title: Cochlear implant electrode misplacement: incidence, evaluation, and management.
abstract: OBJECTIVE
  To review the presentation and management of improper electrode array placement, and to help guide clinical decision-making.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Pediatric and adult cochlear implant patients managed from January 2001 to present whose electrode arrays were not placed properly within the cochlea or extended beyond the cochlea into the internal auditory canal or adjacent structures.
  
  
  RESULTS
  Four patients, three pediatric and one adult, were identified from over 824 cases (< 1%) managed over the study duration. All cases had normal cochlear anatomy. These cases were initially identified due to poor auditory skill development or absent behavioral responses following implantation, which prompted imaging. Two patients presented several years after surgery. Sites of improper placement included the eustachian tube, vestibule, internal carotid artery canal, and internal auditory canal (IAC). Intraoperative findings and management are reviewed.
  
  
  CONCLUSIONS
  Electrode array malpositioning is a rare, but serious and correctable complication in cochlear implant surgery. A multidisciplinary approach, including prompt audiologic evaluation and imaging, is important, particularly when benefit from the implant is limited or absent. Management of electrode arrays in the IAC may be more challenging.
authors.affiliation: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA. yying@lsuhsc.edu
authors.forename: Yu-Lan Mary
authors.initials: YL
authors.lastname: Ying
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Lin
authors.forename: John S
authors.initials: JS
authors.lastname: Oghalai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D000368:Aged; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects* / Q000379:methods; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies