Another reason for intra-operative imaging during cochlear implantation.
OBJECTIVE
We report a case of a rare cochlear implant complication: the introduction of the electrode array into the superior semicircular canal, with intra-operative measurements of neural response reactions suggesting reasonable functioning of the implant.


METHODS
A two-year old patient affected by congenital, profound, sensorineural deafness underwent bilateral cochlear implantation at the ENT clinic of the 'La Sapienza' University of Rome. Two Clarion 90k devices were implanted, and electrophysiological and radiological checks were performed. After the introduction of the array in the right side, neural response imaging was performed, and a neural potential was found only on two apical electrodes, at a stimulation intensity of 431 clinical units. The situation differed on the left side, where neural response imaging was present at a stimulation intensity of 300 clinical units on the two electrodes tested (one apical electrode (number three), and one middle electrode (number nine)). Intra-operative radiological assessment with a transorbital plain films was performed as usual in order to assess the position of the electrodes inside the cochlea. This radiography showed the electrode array to be in the superior semicircular canal in the right ear.


CONCLUSIONS
Intra-operative monitoring tests during cochlear implant surgery play different roles; measurement of impedances and neural response imaging can evaluate the integrity of implant electrodes and the status of the electrode-cochlea interface, but it must not be the sole way in which correct positioning of the array is confirmed. In our opinion, intra-operative radiological assessment is mandatory during cochlear implant surgery.
Viccaro
M
M
ENT Department, University La Sapienza of Rome, Italy. marikaviccaro@tiscali.it
De Seta
E
E
Covelli
E
E
Marvaso
V
V
Filipo
R
R
D002675:Child, Preschool; D003051:Cochlea / Q000000981:diagnostic imaging; D019929:Cochlear Implantation / Q000379:methods*; D003638:Deafness / Q000151:congenital / Q000601:surgery*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D011859:Radiography; D012665:Semicircular Canals / Q000000981:diagnostic imaging