“Seeing” cochlear implant misplacement without imaging test

Batuecas‐Caletrío, Ángel; Ying, Yu‐Lan Mary; González-Sánchez, Enrique; Santacruz‐Ruiz, Santiago

doi:10.1016/j.amjoto.2014.05.001

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Proper visualization is crucial to confirming accurate electrode placement, obtaining adequate exposure is of immense importance for the surgeon. This is supported by previous studies that have found identification of anatomic landmarks to be of extreme value, even when visualization is made difficult by unexpected factors, such as mucosal edema, fibrosis, ossification, facial nerve dehiscence, or other abnormalities (3,4,6,8,9,11,13,14).…”

Section: Discussionsupporting

confidence: 75%

“…Difficulties with anatomic visualization have often been noted in cases of CI misplacement. In this series, the most cited technical factor was poor visualization or misidentification of the round window (3,6,8,9,11,13,14). Thus, lack of visualization of the round window may be associated with CI misplacement.…”

Section: Discussionmentioning

confidence: 89%

“…While intraoperative x-ray can identify misplaced electrodes and allow for immediate repositioning, normal or inconclusive radiographs do not rule out electrode misplacement (2,15,20,35). Furthermore, precurved electrodes can appear appropriately curved on radiographs even when malpositioned, although radiographs may be able to demonstrate whether the curl is intra-or extracochlear (13,14,18). In the case of patient case-3, while the postoperative x-ray appeared to demonstrate appropriate electrode curvature, the electrode was curving over the temporal bone instead of around the modiolus (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Patient symptoms and long-term outcomes may depend on the location of the misplaced electrode. Patients with cochlear implant misplacement in the vestibular system may present with severe vertigo, nystagmus, or vomiting either immediately postoperatively or at the time of device activation (2,8,14,18,32). IAC misplacement poses significant risk of damage to the auditory and facial nerves, potentially resulting in facial paralysis and poor long-term CI performance following revision due to damage of the auditory nerve within the IAC.…”

Section: Discussionmentioning

confidence: 99%

“…Given the serious consequences of electrode misplacement and the need for revision surgery, identification of causative factors is key to reducing rates of electrode misplacement. Individual case series have mentioned difficulties with anatomic visualization in cases where electrodes were misplaced (3,6,8,9,(14)(15)(16). Intraoperative testing such as impedance measurements, neural response telemetry (NRT), and intraoperative imaging are sometimes used as adjuncts in confirming placement, but are not always reliable (9,(17)(18)(19)(20)(21).…”

mentioning

confidence: 99%

See 4 more Smart Citations

Cochlear Implant Electrode Misplacement: A Case Series and Contemporary Review

Shin

Totten²,

Tucker³

et al. 2022

Otology &Amp; Neurotology

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Objective:To determine root causes leading to misplaced cochlear implant (CI) electrode arrays and discuss their management using a case series and contemporary literature review.Study Design:Retrospective case review and contemporary literature review.Setting:Single tertiary-referral center.Patients:Adult and pediatric patients who were diagnosed with a misplaced CI electrode array, excluding tip-foldover. Literature review was performed via a MEDLINE database PubMed query. All articles that described at least one case of extracochlear electrode array misplacement were included; partial insertions and extrusions were excluded.Main Outcome Measure:Extracochlear misplacement.Results:A total of 61 cases were reviewed, including 4 new cases and 57 cases from 29 previously published articles. We discuss management of CI arrays in the carotid canal, the vestibule, and the modiolus. The rate of CI misplacement is estimated to be 0.49%. The most frequent location of misplacement CI was the vestibular system (50.8%) followed by the internal carotid canal (11.5%). Normal cochlear anatomy was noted on preoperative computer tomography (CT) in 59.0% of patients; abnormalities were noted in 27.9%. The most common technical issue was misidentification or poor visualization of the round window.Conclusion:CI electrode misplacement is rare but can cause postoperative complications and may result in permanently diminished CI performance and hearing outcomes, even after revision surgery. Failure to identify the round window is the most common reason for CI misplacement, despite most patients having normal cochlear anatomy. Surgical strategies to localize the round window and basal turn are imperative for proper electrode placement.Level of Evidence:4.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Cochlear Implant Electrode Misplacement: A Case Series and Contemporary Review

Shin

Totten²,

Tucker³

et al. 2022

Otology &Amp; Neurotology

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What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis

Abouzayd

Smith

Moreau

et al. 2016

Eur Arch Otorhinolaryngol

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Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.

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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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“Seeing” cochlear implant misplacement without imaging test

Cited by 3 publications

References 3 publications

Cochlear Implant Electrode Misplacement: A Case Series and Contemporary Review

Cochlear Implant Electrode Misplacement: A Case Series and Contemporary Review

What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis

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

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