Fadwa Alnafjan, Melville J da Cruz, Catherine M McMahon
{"title":"Characteristics of Medial and Lateral Wall Cochlear Implant Arrays Demonstrated with Cone Beam CT and Evoked Electrical Auditory Brainstem Responses.","authors":"Fadwa Alnafjan, Melville J da Cruz, Catherine M McMahon","doi":"10.1097/MAO.0000000000004431","DOIUrl":null,"url":null,"abstract":"<p><strong>Hypothesis: </strong>This study investigates how electrode array types-straight versus perimodiolar-affect cochlear implant (CI) placement (i.e., modiolar proximity and angular depth) and outcomes using cone beam computed tomography (CBCT) and evoked electrical auditory brainstem responses (eABR).</p><p><strong>Background: </strong>Cochlear implants (CIs) have revolutionized auditory rehabilitation, yet optimizing electrode placement remains crucial for improving speech perception and pitch discrimination. Array designs influence electrode proximity to neural structures, impacting neural stimulation efficacy.</p><p><strong>Methods: </strong>We analyzed 108 patients using CBCT to compare straight and perimodiolar electrode arrays (each with 22 electrodes) in terms of angular depth, spiral diameter, intracochlear positioning index (ICPI), electrode to modiolus, medial-lateral distance (EMML), and wrapping factor. A subset of 50 patients underwent eABR assessments across cochlear regions.</p><p><strong>Results: </strong>Significant differences were found between array types. Straight arrays showed less variability with consistent lateral placement compared to perimodiolar arrays. Measurements revealed differences: wrapping factor (M = 0.692 vs. 0.826; t(11) = 8.104, p = 0.000), angular depth (M = 351.2° vs. 437°; t(11)=4.527, p = 0.000), spiral diameter (M = 3.24 mm vs. 5.027 mm; t(11)=11.1, p = 0.000), and modified ICPI (M = 0.628 vs. 0.783; t(11)=9.742, p = 0.000). eABR results showed larger average amplitudes with straight arrays in basal and mid regions (p < 0.05), suggesting potentially enhanced neural stimulation and a more focused stimulation with perimodiolar arrays.</p><p><strong>Conclusion: </strong>Our findings underscore the importance of electrode array type in CI outcomes, emphasizing the need for precise positioning to optimize neural stimulation and clinical outcomes. Personalized array selection based on CBCT assessments may lead to improved speech perception, pitch discrimination, and overall auditory function. Future research should aim to refine stimulation strategies to maximize CI benefits, particularly where direct measurements strongly correlate with clinical outcomes compared to derived measurements.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"364-371"},"PeriodicalIF":1.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otology & Neurotology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MAO.0000000000004431","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/20 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Hypothesis: This study investigates how electrode array types-straight versus perimodiolar-affect cochlear implant (CI) placement (i.e., modiolar proximity and angular depth) and outcomes using cone beam computed tomography (CBCT) and evoked electrical auditory brainstem responses (eABR).
Background: Cochlear implants (CIs) have revolutionized auditory rehabilitation, yet optimizing electrode placement remains crucial for improving speech perception and pitch discrimination. Array designs influence electrode proximity to neural structures, impacting neural stimulation efficacy.
Methods: We analyzed 108 patients using CBCT to compare straight and perimodiolar electrode arrays (each with 22 electrodes) in terms of angular depth, spiral diameter, intracochlear positioning index (ICPI), electrode to modiolus, medial-lateral distance (EMML), and wrapping factor. A subset of 50 patients underwent eABR assessments across cochlear regions.
Results: Significant differences were found between array types. Straight arrays showed less variability with consistent lateral placement compared to perimodiolar arrays. Measurements revealed differences: wrapping factor (M = 0.692 vs. 0.826; t(11) = 8.104, p = 0.000), angular depth (M = 351.2° vs. 437°; t(11)=4.527, p = 0.000), spiral diameter (M = 3.24 mm vs. 5.027 mm; t(11)=11.1, p = 0.000), and modified ICPI (M = 0.628 vs. 0.783; t(11)=9.742, p = 0.000). eABR results showed larger average amplitudes with straight arrays in basal and mid regions (p < 0.05), suggesting potentially enhanced neural stimulation and a more focused stimulation with perimodiolar arrays.
Conclusion: Our findings underscore the importance of electrode array type in CI outcomes, emphasizing the need for precise positioning to optimize neural stimulation and clinical outcomes. Personalized array selection based on CBCT assessments may lead to improved speech perception, pitch discrimination, and overall auditory function. Future research should aim to refine stimulation strategies to maximize CI benefits, particularly where direct measurements strongly correlate with clinical outcomes compared to derived measurements.
假设：本研究利用锥形束计算机断层扫描（CBCT）和诱发听觉脑干电反应（eABR）研究电极阵列类型-直型和周型-如何影响人工耳蜗植入（CI）的放置（即模孔接近度和角深度）和结果。背景：人工耳蜗（CIs）已经彻底改变了听觉康复，但优化电极放置仍然是提高语音感知和音高辨别的关键。阵列设计会影响电极与神经结构的接近程度，从而影响神经刺激的效果。方法：我们对108例患者进行CBCT分析，比较直齿和磨牙周围电极阵列（各有22个电极）的角深度、螺旋直径、耳蜗内定位指数（ICPI）、电极到磨牙的距离、中外侧距离（EMML）和包裹因子。50例患者接受了耳蜗各区域的eABR评估。结果：数组类型之间存在显著差异。与磨牙周围排列相比，直线排列在一致的侧位上表现出较少的可变性。测量结果显示差异：包裹因子(M = 0.692 vs. 0.826；t(11) = 8.104, p = 0.000)，角深度(M = 351.2°vs. 437°；t(11)=4.527, p = 0.000)，螺旋直径(M = 3.24 mm vs. 5.027 mm；t(11)=11.1, p = 0.000)，修正ICPI (M = 0.628 vs. 0.783；T (11)=9.742, p = 0.000)。eABR结果显示，基底区和中央区直线阵列的平均振幅更大（p < 0.05），提示磨牙周围阵列的神经刺激可能增强，刺激更集中。结论：我们的研究结果强调了电极阵列类型在CI结果中的重要性，强调了精确定位以优化神经刺激和临床结果的必要性。基于CBCT评估的个性化阵列选择可能会改善语音感知、音高辨别和整体听觉功能。未来的研究应致力于完善刺激策略，以最大限度地提高CI效益，特别是与衍生测量相比，直接测量与临床结果密切相关。
期刊介绍：
Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.
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