Cury Joaquin, Rivera Arnaldo, Schneider Rebecca, Tan Ray, Tan Xiaodong, Richter Claus-Peter
Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Department of Otolaryngology, School of Medicine, Missouri University, Columbia, MO, United States.
Front Audiol Otol. 2024;2. doi: 10.3389/fauot.2024.1376699. Epub 2024 Apr 15.
INTRODUCTION: Worldwide, thousands of patients with severe to profound hearing loss restore their hearing with cochlear implant (CI) devices. Newer developments in electrode design and manufacturing and a better understanding of cochlear mechanics allow for conserving critical structures, often translating into serviceable residual hearing and improving device performance. Monitoring insertion speed and intraluminal pressure helps mitigate some of these challenges. However, the information becomes available after irreparable damage has occurred. METHODS: We developed and tested a high-resolution optical system to navigate the intricate anatomy of the cochlea during electrode insertion. The miniaturized optical system was integrated in conventional cochlear implants electrode arrays and custom-made cochlear probes. Electrode insertion were conducted in eight cadaveric human temporal bones and video recordings were acquired. Micro-computed tomography (μCT) scans were performed to evaluate the position of the modified electrode arrays. RESULTS: Full insertions of the modified CI electrode were successfully conducted and verified by μCT scans. Video recordings of the cochlear structures visible in scala tympani were acquired, and no scala migration was detected. DISCUSSION: Surgeons can now follow the CI electrode's path during its insertion and reduce cochlear damage through early interventions and steering of the CI electrode. Our device will be compatible with robotic platforms that are already available to insert these electrodes.
引言:在全球范围内,成千上万重度至极重度听力损失患者通过人工耳蜗(CI)装置恢复了听力。电极设计与制造方面的新进展以及对耳蜗力学的更深入理解,使得关键结构得以保留,这通常转化为可用的残余听力并改善了装置性能。监测插入速度和管腔内压力有助于缓解其中一些挑战。然而,这些信息在造成无法挽回的损伤之后才会获得。 方法:我们开发并测试了一种高分辨率光学系统,以便在电极插入过程中引导通过耳蜗复杂的解剖结构。该小型化光学系统集成在传统人工耳蜗电极阵列和定制的耳蜗探针中。在八具人类尸体颞骨上进行电极插入,并采集视频记录。进行微型计算机断层扫描(μCT)以评估改良电极阵列的位置。 结果:成功完成了改良人工耳蜗电极的完全插入,并通过μCT扫描进行了验证。获取了鼓阶中可见的耳蜗结构的视频记录,未检测到鼓阶移位。 讨论:外科医生现在可以在人工耳蜗电极插入过程中跟踪其路径,并通过早期干预和人工耳蜗电极的引导减少耳蜗损伤。我们的装置将与现有的用于插入这些电极的机器人平台兼容。
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