测试人工耳蜗电极插入训练系统，以优化不同内耳解剖结构中电极阵列的位置
2026年2月6日
在这里，我们提出了一套结构化的人工耳蜗电极插入训练方案，采用一种新型模拟系统，使得在正常和畸形内耳解剖结构中进行实践。
我们想做的是模拟并训练耳蜗三维形状的印象，模型展示了这个模型，同时尽可能深入地将电极引入耳蜗，模仿自然，为此，他们将测试工具。我们不仅检测正常解剖结构，还拥有我一生中见过的所有畸形的耳蜗模型。现有的培训机会缺乏对内耳畸形的暴露。
该协议采用可互换的透明模型，实现真实、可重复且针对解剖学的插入训练。首先，设置电极插入训练系统。插入前准备电极和所需仪器。
使用制造商提供的斜角软握钳，握住电极并将电极导线置于倾斜尖端的直线段内。然后，将电极锁定在阵列塞后方。在接近耳蜗造口或圆窗前，确认电极固定稳定。
现在先对齐镊子，再推进电极。推进时保持上下插入角。引导电极朝向耳蜗的侧壁，同时避免下上角和内侧壁。
如果出现电阻，立即停止推进电极，并将电极后退几毫米。在保持侧壁轨迹并防止耳蜗外屈曲的同时，缓慢重新推进电极。对于不完全分割1型解剖，应在影像软件上识别完整的囊性耳蜗部分。
选择适合有限角度插入的电极长度。将电极沿侧壁严格以上下角插入。将插入深度限制在最大360度，并防止顶端接触重叠。
对于不完全分割型2解剖，应将正常的基底转弯与囊性顶端区分。将电极插入正常形成的基底贴痕，保持侧壁轨迹。将球推进至450度，并在进入囊性顶端前停止，以避免重叠。
对于不完全分割型3型解剖，应识别内耳道宽度。以上下角度插入电极，并沿侧壁持续引导，确认电极仍留在耳蜗内。对于公共腔，识别出一个未分割的空腔。
轻柔地预弯电极阵列，先引入弯曲段。让电极在腔内形成一个环。在防止电极进入内耳道的同时，稳定该配置。
对于耳蜗发育不全，安装前测量耳蜗长度。选择匹配的电极长度，仅推进至腔完全覆盖，且基底转弯后不会过度插入。对于前庭导管增大，应将正常的基底转弯与轻度囊性顶端区分。
将电极沿侧壁以上下角度插入，并以最高540度推进。在囊性顶端之前停止插入，避免顶端重叠。对于不同大小的正常解剖，术前测量A值。
根据耳蜗大小选择电极长度，并沿侧壁完全插入。较小耳蜗的角度附着较深，较大的耳蜗则角度附着减少。使用软握柄镊子的不同抓取技术，使得电极导线的控制可变，同时正确啮合倾斜尖端的直线部分，确保插入时的可靠控制。
上上-下排列引导电极沿外侧耳蜗壁移动，而上下-上方排列则增加内侧壁偏移的可能性。在不完全分割型1中，选择与囊性耳蜗相匹配的电极长度，实现了适当的角度覆盖。插入超过360度角深度会导致电极重叠。
在不完全分区2型中，当插入限制在已成型的耳蜗转弯处时，可以实现稳定的位置。在不完全隔墙3型中，侧壁导向插入法减少了意外进入内耳道，并支持耳蜗腔内的滞留。在常见的腔体畸形中，引入弯曲段首先促进腔内的环形构型，并促进稳定定位。
在耳蜗发育不全中，降低的耳蜗尺寸限制了可实现的插入深度，需要仔细选择电极长度。在扩大的前庭导水渠解剖结构中，限制插入深度可降低电极重叠和通道间干扰的风险。较小的耳蜗尺寸使得相同长度电极的角度覆盖面积比较大耳蜗更大。
解剖学识别和正确选择电极对于可重复且有价值的术后效果至关重要。术后分析包括评估插入精度、弹道、角度深度，并比较不同解剖结构下的技术以优化结果。未来研究可测试不同电极设计，包括多厂家系统，并将训练表现与实际手术结果相关联。
Overview
This study demonstrates an advanced electrode insertion training system using interchangeable transparent inner ear models to simulate both normal and malformed cochlear anatomy. The system enables resident surgeons to practice cochlear implant electrode placement across various anatomical variants, including incomplete partition types I-III, cochlear hypoplasia, common cavity, and enlarged vestibular aqueduct, under expert supervision. The goal is to improve surgical precision and reduce complications by providing experiential training that reflects the anatomical diversity encountered in clinical cochlear implant populations.
Key Study Components
Area of Science
- Otolaryngology
- Neurotology
- Surgical Simulation
Background
- Successful cochlear implant electrode insertion is critical for postoperative rehabilitation and device function.
- Anatomical variations in the inner ear are more prevalent in cochlear implant recipients than in the general population.
- Standard cadaveric temporal bone training often lacks exposure to congenital inner ear malformations.
- Inadequate training in malformed anatomies contributes to intraoperative complications during electrode insertion.
Purpose of Study
- To demonstrate the use of a transparent, interchangeable inner ear model training system for cochlear implant electrode insertion.
- To provide experiential recommendations for optimal electrode placement across different inner ear anatomies.
- To evaluate training effectiveness through supervised practice by resident surgeons.
Methods Used
- Use of manufacturers-provided angled soft-grip forceps to handle and stabilize the electrode array.
- Alignment of forceps with superior-inferior trajectory to guide electrode along the lateral cochlear wall.
- Advancement of electrode with resistance monitoring and slow re-advancement to prevent buckling or extracochlear deviation.
- Anatomy-specific techniques: for IP type I, limit insertion to 360 degrees; for IP type II, stop before cystic apex; for IP type III, maintain lateral wall trajectory to avoid internal auditory canal entry.
- For common cavity: prebend electrode and introduce curved segment first to form a stabilizing loop.
- For cochlear hypoplasia and enlarged vestibular aqueduct: measure cochlear dimensions and select appropriate electrode length to avoid overinsertion.
- Post-procedure analysis of insertion accuracy, trajectory, angular depth, and technique comparison across anatomies.
Main Results
- Superior-inferior electrode alignment promoted lateral wall trajectory and reduced medial wall deviation.
- In IP type I, electrode lengths matching cystic cochlea enabled appropriate angular coverage; insertion beyond 360 degrees caused apical contact overlap.
- In IP type II, stable positioning was maintained when insertion was confined to the formed basal turn.
- In IP type III, lateral wall-directed insertion prevented unintended entry into the internal auditory canal.
- In common cavity, introducing the curved electrode segment first facilitated a stable looped configuration.
- In cochlear hypoplasia, reduced dimensions limited insertion depth, requiring precise electrode length matching.
- In enlarged vestibular aqueduct, limiting insertion depth prevented overlap and interchannel interference.
- Smaller cochleae allowed greater angular coverage for electrodes of identical length compared to larger cochleae.
Conclusions
- Anatomical identification and proper electrode selection are essential for reproducible and safe electrode insertion.
- The training system allows repeatable, anatomy-specific practice that bridges the gap between standard simulation and clinical variability.
- Resident surgeons benefit from supervised exposure to both normal and malformed inner ear models, improving technical readiness.
- Future work should evaluate different electrode designs and correlate training performance with actual surgical outcomes.
Frequently Asked Questions
Executive Industry Relevance
This training system addresses a critical gap in preclinical surgical preparation by enabling repeatable, anatomy-specific practice for cochlear implant electrode insertion across normal and malformed inner ear variants. By simulating anatomical diversity encountered in clinical populations, it supports mechanistic de-risking of surgical technique and improves predictive confidence in procedural readiness. The platform enhances translational continuity from discovery-based simulation to preclinical validation, reducing biological variability in early-stage device training workflows.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of electrode-tissue interaction hypotheses across anatomically variant cochlear models.
- Operational Value: Provides standardized, reproducible platforms for evaluating insertion trajectory and depth control.
- Predictive Value: Supports functional target validation by correlating electrode placement accuracy with cochlear lumen retention and lateral wall alignment.
Screening & Assay Development
- Scientific Value: Facilitates preparation of validated biological surrogates for downstream screening of electrode designs and materials.
- Operational Value: Ensures assay standardization through interchangeable transparent models and quantitative angular depth metrics.
- Scalability: Enables platform reuse across multiple anatomical variants and electrode configurations for high-throughput evaluation.
Translational & Preclinical Research
- Scientific Value: Maintains disease relevance by modeling congenital inner ear malformations present in cochlear implant recipient populations.
- Operational Value: Supports continuity from discovery to preclinical validation by standardizing insertion technique across normal and pathologic anatomies.
- Risk Mitigation: Improves risk-adjusted advancement decisions by identifying electrode design limitations in malformed cochleae prior to in vivo testing.
Pipeline & Workflow Integration
The system integrates into the discovery continuum by supporting hypothesis testing in early discovery, assay readiness in screening, and translational validation in preclinical workflows, specifically for otologic implantable devices.
- Discovery Biology: Supports mechanistic de-risking by enabling systematic evaluation of electrode-cochlear interface behavior across anatomical variants.
- Screening: Delivers assay readiness through standardized insertion protocols, trajectory control, and repeatable angular depth measurements.
- Analytics: Generates quantitative readouts on insertion accuracy, angular depth, and wall adherence to enable cross-condition comparison.
- Translational Research: Connects to preclinical continuity by modeling human-relevant anatomical diversity observed in implant candidate populations.
- Enterprise Reuse: Functions as a reusable capability for iterative electrode design evaluation across multiple cochlear pathologies and device iterations.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in electrode design performance by reducing mechanistic ambiguity in anatomical variability.
- Operational Value: Enhances standardization, reproducibility, and scalability of surgical training and device evaluation workflows.
- Strategic Value: Improves go/no-go decisions by enabling early identification of insertion risks in malformed anatomies, reducing late-stage biological failure.
- Portfolio Impact: Supports risk-adjusted prioritization of electrode candidates based on performance across normal and variant inner ear models.
Implementation Considerations
- Requires expertise in otologic surgical simulation and cochlear implant electrode handling techniques.
- Depends on access to 3D-printed or fabricated transparent inner ear models representing normal and pathologic anatomies.
- Necessitates cross-team standardization of insertion protocols, forceps handling, and angular depth measurement between research and surgical training teams.
- Involves adaptation considerations for scaling across different electrode array designs, manufacturers, and cochlear size variants.
- Limited by the need for expert supervision to ensure correct technique transfer and prevent reinforcement of suboptimal insertion habits.
