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Cochlear Implant Insertion Depth Prediction: A Temporal Bone Accuracy Study.

Lukas Anschuetz1, Stefan Weder1, Georgios Mantokoudis1

  • 1Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern.

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This study presents a method to predict cochlear implant (CI) electrode array length for accurate insertion depth. Thiel-fixed specimens showed high accuracy, while formalin-fixed specimens encountered resistance, highlighting the importance of preservation methods for CI surgery.

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Area of Science:

  • Otolaryngology
  • Biomedical Engineering
  • Surgical Technology

Background:

  • Human cochlear anatomy varies significantly between individuals.
  • Accurate prediction of cochlear implant (CI) electrode array length is crucial for surgical success.
  • Optimizing CI insertion depth can improve patient outcomes.

Purpose of the Study:

  • To develop and validate a method for predicting the necessary cochlear implant (CI) electrode array length based on desired angular insertion depth (AID).
  • To assess the accuracy of predicted electrode array lengths in relation to achieved insertion depths.
  • To compare the efficacy of different preservation methods (Thiel vs. formalin) for cochlear implant insertion studies.

Main Methods:

  • Computed tomography (CT) scans of 16 temporal bone specimens (8 Thiel-fixed, 8 formalin-fixed) were used to estimate linear insertion depth for a 540-degree AID.
  • Free-fitting electrode arrays were marked and inserted using a custom guide tube.
  • Postoperative micro-CT scans were performed to assess the achieved AIDs.

Main Results:

  • In Thiel-fixed specimens, the mean prediction error was -11 degrees, with achieved depths close to the target 540 degrees (average 529 degrees).
  • Formalin-fixed specimens showed significant insertion resistance (average 409 degrees), with a mean error of -131 degrees and electrode array bending in 50% of cases.
  • The Thiel conservation method proved highly suitable for simulating cochlear implant electrode insertion.

Conclusions:

  • The developed equation for calculating linear insertion depths aids in selecting appropriate cochlear implant electrode array lengths.
  • Thiel fixation is a superior preservation method for cadaveric studies involving cochlear implant electrode insertion.
  • An online calculator is available to assist clinicians in selecting CI electrode array lengths.