van der Jagt Annerie M A, Briaire Jeroen J, Boehringer Stefan, Verbist Berit M, Frijns Johan H M
Department of Otorhinolaryngology.
Department of Biomedical Data Science.
Otol Neurotol. 2022 Apr 1;43(4):e427-e434. doi: 10.1097/MAO.0000000000003499.
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.
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.
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.
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.
Slowing down insertion speed till 25 seconds or longer reduces the incidence of translocation.
人工耳蜗植入过程中的插入速度决定了耳蜗创伤的风险。通过减慢插入速度，触觉反馈得以改善。这对于控制电极阵列沿耳蜗轮廓的进程并防止其从中鼓阶移位至前庭阶极为有利。
限制插入创伤是人工耳蜗植入的一个专门目标，目的是为耳蜗剩余可刺激神经成分的电刺激维持最有利的条件。手术技术是影响电极阵列移位行为的潜在因素之一。
对226例均植入预弯电极阵列且目标为中鼓阶位置的患者的鼓阶内位置进行了评估。一组（n = 113）代表插入时间少于25秒的植入（快速插入），另一组（n = 113）的植入时间为25秒或更长（慢速插入）。进行了逻辑回归分析，研究插入速度对插入创伤的影响，并对手术方式、耳蜗大小和角向插入深度进行了控制。此外，使用线性混合模型评估了移位对言语表现的影响。
快速插入组和慢速插入组的移位率分别为27%和10%。逻辑回归分析表明，在对手术方式、耳蜗大小和角向插入深度进行控制的情况下，快速插入时脱位的几率增加2.527倍（95%可信区间 = 1.135, 5.625）。我们未发现电极阵列移位的患者与未移位患者在言语识别方面存在差异。
将插入速度减慢至25秒或更长时间可降低移位的发生率。
