entire CIED system, control of infection, and new device implantation. Occasionally, a complete CIED removal can not be performed for several reasons, such as very old age, severe comobidity, limited life expectancy, or refusal by a patient. We encountered a male patient who developed traumatic CIED infection five years after cardioverter-defibrillator implantation. An intravenous electrode could not be removed by a simple transvenous extraction procedure, and he refused surgical removal of the remnant electrode. After control of local infection, the tips of the electrode were separated and buried between muscles, and the wound was closed with a local flap. CIED infection did not recur for 12 months even without relying on long-term antimicrobial treatment.
Defibrillators, Implantable ; Disulfiram ; Electrodes ; Electrodes, Implanted ; Electronics ; Electrons ; Humans ; Life Expectancy ; Male ; Muscles

OBJECTIVE: The aim of this study was to evaluate the clinical features of cochlear reimplantation. To review our experience of cochlear reimplant surgery. METHOD: Retrospective analysis of all 25 cochlear reimplant surgeries between 2002 and 2012. Causes of revision operations, number of electrode channels inserted, surgical findings and postoperative speech performances were analyzed. RESULT: Causes of reimplantation were eight hard failures; eight poor implanted electrodes position, four poor outcome, three skin flap infection lead to implant device exposure, one postoperative symptoms of facial nerve stimulation, one postoperative temporal bone lesions. All cochlear reimplantations were successfully performed in our hospital, audiologic performances were stable or improved following reimplantation in most of cases. CONCLUSION Cochlear implant surgeons should have a good knowledge of how to diagnose cochlear implant failures and how to deal with medical complications related to cochlear implantation. Medical and audiologic outcomes are generally excellent. Cochlear reimplantation appears to be a safe and effective.
Cochlea ; Cochlear Implantation ; Cochlear Implants ; Electrodes ; Electrodes, Implanted ; Facial Nerve ; Humans ; Postoperative Period ; Reoperation ; Retrospective Studies ; Speech ; Speech Perception ; Surgical Flaps ; Temporal Bone

This paper discusses virtual channels of cochlear implant, which is produced by simultaneous or sequential activation of adjacent cochlear implant electrodes. Virtual channels create and transfer more available spectral pitch information with the limited number of fixed electrodes, which can be recognized as pitch percepts intermediate to those produced by each electrode separately. This technique not only utilizes the interaction of electrodes but also increases the number of place-pitch steps available to cochlear implant listeners. Virtual channels could be used to realize speech recognition in noisy environment, in enjoying music, and in understanding Chinese language. The study of virtual channels would significantly enhance the traditional cochlear implant therapy and benefit people suffering severe to profound hearing loss.
Cochlear Implants ; trends ; Computer Simulation ; Electric Stimulation ; instrumentation ; methods ; Electrodes, Implanted ; Evoked Potentials, Auditory ; physiology ; Hearing Loss, Sensorineural ; therapy ; Humans

OBJECTIVE: To evaluate the position and shape of inserted electrode arrays by plain X-ray during cochlear implantation. METHOD: Cochlear view of implanted electrode arrays by plain X-ray were observed during operation in 54 patients received cochlear implant. RESULT: The image in cochlear view could provide the information about position and shape of inserted electrode arrays. The spiral-shape electrode arrays without distortion and folding were found in 52 cases. The complete insertion of intracochlear electrode in these patients were confirmed by surgery. Of 54 cases, the other 2 cases showed improper position and C-shape of intracochlear electrodes, one was partial insertion and the other was bending inside the cochlea. The bending electrode array was reinserted immediately during operation. CONCLUSION Routine plain X-ray after inserted electrode during operation was a best way of knowing the shape and depth of the electrode array, especial for the difficult cochlear implantation, and also could avoided anesthetization again.
Adolescent ; Child ; Child, Preschool ; Cochlea ; diagnostic imaging ; Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Female ; Humans ; Infant ; Male ; Radiography ; X-Rays ; Young Adult

OBJECTIVE: To evaluate the instructional effect of Multi-slice (MSCT) in the cochlear implantation pre- and post-operatively, and to contrast the image feature between the X-ray and the MSCT three-dimensional reconstruction of inner ear with implanted electrode. METHOD: Twenty-four cochlear implant (MEDEL Combi 40+) recipients,in No. 1 Hospital of China Medical University from January to October 2014, were involved in this study. Among them, 18 were male and 6 female,with an average age of 4 years. MSCT and three dimensional reconstruction of inner ear were performed in all of the 24 implanted inner ears pre- and post-operatively. And X-ray plain film were examined by using 60° lateral oblique position postoperatively. All data of the spiral CT scan with axial 1 mm image slices were transferred to workstation for three-dimensional reconstruction (direct volume rendering) of the inner ear. RESULT: In 1 of the 24 cases, preoperative three-dimensional reconstruction CT scan reveal that the length of the cochlear was shorter than the electrode. And this was confirmed by MSCT postoperatively that the electrode couldn't be inserted by full length. The insertion depth of the electrode can be evaluated directly by MSCT. Moreover, each of the electrode pairs can be identified clearly. CONCLUSION MSCT plays an indispensable role in the preoperative evaluation of cochlear implantation. Postoperative evaluation by three-dimensional reconstruction of inner ear provide more accurate image to show the electrode insertion depth in the cochlea. MSCT combined with curved planar reformation to measure cochlear length could provide guidance in choosing the more adaptive electrode. And MSCT is superior to DR in demonstration of electrode postoperatively.
Child, Preschool ; China ; Cochlea ; anatomy & histology ; Cochlear Implantation ; methods ; Cochlear Implants ; Electrodes, Implanted ; Female ; Humans ; Male ; Postoperative Period ; Preoperative Care ; Tomography, Spiral Computed ; Tomography, X-Ray Computed