Predictive Value of Transimpedance Matrix Measurements to Detect Electrode Tip Foldover

Kay‐Rivest, Emily; McMenomey, Sean O.; Jethanamest, Daniel; Shapiro, William H.; Friedmann, David R.; Waltzman, Susan B.; Roland, J. Thomas

doi:10.1097/mao.0000000000003667

Cited by 9 publications

(15 citation statements)

References 20 publications

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“…Studies were conducted in North America-the United States [ 33 ], Europe- including the United Kingdom [ 32 ], Netherlands [ 24 , 28 ], Germany [ 26 ], Finland [ 25 ], Italy [ 30 ], Spain [ 27 ], Belgium [ 31 ], Asia Pacific-Australia [ 34 ]. One study was an international multicentre collaboration (Australia, Germany, and Spain) [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices

Ayas,

Muzaffar,

Borsetto

et al. 2024

PLoS ONE

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Background Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as Trans-Impedance Matrix (TIM) measurements may enable clinicians to identify electrode malposition and direct surgeons to correctly place the electrode array during surgery. Objectives To assess the current literature on the effectiveness of TIM measurements in identifying extracochlear electrodes and tip fold overs. Methods A scoping review of studies on TIM-based measurements were carried out using the Databases-Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Eleven full texts articles met the inclusion criteria. Only human studies pertaining to TIM as a tool used in CI were included in the review. Further, patient characteristics, electrode design, and TIM measurement outcomes were reported. Results TIM measurements were available for 550 implanted ears with the subjects age ranged between 9 months to 89 years. Abnormal TIM measurements were reported for 6.55% (36). Tip fold over was detected in 3.64% (20) of the cases, extracochlear electrodes in 1.45% (8), and 1.45% (8) were reported as buckling. Slim-modiolar electrode array designs were more common (54.71%) than pre-curved (23.34%) or lateral wall (21.95%) electrode array. Abnormal cochlear anatomy was reported for five ears (0.89%), with normal cochlear anatomy for all other patients. Conclusion TIM measurement is a promising tool for the intraoperative detection of electrode malposition. TIM measurement has a potential to replace intraoperative imaging in future. Though, TIM measurement is in its early stages of clinical utility, intuitive normative data sets coupled with standardised criteria for detection of abnormal electrode positioning would enhance its sensitivity.

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Section: Resultsmentioning

confidence: 99%

A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices

Ayas,

Muzaffar,

Borsetto

et al. 2024

PLoS ONE

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“…A recent systematic review noted a TF rate of 5.9% for the CI 532 model, suggesting a heightened risk of TF with the use of slim PM electrodes with removable external sheaths [ 23 ]. Although research on the TF rate for the CI 600 series is limited [ 28 ], electrode-related complications are expected to follow a pattern similar to that of the CI 500 series, as the CI 600 series employs the same electrodes. The results of this study indicate a TF rate of 3.5% for slim PM electrodes (such as those present in the CI 532 and CI 632), while the rate for slim LW electrodes (as in the CI 522 and CI 622) was only 0.7%.…”

Section: Discussionmentioning

confidence: 99%

Changes in Revision Cochlear Implantation and Device Failure Profiles

Song,

Oh,

Kim

et al. 2024

Clin Exp Otorhinolaryngol

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Objectives. As cochlear implantation (CI) experiences rapid innovations and its indications expand, the characteristics of revision CI (RCI) are evolving. This study investigated changes in the RCI profile and explored their clinical implications.Methods. A retrospective chart review was conducted of all CIs performed at a tertiary medical institution between October 2001 and January 2023. The rates of and reasons for RCI were evaluated in relation to the manufacturer and device model. Kaplan-Meier analysis was employed to examine cumulative and device survival curves. Cumulative and device survival rates were additionally analyzed based on age group, period of primary CI, and manufacturer. A Cox proportional hazards model was employed to evaluate the association between RCI and the device manufacturer.Results. Among 1,430 CIs, 73 (5.1%) required RCI. The predominant reason for RCI was device failure (40 of 73 RCIs [54.8%]), with an overall device failure rate of 2.8%. This was followed by flap-associated problems and migration (nine of 73 RCIs each [12.3%]). Flap retention issues emerged as a new cause in three cases (two involving the CI 632 and one involving the SYNCHRONY 2 implant), and six instances of electrode tip fold-over arose (four for the CI 600 series and two for the CI 500 series). The overall 10-year cumulative and device survival rates were 93.4% and 95.8%, respectively. After excluding models with recall issues, significant differences in cumulative (<i>P</i> =0.010) and device (<i>P</i> =0.001) survival rates were observed across manufacturers.Conclusion. While the overall CI survival rate is stable, device failure persists as the predominant reason for RCI. Moreover, the types of complications leading to revision (including issues with flap retention and electrode tip fold-over) have shifted, particularly for newer implant models. Given the clinical importance of device failure and subsequent reoperation, clinicians should remain informed about and responsive to these trends.

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“…In addition to ECochG, there are other novel technologies that show promise in identifying tip fold‐over by measuring electrophysiologic data off the SME during implantation. Transimpedance matrix (TIM) and spread of excitation (SOE) measurements have been more recently evaluated for identifying tip fold‐over 38,39 . The Hans et al, study included 100 patients with 4 tip fold‐over events and had encouraging results showing sensitivity of 100% and specificity between 97% and 98% in identifying tip fold‐over for both technologies.…”

Section: Discussionmentioning

confidence: 99%

“…Transimpedance matrix (TIM) and spread of excitation (SOE) measurements have been more recently evaluated for identifying tip fold-over. 38,39 The Hans et al, study included 100 patients with 4 tip foldover events and had encouraging results showing sensitivity of 100% and specificity between 97% and 98% in identifying tip fold-over for both technologies. One limitation is that pattern recognition criteria were more subjectively defined without explicit cutoffs to what constituted an atypical result which raises concern for underrepresented false positive cases.…”

Section: Alternative Methods Of Electrophysiologic CI Monitoringmentioning

confidence: 99%

Identifying Slim Modiolar Electrode Tip Fold‐Over With Intracochlear Electrocochleography

Varghese,

Walia,

Lefler

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo evaluate the predictive value of intracochlear electrocochleography (ECochG) for identifying tip fold‐over during cochlear implantation (CI) using the slim modiolar electrode (SME) array.Study DesignProspective cohort study.SettingTertiary referral center.MethodsFrom July 2022 to June 2023, 142 patients, including adults and children, underwent intracochlear ECochG monitoring during and after SME placement. Tone‐bursts were presented from 250 Hz to 2 kHz at 108 to 114 dB HL. A fast Fourier transform (FFT) allowed for frequency‐specific evaluation of ECochG response. ECochG patterns during insertion and postinsertion were evaluated using sensitivity and specificity analysis to predict tip fold‐over. Intraoperative plain radiographs served as a reference standard.ResultsFifteen tip fold‐over cases occurred (10.6%) with significant ECochG response (>2 µV). Sixty‐one cases without tip fold‐over occurred (43.0%) with significant ECochG response. All tip fold‐overs had both a nontonotopic postinsertion sweep and nonrobust active insertion pattern. No patients with robust insertion or tonotopic sweep patterns had tip fold‐over. Sensitivity of detecting tip fold‐over when having both nonrobust insertion and nontonotopic sweep patterns was 100% (95% confidence inteval [CI] 78.2%‐100%), specificity was 68.9% (95% CI 55.7%‐80.1%), and the overall accuracy was 72.0% (95% CI 60.5%‐81.7%).ConclusionIntracochlear ECochG monitoring during cochlear implantation with the SME can be a valuable tool for identifying properly positioned electrode arrays. In cases where ECochG patterns are nonrobust on insertion and nontonotopic for electrode sweeps, there may be a concern for tip fold‐over, and intraoperative imaging is necessary to confirm proper insertion.

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Predictive Value of Transimpedance Matrix Measurements to Detect Electrode Tip Foldover

Cited by 9 publications

References 20 publications

A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices

A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices

Changes in Revision Cochlear Implantation and Device Failure Profiles

Identifying Slim Modiolar Electrode Tip Fold‐Over With Intracochlear Electrocochleography

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