Pilot Clinical Study Using Pre-operative Simulation for Patients Undergoing Cochlear Implant
Primary Purpose
Sensori-Neural Deafness
Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Pre operative computer based cochlear implant surgical simulation
Sponsored by
About this trial
This is an interventional device feasibility trial for Sensori-Neural Deafness
Eligibility Criteria
Inclusion Criteria:
- Sensorineural Deafness
- Candidate for cochlear implantation
Exclusion Criteria:
- Inability to participate
- Not a candidate for cochlear implantation
- Age less than 18 or greater than 90
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Preoperative Cochlear Implant
Arm Description
The intervention will be the use of a surgical simulation system preoperatively by the surgeon to develop the surgical plan to optimize electrode array placement with respect to scalar location and modiolar distance.
Outcomes
Primary Outcome Measures
Change of CNC score
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Secondary Outcome Measures
AZBio scores
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
CNC scores
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
AZBio scores
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Full Information
NCT ID
NCT04588870
First Posted
September 30, 2020
Last Updated
January 16, 2023
Sponsor
Nationwide Children's Hospital
Collaborators
Ohio State University, Region Capital Denmark
1. Study Identification
Unique Protocol Identification Number
NCT04588870
Brief Title
Pilot Clinical Study Using Pre-operative Simulation for Patients Undergoing Cochlear Implant
Official Title
Pilot Clinical Study Using Pre-operative Simulation for Patients Undergoing Cochlear Implant
Study Type
Interventional
2. Study Status
Record Verification Date
January 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
February 2024 (Anticipated)
Primary Completion Date
August 2025 (Anticipated)
Study Completion Date
March 2026 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Nationwide Children's Hospital
Collaborators
Ohio State University, Region Capital Denmark
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
36 patients will be enrolled in a pilot trial. Eligible patients (receiving CI at OSU) that consent to participate into the study will be enrolled. A simulation with visualize cochlear substructures will be created for each patient, and surgeon will conduct virtual surgery with various cochlear implant electrode types and using different techniques for optimal positioning. Based on the feedback from the simulation platform, the surgeon will find the optimal CI electrode and surgical technique using the virtual simulation and a formal plan will be recorded to guide the actual surgery. Patient demographic information, medical history and pre op audiogram will be collected once enrolled. Post-op images will be used to identify the actual electrode location (scalar location (SL), modiolar distance (MD) and and angular insertion depth (AID). At 6- and 12-months post-op, word score (CNC) will be obtained as primary clinical outcomes and AZBio scores will also be obtained and evaluated as a secondary clinical outcome. All outcomes data to be collected for SA3 are considered as part of routine clinical care for patients undergoing CI at our institution. The prospective data collection plan will ensure these data will be collected timely with high quality. OSU IRB approval has been obtained for this study (OSU IRB# 2020H0080: Virtual Reality simulation for patient specific surgical rehearsal in cochlear implantation - OSU#2) pending additional amendments as needed.
Detailed Description
Hypothesis: Patients undergoing pre-operative CI simulation will have improved outcomes as measured by SL, MD and audiological outcomes.
The goal of this aim is to demonstrate clinical feasibility and to collect preliminary efficacy data for using the pre-operative simulation with active feedback for CI patients. This will be achieved by prospectively using the CI simulation system and evaluating both technical and clinical audiological outcomes.
C.4.1 Pre-operative Simulation: Prior to surgery, a simulation with visualization of cochlear microstructures will be created for each patient, and the surgeon will conduct iterative virtual surgery with active feedback to determine the optimal surgical approach and cochlear implant electrode position. Based on the feedback from the simulation platform, the surgeon will determine the optimal CI electrode and surgical technique using the virtual simulation to plan the actual surgery. Post-implant feedback will be displayed to the surgeon. Once parameters (SL, MD, AID) are optimized, a surgical plan will be recorded and used during the actual surgical procedure. A surgical plan will consist of the implant type, cochleostomy site, and insertion techniques used for optimal placement. This will be added to the patient electronic medical record to be referenced immediately prior to surgery. Additionally, the simulator will save all performances with the optimized performance being made available for review on the simulator at any time (3-dimensional playback).
C.4.2 Clinical Outcomes: Aided speech perception testing in the CI ear will be administered at 6- and 12-months post activation using monosyllabic words (CNC Word test) presented at 60 dB SPL (A-weighted) as well as sentences (AzBio) in quiet and at +10 signal-to-noise ratio. Percent correct will be calculated for each test and will serve as the primary clinical outcomes.
C.4.3 User Evaluation: Simulator evaluation (user interface, usefulness, potential usage in future, and overall satisfactory) and feedback/comments from the surgeon about the simulation platform will continued to be collected pre and post-operatively to provide insight into continued future improvement of the simulation platform.
C.4.5 Reproducibility and Rigor:
Statistical Analysis: Demographic information as well as post-op CI location parameters (SL, MD, AID), pre/post-op CNC and AzBio scores will be summarized with descriptive statistics: mean/SD, median/IQR for continuous variables and count/percentage for categorical data. Changes of the CNC /AzBio scores overtime will be analyzed using linear mixed models to account for the association of measures from the same patient at different time points, and to deal with missing data assuming missing data will occur randomly. Exploratory analysis will be conducted to (1) evaluate the association of the CI location parameters with the post-op CNC scores; (2) compare the post-op CI location parameters with the CI patients without pre-op simulations that are reported in the literature and/or those who have undergone CI insertion in this institution (historical controls at OSU).
Sample Size: For this pilot study, a sample size of 30 patients is proposed to evaluate selected feasibility issues, assess the adequacy of instrumentation, and collect preliminary efficacy data (along with historical data) for the design of a larger prospective, randomized trial. For the improvement of the clinical outcome (CNC) after CI, a sample size of 30 patients produces a one-sided 90% upper confidence limit of variance <1.5 when the sample variance of the improvement of CNC is 1.0. Up to 36 patients will be enrolled to account for potential attrition due to various unexpected reasons during the period from the enrollment to implant surgery, to 6-month follow-up.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sensori-Neural Deafness
7. Study Design
Primary Purpose
Device Feasibility
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Preoperative Cochlear Implant
Arm Type
Experimental
Arm Description
The intervention will be the use of a surgical simulation system preoperatively by the surgeon to develop the surgical plan to optimize electrode array placement with respect to scalar location and modiolar distance.
Intervention Type
Device
Intervention Name(s)
Pre operative computer based cochlear implant surgical simulation
Intervention Description
Prior to surgery, the surgeon will perform virtual cochlear implant surgery on patient specific imaging data within a computer simulation program. The surgeon will be able to iterate the procedure on the simulator until achieving the best electrode array location is achieved with respect to scalar location and modiolar distance. A written and graphical surgical plan will then be developed that the surgeon can use in the actual surgery.
Primary Outcome Measure Information:
Title
Change of CNC score
Description
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Time Frame
6 months after cochlear implantation compared to pre surgery.
Secondary Outcome Measure Information:
Title
AZBio scores
Description
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Time Frame
6 months after cochlear implantation
Title
CNC scores
Description
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Time Frame
12 months after cochlear implantation
Title
AZBio scores
Description
Aided speech perception testing in the CI ear, higher percent score (up to 100) means better hearing outcome. Range is from 0 to 100%.
Time Frame
12 months after cochlear implantation
Other Pre-specified Outcome Measures:
Title
Scalar Location
Description
location of the electrode array within the cochlear with respect to scalar
Time Frame
1 to 4 weeks after surgery (first post op imaging)
Title
Modiolar Distance
Description
electrode distance from the mid-modiolar line as an approximation of the distance to the spiral ganglion nerves.
Time Frame
1 to 4 weeks after surgery (first post op imaging)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Sensorineural Deafness
Candidate for cochlear implantation
Exclusion Criteria:
Inability to participate
Not a candidate for cochlear implantation
Age less than 18 or greater than 90
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Pilot Clinical Study Using Pre-operative Simulation for Patients Undergoing Cochlear Implant
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