Measurement and Mitigation of Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion.
Measurement and Mitigation of Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion.
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DOI：
10.1097/mao.0000000000003401
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发表时间：
2022-02-01
影响因子：
2.1
通讯作者：
Greene, Nathaniel T.
中科院分区：
文献类型：
--
作者：
Hartl, Renee M. Banakis;Greene, Nathaniel T.
关键词：
与人工耳蜗植入相关的颅内高压瞬变可通过较小的无针阵列和较长的插入持续时间来降低。随着人工耳蜗植入手术中听力保护的日益关注，无创技术至关重要。先前的研究表明，在植入电极插入过程中可能会产生高强度压力瞬变。由此产生的声损伤可能是术后残余听力丧失的一个促成因素。在尸体标本的30耳手术准备放置颅内压力传感器。使用7种随机排列的电极类型，在10、30或60秒内连续插入植入物。在常见的插入后电极操作和移除过程中也测量了压力。使用ANOVA和Pearson相关性比较电极类型和特征之间的测量。植入物插入和插入后操作对所有受试电极产生高强度压力瞬变，某些测量值超过170 dB峰值SPL。直型无探针电极的平均峰值压力显著较低（p<<0.001）。最慢的插入产生瞬变的可能性最低（p<<0.001）。耳蜗植入体插入可产生相当于高强度脉冲声刺激的耳蜗内压力水平瞬变，已知会导致听力损失。尽管在所有条件下均观察到瞬变，但可通过使用无针电极和缓慢插入速度来缓解暴露。额外的手术操作也可能产生类似的高压事件。这项调查的结果表明，使用非styleted电极，缓慢但稳定的插入速度，并避免插入后的操作是重要的，以减少耳蜗创伤。
High intracochlear pressure transients associated with cochlear implant placement are reduced with smaller, non-styleted arrays and longer insertion durations. With increasing focus on hearing preservation during cochlear implant surgery, atraumatic technique is of the utmost importance. Previous studies revealed that high intensity pressure transients can be generated during the insertion of implant electrodes. Resulting acoustic trauma may be one contributing factor to postoperative loss of residual hearing. Thirty ears in cadaveric specimens were surgically prepared with placement of intracochlear pressure sensors. Sequential implant insertions were made over 10, 30, or 60 seconds using seven randomly ordered electrode styles. Pressures were also measured during common post-insertion electrode manipulations and removal. Measurements were compared between electrode styles and characteristics using ANOVA and Pearson correlation. Implant insertion and post-insertion manipulations produced high-intensity pressure transients with all electrodes tested, with some measurements exceeding 170 dB peak SPL. Average peak pressures were significantly lower for straight, non-stylet electrodes (p<<0.001). The likelihood of generating transients was lowest with the slowest insertions (p<<0.001). Cochlear implant insertion can generate transients in intralabyrinthine pressure levels equivalent to high intensity, impulsive acoustic stimuli known to cause hearing loss. Although transients were observed in all conditions, exposure may be mitigated by using non-styleted electrodes and slow insertion speeds. Additional surgical manipulations can also produce similar high-pressure events. Results from this investigation suggest that use of non-styleted electrodes, slow but steady insertion speeds, and avoidance of post-insertional manipulations are important to reduce cochlear trauma.