Cochlear implant-related three-dimensional characteristics

determined by micro-computed tomography reconstruction

Yusu Ni, MD, PeiDong Dai, PhD, Chunfu Dai, MD, PhD, and Huawei Li,
MD, PhD, Shanghai, China

Author Information

From the Otology and Skull Base Surgery Department (Drs. Ni, Chunfu Dai and
Li); the Central Laboratory, Eye and ENT Hospital of Shanghai Medical School (Dr.
Peidong Dai); and the Institutes of Biomedical Sciences; Fudan University (Dr. Li).
Drs. Yusu Ni and Peidong Dai contributed equally to this work.
Corresponding author: Yusu Ni, MD and Huawei Li, PhD, MD, Eye and ENT
Hospital of Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai
200031, China.
E-mail: niyusu@aliyun.com

This article has been accepted for publication and undergone full peer review but has not been
through the copyediting, typesetting, pagination and proofreading process which may lead to
differences between this version and the Version of Record. Please cite this article as an
‘Accepted Article’, doi: 10.1002/ca.22770

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 Cochlear implant-related three-dimensional characteristics

determined by micro-computed tomography reconstruction

Objective: To explore the structural characteristics of the cochlea in

three-dimensional (3D) detail using 3D micro-computed tomography (mCT) image
reconstruction of the osseous labyrinth, with the aim of improving the structural
design of electrodes, the selection of stimulation sites, and the effectiveness of
cochlear implantation.
Study Design, Setting, Subjects and Methods: Three temporal bones were selected
from among adult donors’ temporal bone specimens. A micro-CT apparatus (GE
eXplore) was used to scan three specimens with a voxel resolution of 45 µm. We
obtained about 460 slices/specimen, which produced abundant data. The osseous
labyrinth images of three specimens were reconstructed from mCT. The cochlea and
its spiral characteristics were measured precisely using Able Software 3D-DOCTOR.
Results: 3D images of the osseous labyrinth, including the cochlea, vestibule, and
semicircular canals, were reconstructed. The 3D models of the cochlea showed the
spatial relationships and surface structural characteristics. Quantitative data
concerning the cochlea and its spiral structural characteristics were analyzed with
regard to cochlear implantation.
Conclusion: 3D reconstruction of mCT images clearly displayed the detailed spiral
structural characteristics of the osseous labyrinth. Quantitative data regarding the
cochlea and its spiral structural characteristics could help to improve electrode
structural design, signal processing and the effectiveness of cochlear implantation.

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INTRODUCTION

Cochlear implants (CIs) are established as successful auditory rehabilitation

devices for patients with severe to profound hearing impairment (Adunka, 2004;
Balkany, 2006; Barkdull, 2007; Briggs, 2005; Klenzner, 1999). Many patients have
some residual usable hearing and their hearing losses are not profound. Encouraged
by the promising results of CIs, we conjectured that it must be possible to make
cochlear implant surgery more effective by improving electrode structural design and
signal processing and by selecting the electrode stimulation sites.
Because the human cochlea is embedded in temporal bone, it is impossible to
view and measure this sophisticated organ directly. In a previous study, we
demonstrated the utility of computed tomography (CT) for studying critical
relationships in temporal bone anatomy. The results of that study highlighted an
important point: current CT resolution is adequate for studying gross structures in
temporal bone (Yusu, 2008) but not for detailing the sophisticated structures of the
cochlea (Whiting, 2008). Recent studies (Shibata, 1996; Vogel, 1999) have confirmed
that micro-computed tomography (mCT) is an effective alternative for obtaining
images of temporal bone. It addresses the resolution and slice-thickness limitations of
conventional CT images. Thus, it is a noninvasive method for visualizing bony
structures.
In this study, we explored the detailed three-dimensional structural
characteristics of the cochlea with the aim of improving the effectiveness of cochlear
implantation.

STUDY DESIGN, SETTING, SUBJECTS AND METHODS

Materials
Three temporal bones were selected from adult donor specimens. We cut the

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temporal bone tissue including the full middle and inner ear, mastoid, and external
auditory canal, retaining the internal auditory canal and the eighth cranial nerve.
Micro-CT (GE eXplore, London, UK, provided by the Public Health Clinical Center,
Fudan University) with MicroView2.2 (GE) was used to obtain and process the
images.
This study was performed in accordance with protocols approved by the
Institutional Research Review Board at our Hospital.

Micro-CT Image Data

A micro-CT apparatus (GE eXplore) was used to scan three specimens with a
voxel resolution of 45 µm. We obtained about 460 slices/specimen, which produced
abundant data.

Reconstruction and Measurement

All micro-CT images were imported into 3D-DOCTOR software in the scanning
order (Able Software, Lexington, MA, USA) and were used in the modeling. The
structural boundary was segmented by both manual and automated interactive
divisions (Fig. 1).
The software can automatically set calibration parameters for series CT image
data. After image segmentation is complete, the computer automatically finishes the
reconstruction and eventually generates 3D models of the cochlea. Simple rendering
of the structure can display the spatial relationship and surface structural
characteristics fully (Fig. 2). We measured and quantified the 3D structural
characteristics of the cochlea with the aim of improving the effectiveness of cochlear
implantation (Figs. 3, 4). Fig. 3 shows the 3D models of the cochlea and the virtual
electrodes of the cochlear implants. The green structures are the osseous labyrinth
including the cochlea, vestibule, and semicircular canals. The pink structure is the
round window. The dashed line in the osseous labyrinth is the virtual electrode of a
cochlear implant. The red lines (in B, C, D) are the electrodes entering from the
anteroinferior quadrant of the cochlea. The pink lines (in C, D) are the electrodes

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entering from the round window membrane. The yellow structure is the site of the
cochleostomy (in D).

RESULTS

The 3D models of the cochlea showed its spatial relationships and surface
structural characteristics (Fig. 5). The spatial picture revealed 3D details of the
complicated structures of the cochlea. We then measured and quantified those
structures.
Beginning at the round window membrane, the length of the cochlear basal turn
was 19.84±0.26 mm. The length of the cochlear basal turn plus the second turn was
29.19±0.30 mm. The length of the cochlear basal turn plus the second turn plus the
top turn — that is, the total length of the cochlea — was 31.56±0.21 mm.
The site of the cochleostomy is critical for preserving residual hearing. The
cochleostomy was placed in the anteroinferior quadrant of a box formed by drawing
one line at the superior margin of the round window and another line crossing it
perpendicularly at the inferior aspect of the round window. The cochleostomy is thus
begun in the inferior portion of the quadrant. From this position, we can go straight
into the basal turn of the scala tympani and avoid the osseous spiral lamina when
entering the scala tympani (Fig. 5). The distance from the round window membrane to
the site of the cochleostomy is shown in Fig. 5; it was 1.74±0.15 mm (Figs. 4, 5).

DISCUSSION
Numerous researchers (Gfeller, 2006; Gfeller, 2007; Gstoettner, 2006; Lenarz, 2009;
Roland, 2008; Skarzynski, 2007; Turner, 2004) have spent time and energy on
cochlear implant technology to improve and preserve residual hearing. They have
made great progress.
In 1952, Békésy (Békésy, 1952) successfully measured the frequency and
transformation of sound waves traveling in the cochlear partitions. Because of his
studies, selected patients with residual hearing as well as completely deaf patients are

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suitable for cochlear implantation with modified electrodes.
In 2003, Gantz and Turner (Gantz, 2003) reported on severe high-frequency
impairment in adults. These patients were given implants with 6- or 10-mm hybrid
electrodes, following which their acoustic hearing was preserved. Their preoperative
monosyllabic word and sentence scores were unchanged after implantation.
Subsequently, the same group conducted a larger, multicenter clinical trial. They
studied patients who had enrolled in a trial of the Hybrid S12 10-mm electrode and
showed that hearing was maintained in 91% of patients at three months to five years
after implantation (Gantz, 2006; Gantz, 2009).
With the rapid developments in modern medicine, the design and function of
cochlear implant electrodes have also been improved. We believe that in the near
future an electrode will be produced that corresponds to the full length of the cochlear
spiral. It will be able to stimulate the cochlea at different frequencies according to
requirements to afford individuals better hearing function. Also, according to the
precise frequencies of hearing loss, cochlear implant electrodes could be designed at
various lengths (e.g., an electrode specifically designed to be located at the basal
cochlear turn for high-frequency hearing loss).
The mCT reconstruction described here provided a 3D anatomical model of the
human cochlea. Such a reliable model can form the basis for further exploration of the
3D structural characteristics of the cochlea with the aims of improving electrode
structural design and signal processing, selecting the electrode stimulation sites, and
improving the effectiveness of cochlear implant surgery.
In this study, we took account of the different frequencies in the cochlear
partitions in order to measure the relative lengths of the cochlear turns. Our results
could help in improving the design and function of cochlear implant electrodes. For
example, if one selects cochlear implants starting at the round window membrane and
entering the scala tympani to treat only high-frequency (>4000 Hz) profound hearing
loss the electrode length could be 9.32±0.27 mm, whereas to treat only
high-frequency (>2000 Hz) profound hearing loss the electrode length could be
15.59±0.22 mm. For high-frequency (>2000 Hz) and middle-frequency (500–2000 Hz)

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profound hearing loss, the electrode length could be 26.27±0.72 mm. Finally, for
almost no hearing at any frequency, the electrode length could be 31.56±0.21 mm. If
the cochleostomy is performed from the anteroinferior quadrant of the round window
and entering the scala tympani, the electrode length could be 1.74±0.15 mm shorter
than if it were performed from the round window membrane and entering the scala
tympani.
A limitation of this study was that because of the small scope of our work we
could not arrive at a definitive conclusion. Further study is needed to confirm our
findings. However, our study could guide us and others to explore improvements in
the design of cochlear implant electrodes.

CONCLUSION
3D reconstruction of mCT images clearly displayed the detailed spiral structure
characteristics of the osseous labyrinth. Quantitative data regarding the cochlea and its
spiral structural characteristics could help to improve the electrode structural design,
signal processing, and the effectiveness of cochlear implantation.

FINANCIAL DISCLOSURE
This study was supported by the Research Special Fund for Welfare Industry of
Health (No. 201202001).

ACKNOWLEDGMENT
We express our gratitude to those who donated their bodies and their families.

LEGENDS ：

Figure 1 Micro-CT images. a Basal turn of the cochlea. b Second turn of the cochlea.
c Top turn of the cochlea. d Scala tympani.

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Figure 2 3D models of the cochlea. A The green structures are the osseous labyrinth,
including the cochlea, vestibule, and semicircular canals. The pink structure is the
round window. B The osseous labyrinth (including the cochlea, vestibule, and
semicircular canals) is shown in this hyalinization and meshing model.

Figure 3 3D models of the cochlea and the virtual electrode of cochlear implants. The
dashed line in the osseous labyrinth is the virtual electrode of a cochlear implant. The
red lines (in B, C, D) are the electrodes entering from the anteroinferior quadrant of
the cochlea. The pink lines (in C, D) are the electrodes entering from the round
window membrane. The yellow structure is the site of the cochleostomy (in D).

Figure 4 Distance from the round window membrane to the site of the cochleostomy
(yellow line in B).

Figure 5 3D models of the cochlea show the spatial relationships and surface
structural characteristics. A a–k, and m within the cochlea, correspond to the different
frequency-related sites: 20,000, 7000, 5000, 4000, 3000, 2000, 1500, 1000, 800, 600,
400, and 200 Hz, respectively.

Figure 6 The relative length of electrode needed for cochlear implants according to
the frequencies in the cochlear partitions.

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Page 11 of 16 Clinical Anatomy

Micro-CT images. a Basal turn of the cochlea. b Second turn of the cochlea. c Top turn of the cochlea. d
Scala tympani.

467x392mm (72 x 72 DPI)

John Wiley and Sons, Inc.

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 Clinical Anatomy Page 12 of 16

3D models of the cochlea. A Green structures are the osseous labyrinth, including the cochlea, vestibule,
and semicircular canals. The pink structure is the round window. B Osseous labyrinth (including the cochlea,
vestibule, and semicircular canals) is shown in this hyalinization and meshing model.

279x105mm (96 x 96 DPI)

John Wiley and Sons, Inc.

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Page 13 of 16 Clinical Anatomy

3D models of the cochlea and the virtual electrode of cochlear implants. Dashed line in the osseous labyrinth
is the virtual electrode of a cochlear implant. Red lines (in B, C, D) are the electrodes entering from the
anteroinferior quadrant of the cochlea. Pink lines (in C, D) are the electrodes entering from the round
window membrane. Yellow structure is the site of the cochleostomy (in D).

248x165mm (96 x 96 DPI)

John Wiley and Sons, Inc.

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 Clinical Anatomy Page 14 of 16

Distance from the round window membrane to the site of the cochleostomy (yellow line in B).

295x111mm (96 x 96 DPI)

John Wiley and Sons, Inc.

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Page 15 of 16 Clinical Anatomy

3D models of the cochlea show the spatial relations and surface structural characteristics. A a–k, and m
within the cochlea correspond to the different frequency-related sites: 20 000, 7000, 5000, 4000, 3000,
2000, 1500, 1000, 800, 600, 400, and 200 Hz, respectively.

249x82mm (96 x 96 DPI)

John Wiley and Sons, Inc.

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 Clinical Anatomy Page 16 of 16

The relative length of the electrode needed for the cochlear implants according to the frequencies in the
cochlear partitions.

210x112mm (150 x 150 DPI)

John Wiley and Sons, Inc.

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