Review of Electrode Placement with the Slim Modiolar Electrode: Identification and Management

Dimák, Balázs; Nagy, Roland; Perényi, Ádám; Jarabin, János András; Schulcz, Rebeka; Csanády, Miklós; Jóri, József; Rovó, László; Kiss, J.

doi:10.18071/isz.73.0053

Cited by 8 publications

(8 citation statements)

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“…Postoperative X-ray is considered the gold standard to check the position of the electrode array, as TF can be detected easily with this imaging modality. Whereas TF classically displays normal intraoperative telemetry measurements (14,16), transimpedance matrix (TIM) can reliably detect TF as found in recent studies (17). Suboptimal placement of the array in the form of TF or kinking, although not ideal, may be successfully managed with deactivation of affected electrodes during mapping if needed (18,19).…”

mentioning

confidence: 96%

Misplaced Cochlear Implant Electrodes Outside the Cochlea: A Literature Review and Presentation of Radiological and Electrophysiological Findings

Cheung

Kong

Chu

et al. 2022

Otology &Amp; Neurotology

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Hypothesis:It is possible to detect when misplacement and malposition of the cochlear implant (CI) electrode array has occurred intraoperatively through different investigations. We aim to explore the literature surrounding cochlear implant misplacements and share our personal experience with such cases to formulate a quick-reference guide that may be able to help cochlear implant teams detect misplacements early.Background:Misplacement and malposition of a cochlear implant array can lead to poor hearing outcomes. Where misplacements go undetected during the primary surgery, patients may undergo further surgery to replace the implant array into the correct intracochlear position.Methods:Systematic literature review on cochlear implant misplacements and malpositions and a retrospective review of our program's cases in over 6,000 CI procedures.Results:Twenty-nine cases of CI misplacements are reported in the English literature. Sixteen cases of cochlear implant misplacements are reported from our institution with a rate of 0.28%. A further 12 cases of intracochlear malpositions are presented. The electrophysiological (CI electrically evoked auditory brainstem response, transimpedance matrix) and radiological (X-ray and computed tomography scan) findings from our experience are displayed in a tabulated quick-reference guide to show the possible characteristics of misplaced and malpositioned cochlear implant electrode arrays.Conclusion:Both intraoperative electrophysiological and radiological tests can show when the array has been misplaced or if there is an intracochlear malposition, to prompt timely intra-operative reinsertion to yield better outcomes for patients.

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confidence: 96%

Misplaced Cochlear Implant Electrodes Outside the Cochlea: A Literature Review and Presentation of Radiological and Electrophysiological Findings

Cheung

Kong

Chu

et al. 2022

Otology &Amp; Neurotology

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“…The spiral ganglion cells are directly stimulated by electrical signals that are transmitted via an electrode array that is surgically inserted into the cochlea. This can lead to buckling, interscalar dislocation or tip-fold over [2][3][4][5] . Another possible hazard is short circuiting and implant loss.…”

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confidence: 99%

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

Horváth¹,

Perényi²,

Molnár³

et al. 2021

Ideggyogy Sz

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Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

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“…Ugyanakkor na gyon kevés publikáció írja le az elektródasor nem megfe lelő helyzetének előfordulási gyakoriságát, pontosabban a csúcs visszatekeredését (tip foldover). A visszatekere dést számos tényező alakíthatja: 1) kicsi az elektróda keresztmetszeti átmérője, így elegendő hely van a scala tympaniban való betekeredéshez az oldalfal vagy a basalis membrán megsértése nélkül; 2) preoperatív képalkotók segítségével nem regisztrált rendellenesség kerülhet az elektródasor útjába a behelyezéskor, mely visszafordít hatja az előre görbített, flexibilis típusú elektródasort [13][14][15].…”

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Az elektródasor visszatekeredésének kimutatása transzimpedanciamátrix (TIM)-vizsgálattal cochlearis implantátumban

Nagy

Perényi

Dimák

et al. 2021

Self Cite

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Összefoglaló. Bevezetés: Az elmúlt években a cochlearis implantátum a súlyos halláskárosodás vagy a teljes siketség rutinszerű és hatékony kezelési eszközévé vált. Korunk egyik leggyakrabban használt és leghatékonyabb újítása a cochlearis implantációban a perimodiolaris vékony elektródasorok alkalmazása. A cochlea középtengelyét, a modiolust szorosan ölelő atraumatikus elektródasor igen meggyőző eredménnyel bizonyítja népszerűségét, mind az elektrofiziológiai mérések során, mind az akusztikus hallás megőrzése terén nyújtott teljesítményével. Ugyanakkor igen kevés publikáció írja le az elektródasor nem megfelelő helyzetének előfordulási gyakoriságát, pontosabban a visszatekeredését a csúcsi szakaszon. Célkitűzés: Tanulmányunk célja olyan szoftveres technika, a transzimpedancia-mátrix (TIM) beillesztése a rutin intraoperatív elektrofiziológiai mérési metodikák közé, amely képes objektív diagnosztikai lehetőséget biztosítani ahhoz, hogy korán felismerhessük a cochlearis implantátum elektródasorán keletkezett hurkot. Módszer: Hároméves kisgyermek kétoldali cochlearis implantációját követően, posztoperatív röntgenfelvételen a bal oldalon az elektródasor megfelelő pozíciója figyelhető meg, míg a jobb oldalon az intracochlearis elektródasor végének visszatekeredése igazolódott. Képalkotó vizsgálatot követően elektrofiziológiai metódusként TIM-vizsgálatot végeztünk. Az eljárás során a mérőeszköz a kijelölt stimuláló elektródákon 1 V nagyságrendű feszültséget közöl állandó áramerősség mellett a cochlea közel eső struktúrái felé. Mérőelektródák segítségével regisztráljuk a szöveteken mérhető feszültséget, majd transzimpedancia-mátrixszá alakítjuk a mért értékeket. Eredmények: Az elektródasor visszatekeredése, amelyet korábban radiológiai vizsgálattal igazoltunk, az objektív elektrofiziológiai mérések segítségével is jól azonosítható, és a vizsgálatok szoros párhuzamot mutatnak. Következtetés: Az elektródák helyzetének megjelenítésére szolgáló standard radiológiai képalkotási technikák kiegészíthetők, illetve kiválthatók egyszerűen elvégezhető, hatékony, objektív elektrofiziológiai vizsgálatokkal. Intraoperatíven, még a sebzárás előtt kimutatható, ha az elektródasor nem megfelelő helyzetbe került, így csökkenthetjük a radiológiai vizsgálatokkal járó sugárterhelés és annak finanszírozási problémáját. Orv Hetil. 2021; 162(25): 988–996. Summary. Introduction: In recent years, the cochlear implant has become a routine and effective treatment tool for severe hearing loss and total deafness. One of the commonly used and effective innovations of our time in cochlear implantation is the perimodiolar thin electrode array. The atraumatic electrode array, which closely embraces the central axis of the cochlea (modiolus), has served its popularity with very convincing results, with its performance in both electrophysiological measurements and acoustic hearing preservation. However, very few publications describe the frequency of improper positioning of the electrode array, which is known as ‘tip fold-over’. Objective: The aim of our study is to incorporate a software technique, the transimpedance matrix (TIM), into routine intraoperative electrophysiological measurement methodologies to provide a potential objective diagnostic opportunity for early detection of tip fold-over of the electrode array. Method: Following bilateral cochlear implantation of a three-year-old child, postoperative radiography showed the correct position of the electrode array on the left side, while tip fold-over of the intracochlear electrode array was detected on the right side. Following imaging, a TIM study was performed as an electrophysiological method. During the procedure, the measuring device transmits a voltage of the order of 1 V to the nearby structures of the cochlea at a constant current at the designated stimulus electrodes. Measuring electrodes were used to register the voltage measured on the tissues, and then converted into a TIM. Results: Electrode tip fold-over was previously diagnosed by radiological examination, while it can also be diagnosed by objective electrophysiological measurements now, and these two tests correlate well. Conclusion: Standard radiological imaging techniques for electrode positioning can be supplemented or replaced by easy-to-perform, effective objective electrophysiological studies. Tip fold-over can be detected intraoperatively, even before wound closure, if the electrode array is in the wrong position, thus reducing the radiation exposure associated with radiological examinations as well as reducing relevant costs. Orv Hetil. 2021; 162(25): 988–996.

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Review of Electrode Placement with the Slim Modiolar Electrode: Identification and Management

Cited by 8 publications

References 0 publications

Misplaced Cochlear Implant Electrodes Outside the Cochlea: A Literature Review and Presentation of Radiological and Electrophysiological Findings

Misplaced Cochlear Implant Electrodes Outside the Cochlea: A Literature Review and Presentation of Radiological and Electrophysiological Findings

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

Az elektródasor visszatekeredésének kimutatása transzimpedanciamátrix (TIM)-vizsgálattal cochlearis implantátumban

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