Creation of a Prototype Cochlear Training Model.

OBJECTIVE: Creation of a novel 3D-printed physical cochlear model that demonstrated the feasibility of creating the model, and impact of a Graphical User Interface (GUI) system on training insertion metrics. STUDY DESIGN: Feasibility study with a pilot prospective data collection. SETTING: Tertiary academic center. METHODS: The study was IRB exempt. Five resident trainees (PGY1-PGY5) practiced electrode insertions in cadaveric temporal bones before using the simulator. Nine students were educated on how to hold the electrodes and position them, and then allowed to use the simulator. All trainees were instructed that slower insertions were favorable. One cochlear implant (CI) surgeon used the simulator. The GUI captured the real video feed, but also provided distance, trajectory, and velocity measurements. The program is designed to plot the real-time depth of insertion and speed of insertion of the electrode; the user is also provided real-time occurrence of any kinks and back-outs. RESULTS: A total of 14 trainees and 1 CI surgeon inserted the electrode at least 5 times without the use of the GUI (before) and then at least 5 times with the use of the GUI (after). Average Speed before and after (100.84 and 53.23 mm/s); Average minimum speed before and after (59.34 and 9.65 mm/s); and Average maximum speed before and after (416 and 285.81 mm/s). Statistically significant improvements were noted in all the measured speeds of insertion (P < .001). The other variables improved but not to a statistical significance. CONCLUSIONS: Real-time training using the 3D-printed model and GUI for cochlear implantation can help improve surgical resident training and comfort levels with electrode insertion for surgical trainees. The advantage of this model is that surgeons/trainees can use it as many times as they like, as the whole set-up is easy, economical, and reusable. The real time graphical user interface enhances training and retention of the practiced skills.

[Online training for hearing implant surgery : A new approach to otological training. German version]. / Online-Training für Hörimplantatchirurgie : Ein neuer Ansatz in der otologischen Ausbildung.

OBJECTIVE: Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is a need to broaden education facilities in an on-line format. Therefore, a first basic on-line training for otosurgery was developed. MATERIALS AND METHODS: The system consists of an artificial temporal bone model together with a set of basic surgical instruments and implant dummies. As an essential part of the training kit, a high-resolution camera set is included that allows for connection to a video streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, a pre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. RESULTS: Over the three courses held to date, 28 participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of a questionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. CONCLUSION: The presented program of an otosurgical online training allows for basal education in practical exercises on a remote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.

Qualitative assessment of YouTube videos as a source of patient information for cochlear implant surgery.

BACKGROUND: YouTube is increasingly used as a source of healthcare information. This study evaluated the quality of videos on YouTube about cochlear implants. METHODS: YouTube was searched using the phrase 'cochlear implant'. The first 60 results were screened by two independent reviewers. A modified Discern tool was used to evaluate the quality of each video. RESULTS: Forty-seven videos were analysed. The mean overall Discern score was 2.0 out of 5.0. Videos scored higher for describing positive elements such as the benefits of a cochlear implant (mean score of 3.4) and scored lower for negative elements such as the risks of cochlear implant surgery (mean score of 1.3). CONCLUSION: The quality of information regarding cochlear implant surgery on YouTube is highly variable. These results demonstrated a bias towards the positive attributes of cochlear implants, with little mention of the risks or uncertainty involved. Although videos may be useful as supplementary information, critical elements required to make an informed decision are lacking. This is of particular importance when patients are considering surgery.

Implicit learning of non-verbal regularities by deaf children with cochlear implants: An investigation with a dynamic temporal prediction task.

Some deaf children continue to show difficulties in spoken language learning after cochlear implantation. Part of this variability has been attributed to poor implicit learning skills. However, the involvement of other processes (e.g. verbal rehearsal) has been underestimated in studies that show implicit learning deficits in the deaf population. In this study, we investigated the relationship between auditory deprivation and implicit learning of temporal regularities with a novel task specifically designed to limit the load on working memory, the amount of information processing, and the visual-motor integration skills required. Seventeen deaf children with cochlear implants and eighteen typically hearing children aged 5 to 11 years participated. Our results revealed comparable implicit learning skills between the two groups, suggesting that implicit learning might be resilient to a lack of early auditory stimulation. No significant correlation was found between implicit learning and language tasks. However, deaf children's performance suggests some weaknesses in inhibitory control.

Patient-specific Virtual Temporal Bone Simulation Based on Clinical Cone-beam Computed Tomography.

OBJECTIVES: Patient-specific surgical simulation allows presurgical planning through three-dimensional (3D) visualization and virtual rehearsal. Virtual reality simulation for otologic surgery can be based on high-resolution cone-beam computed tomography (CBCT). This study aimed to evaluate clinicians' experience with patient-specific simulation of mastoid surgery. METHODS: Prospective, multi-institutional study. Preoperative temporal bone CBCT scans of patients undergoing cochlear implantation (CI) were retrospectively obtained. Automated processing and segmentation routines were used. Otologic surgeons performed a complete mastoidectomy with facial recess approach on the patient-specific virtual cases in the institution's temporal bone simulator. Participants completed surveys regarding the perceived accuracy and utility of the simulation. RESULTS: Twenty-two clinical CBCTs were obtained. Four attending otologic surgeons and 5 otolaryngology trainees enrolled in the study. The mean number of simulations completed by each participant was 16.5 (range 3-22). "Overall experience" and "usefulness for presurgical planning" were rated as "good," "very good," or "excellent" in 84.6% and 71.6% of the simulations, respectively. In 10.7% of simulations, the surgeon reported to have gained a significantly greater understanding of the patient's anatomy compared to standard imaging. Participants were able to better appreciate subtle anatomic findings after using the simulator for 60.4% of cases. Variable CBCT acquisition quality was the most reported limitation. CONCLUSION: Patient-specific simulation using preoperative CBCT is feasible and may provide valuable insights prior to otologic surgery. Establishing a CBCT acquisition protocol that allows for consistent segmentation will be essential for reliable surgical simulation. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1855-1862, 2021.

A tecnologia a favor da educação continuada no implante coclear / Technology in favor of continuous professional development in cochlear implant

RESUMO Objetivo avaliar a teleconsulta de forma síncrona no mapeamento do implante coclear (IC) como ferramenta de educação continuada para fonoaudiólogos em capacitação e treinamento. Métodos estudo prospectivo longitudinal, na modalidade de preceptorado clínico, com teleconsulta de forma síncrona direcionada ao atendimento de mapeamento dos usuários de IC. A educação continuada foi oferecida aos fonoaudiólogos aprimorandos em um hospital e o fonoaudiólogo tutor, em unidade remota. A plataforma utilizada permitiu ao tutor visualizar e realizar intervenções na tela de mapeamento do IC. Foram aplicados três questionários abrangendo os marcadores de ensino; qualidade e importância da teleconsulta; interação entre os profissionais e autoavaliação sobre a confiança na realização das etapas do mapeamento antes e após as teleconsultas. Resultados participaram sete fonoaudiólogos e foram analisados 268 atendimentos, ao longo de três anos. Os marcadores clínicos mostraram, na média e individualmente, que houve correlação estatística com diminuição do número de intervenções totais, nas intervenções do mapeamento do IC e raciocínio clínico, no decorrer das sessões. A média das notas nas avaliações da importância da teleconsulta foi 9,7 e a interação com o tutor, 9,3. Na autoavaliação, todos os aprimorandos responderam que estavam "nada/pouco confiantes" para as etapas do mapeamento antes da intervenção e, ao final do curso, responderam "moderadamente/muito confiantes" para as mesmas etapas. Conclusão o uso da teleconsulta síncrona foi viável e eficiente como ferramenta de ensino para fonoaudiólogos. Foi possível observar a diminuição do número de intervenções ao longo do tempo, evidenciando a curva de aprendizado.

ABSTRACT Purpose To evaluate the teleconsultation synchronously in the mapping of the cochlear implant (CI) as an ongoing professional development tool in training programmes for audiologists. Methods It was a prospective longitudinal study, in the form of clinical preceptor with teleconsultation in a synchronous way directed at assisting the mapping of CI users. Distance learning was offered to fellow audiologists in a hospital and the audiology tutor in the remote unit. The chosen platform allowed the tutor to view and perform interventions on the CI mapping screen. Three questionnaires covering teaching markers were applied; the quality and importance of teleconsultation; interaction between professionals; and self-assessment of confidence in carrying out the mapping steps before and after teleconsultations. Results Seven audiologists participated; 268 consultations were analyzed over three years. The clinical markers showed, on average and individually, that there is a statistical correlation with a decrease in the number of total interventions, in the interventions of CI mapping and clinical reasoning throughout the sessions. The average of the scores of the importance of teleconsultation was 9.7 and the interaction with the tutor was 9.3. In the self-assessment, all audiologists responded that they were "not at all/not very confident" for the mapping steps before the intervention, and at the end of the course they responded "moderately/very confident" for the same steps. Conclusion The use of synchronous teleconsultation was feasible and efficient as a teaching tool for audiologists. It was possible to observe the decrease in the number of interventions over time, evidencing the learning curve.

Supporting skill acquisition in cochlear implant surgery through virtual reality simulation.

OBJECTIVES: To evaluate the effectiveness of a virtual reality (VR) temporal bone simulator in training cochlear implant surgery. METHODS: We compared the performance of 12 otolaryngology registrars conducting simulated cochlear implant surgery before (pre-test) and after (post-tests) receiving training on a VR temporal bone surgery simulator with automated performance feedback. The post-test tasks were two temporal bones, one that was a mirror image of the temporal bone used as a pre-test and the other, a novel temporal bone. Participant performances were assessed by an otologist with a validated cochlear implant competency assessment tool. Structural damage was derived from an automatically generated simulator metric and compared between time points. RESULTS: Wilcoxon signed-rank test showed that there was a significant improvement with a large effect size in the total performance scores between the pre-test (PT) and both the first and second post-tests (PT1, PT2) (PT-PT1: P = 0.007, r = 0.78, PT-PT2: P = 0.005, r = 0.82). CONCLUSION: The results of the study indicate that VR simulation with automated guidance can effectively be used to train surgeons in training complex temporal bone surgeries such as cochlear implantation.

Effects of anatomical variation on trainee performance in a virtual reality temporal bone surgery simulator.

OBJECTIVE: To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery. METHODS: Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups. RESULTS: On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05). CONCLUSION: Training on temporal bones with differing anatomies is beneficial in the development of expertise.

Cochlear Dummy Electrodes for Insertion Training and Research Purposes: Fabrication, Mechanical Characterization, and Experimental Validation.

To develop skills sufficient for hearing preservation cochlear implant surgery, surgeons need to perform several electrode insertion trials in ex vivo temporal bones, thereby consuming relatively expensive electrode carriers. The objectives of this study were to evaluate the insertion characteristics of cochlear electrodes in a plastic scala tympani model and to fabricate radio opaque polymer filament dummy electrodes of equivalent mechanical properties. In addition, this study should aid the design and development of new cochlear electrodes. Automated insertion force measurement is a new technique to reproducibly analyze and evaluate the insertion dynamics and mechanical characteristics of an electrode. Mechanical properties of MED-EL's FLEX(28), FLEX(24), and FLEX(20) electrodes were assessed with the help of an automated insertion tool. Statistical analysis of the overall mechanical behavior of the electrodes and factors influencing the insertion force are discussed. Radio opaque dummy electrodes of comparable characteristics were fabricated based on insertion force measurements. The platinum-iridium wires were replaced by polymer filament to provide sufficient stiffness to the electrodes and to eradicate the metallic artifacts in X-ray and computed tomography (CT) images. These low-cost dummy electrodes are cheap alternatives for surgical training and for in vitro, ex vivo, and in vivo research purposes.

Influence of trainee participation on operative times for adult and pediatric cochlear implantation.

Objective Few studies have examined operative times for cochlear implantation (CI) using multivariable linear regression analyses to identify predictors of case length. Herein, we assess whether trainee participation, among other factors, influences operating room (OR) times. Methods We retrospectively reviewed total OR and procedural times for isolated unilateral implants over a 5-year period (2009-2013) in children and adults. Total operating and procedural times were compared. Multivariable linear regression analyses were used to identify predictors of procedural time. Results We identified a total of 455 unilateral CI procedures (n = 35 pediatric, n = 420 adult). Mean total OR time was 193.6 minutes (SD = 58.9 minutes) and mean procedural time was 147.1 minutes (SD = 56.2). The presence of trainees was associated with a significant difference in procedure time: 149.9 minutes (SD = 54.9) with trainees versus 136.6 minutes (SD = 59.9) without trainees, P = 0.0375. Trainee involvement did not significantly increase total OR time: 196.3 minutes (SD = 56.9) with trainees versus 183.8 minutes (SD = 65.0) without trainees, P = 0.0653. Surgeon identity was also associated with differences in procedural time (P < 0.001). Patient age, gender, American Society of Anesthesiologists classification, and pediatric designation had no significant impact on length of case. Conclusions Major predictors of longer procedural OR times for CI are surgeon identity and trainee participation. Few published data exist on length of CI in an academic setting using multivariable linear regression analyses. Our data may be instructive for comparative analyses and have implications for operative planning and surgical education.

[Investigate of the learning curve of cochlear implantation].

OBJECTIVE: To investigate the learning curve of cochlear implantation and its guiding significance for clinical surgery. METHODS: A retrospective analysis of the clinical data of two otologists in early cochlear implant surgeries, including 98 cases of Dr. A and 54 cases of Dr. B.Statistics of the two doctors incidence of complications and operating time. Operation time as index were drawing a, b two groups of cases of scatter plot, the oscillating sine curve model Y = sin(X)-P/2 and logarithmic curve model Y = b1ln(X)+b0 curve fit were analyzed. Then, extract the early 90 cases of surgery by Dr. A which was divided into a, b, c three groups with 30 cases a group. The operating time and complications were further compared and analyzed(SPSS 16.0). RESULTS: From the operation sequence,A and B physicians, early operation cases cost more operating time, and more complications.Learning curve before and after about 30 cases appeared inflection point, showing a rapid decline in period (learning phase) and slow decline period (consolidation phase) in two stages.Group contrast to Dr. A's early 90 consecutive cases, the operating time of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.68), the complication rate of Phase b and Phase c decreased significantly than Phase a (P(a-b) < 0.01, P(a-c) < 0.01), while there was no significant difference between group Phase b and Phase c (P(b-c) = 0.15). CONCLUSIONS: Our department of cochlear implantation followed the learning curve rule. The minimum number of cases that should accumulate in the learning phase needs about 30 cases.

An artificial temporal bone as a training tool for cochlear implantation.

OBJECTIVE: Description and evaluation of a newly developed artificial temporal bone (TB) model suitable for surgical training for cochlear implantation. SUBJECT: Based on micro-computed tomographic images, a TB model was designed with material properties as similar to bone as possible. The bony anatomic details were rebuilt as closely as possible with preservation of the endocochlear lumen. INTERVENTION: The TB model was compared with a human cadaveric TB by 8 otologists experienced in cochlear implantation. MAIN OUTCOME MEASURE: The otologists were asked to respond to a semiquantitative questionnaire with scales from 1 (strongly disagree) to 5 (strongly agree). Anatomic details were compared macroscopically and microscopically. The surgical steps of mastoidectomy, posterior tympanotomy, cochleostomy, and insertion of a cochlear electrode were assessed. RESULTS: The material properties and anatomic details of the TB model were generally comparable to the human TB. One exception was the round window membrane, which was not modeled appropriately. The surgical steps, including the insertion of the electrode, were rated as comparable. CONCLUSION: The TB model is suitable for surgical training for interventions such as cochlear implantation. It cannot replace cadaveric human temporal bones completely, but it provides an easily available alternative to train and develop surgical skills. A wider variety of anatomic models, such as an infant's TB or malformations, will increase the value of TB models.

Practices in habilitation of pediatric recipients of cochlear implants in India: A survey.

INTRODUCTION: Cochlear implant (CI) (re)habilitation programs are long-term processes, with many factors contributing to the overall success. The clinics in India that are working toward pediatric CI habilitation vary in their team philosophy, clinical practices, and service delivery. It is important to explore their clinical perspectives and practices to appreciate their current state and suggest directions for improvement in the future. OBJECTIVE: The objective of the study was to characterize the current status and clinical practices of the pediatric CI programs in India. METHODS: Twenty-two clinics involved in the pediatric CI habilitation program across India participated in the survey. The heads of the CI teams of the participant clinics completed a validated survey questionnaire containing multiple-choice and open-ended questions on the details of the CI habilitation team, assessment and therapy protocols used, and other related clinical services. The categorical data obtained were analyzed using descriptive statistical measures. RESULTS AND DISCUSSION: The interpretation of results indicated a need to focus future discussions on early identification and management of hearing impairment, funding for CIs, continuing education programs for professionals, decision processes for providing CIs for children with multiple concerns, choice of language(s) of instruction, assessment protocols used, and outreach/consultation services.

Parents of deaf children with cochlear implants: a study of technology and community.

The cochlear implant (CI) is increasingly used to treat deafness, despite arguments from the deaf community. Deaf children born to hearing parents are the fastest growing group of CI recipients, making parents the primary consumers. Instead of focusing on the controversy over implants, this article examines the clinical structures shaping parental decision-making and how parents integrate clinical practices into family and community. Observations and in-depth interviews were conducted in a CI clinic and at various community sites. The data reveal strong inter-institutional co-operations between the clinic, the state and local school districts. Working together, these institutions anticipate parental needs, foster a CI community and thus increase compliance. I conclude that implantation is an ongoing practice enculturating parents into a new community characterised by the adoption of long-term rehabilitative duties. However, the long-term nature of rehabilitation creates disparities in outcomes, which would be better understood through further research on the social relations in families and across parent networks in the CI community.

[An anatomic facsimile model with origin inner ear structures for temporal bone preparations]. / Die Realisierung von anatomischen Felsenbeinfaksimilemodellen mit cochleären Hohlraumstrukturen.

BACKGROUND: Microsurgical dissection exercises are essential in otosurgery training. Human temporal bone specimens are rarely available for necessary extensive preparation steps up to the cochlea. This requires the development of new Anatomical Facsimile Models (AFM) of the temporal bone with its diffizil internal structures. MATERIAL AND METHODS: The construction of AFM was realized by rapid prototyping technologies. Data for processing come from high resolution CT-scans. RESULTS: With the production of AFM true to the original structures of the temporal bone by rapid prototyping methods it was possible to reproduce the very small cavity structures of the inner ear (cochlea, semicircular canals). All cavity structures of the temporal bone, including the middle ear, are constructed without solid support material. This allows the introduction of Cochlea-Implant electrodes into the cochlea. CONCLUSION: The use of modern rapid prototyping technologies enables us to produce any number of identical models of an original specimen. The preparation steps and the material properties correspond to those of the original temporal bone. Therefore AFM are excellent preparation models.

Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children?

OBJECTIVES: The Würzburg bilateral cochlear implant (CI) program was started with the aim to improve the patients' communicative abilities in complex listening situations. In this study, the auditory skills of children using bilateral cochlear implants were evaluated. STUDY DESIGN AND SETTINGS: Qualitative data based on free observations in the rehabilitation setup were collected in 39 bilaterally implanted children. A speech discrimination in noise test was performed in 18 of these children; lists of bisyllabic words were presented in noise at a signal to noise ratio (SNR) of +15 dB. RESULTS: Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. CONCLUSIONS: To be able to obtain optimal benefit from bilateral cochlear implants, an intensive rehabilitation program is necessary. The important aspects of such a program are creating realistic expectations in older children before implantation; performing the first processor fitting of the second side with the first side switched on; and separate intensive training with the new system in order to balance out the hearing competence of the second CI with that of the first.