A smart micro-drill for cochleostomy formation:a comparison of cochlear disturbances with manual drilling and a human trial

Background: Cochleostomy formation is a key stage of the cochlear implantation procedure. Minimizing the trauma sustained by the cochlea during this step is thought to be a critical feature in hearing preservation cochlear implantation. The aim of this paper is firstly, to assess the cochlea disturbances during manual and robotic cochleostomy formation. Secondly, to determine whether the use of a smart micro-drill is feasible during human cochlear implantation. Materials and methods: The disturbances within the cochlea during cochleostomy formation were analysed in a porcine specimen by creating a third window cochleostomy, preserving the underlying endosteal membrane, on the anterior aspect of the basal turn of the cochlea. A laser vibrometer was aimed at this third window, to assess its movement while a traditional cochleostomy was performed. Six cochleostomies were performed in total, three manually and three with a smart micro-drill. The mean and peak membrane movement was calculated for both manual and smart micro-drill arms, to represent the disturbances sustained within cochlea during cochleostomy formation. The smart micro-drill was further used to perform live human robotic cochleostomies on three adult patients who met the National Institute of Health and Clinical Excellence criteria for undergoing cochlear implantation. Results: In the porcine trial, the smart micro-drill preserved the endosteal membrane in all three cases. The velocity of movement of the endosteal membrane during manual cochleostomy is approximately 20 times higher on average and 100 times greater in peak velocity, than for robotic cochleostomy. The robot was safely utilized in theatre in all three cases and successfully created a bony cochleostomy while preserving the underlying endosteal membrane. Conclusions: Our experiments have revealed that controlling the force of drilling during cochleostomy formation and opening the endosteal membrane with a pick will minimize the trauma sustained by the cochlea by a factor of 20. Additionally, the smart micro-drill can safely perform a bony cochleostomy in humans under operative conditions and preserve the integrity of the underlying endosteal membrane. © W. S. Maney & Son Ltd 2013.

Unity in Christ or Pan-Europeanism?:Nathan Söderblom and the ecumenical peace movement in the interwar period

In the summer of 2014 the Swedish Church is celebrating the 100th anniversary of the appointment of Nathan Söderblom as archbishop of Uppsala, and thus head of the Swedish church organisation. As a Lutheran with an enormously broad-minded and broad-reaching approach to ecumenical understanding and community-building, Söderblom shot to prominence in the interwar period not only because of his ecumenical engagement, calling for an evangelical catholicity so stand side by side with the Roman catholic and Orthodox catholic traditions, but also because of his comprehensive secular engagement for peace and understanding between peoples. In the latter context he also acquired a solid reputation as a perhaps less prominent but still noteworthy figure in the history of European integration. This article investigates how, why and to what extent Söderblom’s ecumenical and secular engagements were intertwined. The first part discusses how his biographical and academic background led to such staunch ecumenical positions, while the second part focuses on the secular engagement, which was perceived by Söderblom as necessary to make progress on the ecumenical front in the practical political realities of the 1920s. The final part, comparing and contrasting Söderblom’s views with those of Count Richard von Coudenhove-Calergi and the Pan-European Union, demonstrates why Söderblom’s engagement for Europe had to be limited: unity in Christ is by definition global in nature and therefore cannot be continent-specific.