Intraoperative Electrophysiologic Variations Caused by the Scalar Position of Cochlear Implant Electrodes.
OBJECTIVE
The position of cochlear implant (CI) electrodes in the cochlea is fundamental for the interaction between the implant and the neurons of the spiral ganglion. The scalar position of the electrode in the cochlea is assumed to be an important parameter for the clinical outcome. In our study, the intraoperative electrophysiologic characteristics in dependence of the position of CI electrodes in the scala tympani or in the scala vestibuli after scalar change should be determined.


METHODS
The intraoperative impedances and neural response telemetry (NRT) data of 23 patients implanted with a Nucleus Advance Contour (Cochlear Pty, Sydney, Australia) electrode were recorded. One CI surgeon and two radiologists evaluated the electrode array's position independently radiologically by flat-panel tomography. Results from 17 patients with the electrode positioned in the scala tympani and six patients with the electrode changing intraoperatively from the tympanic into the vestibular scala were retrospectively analyzed.


RESULTS
We found a statistically significant difference with an NRT threshold-based ratio for the groups. An estimation of the (radiologically confirmed) scalar position based on the NRT ratio was possible retrospectively.


CONCLUSIONS
The evaluation of specific intraoperative electrophysiologic data allowed separating between a regular and an irregular (i.e., scalar changing) position of CI electrodes. This noninvasive methodology can support the postoperative radiologic evaluation of the CI electrode array position.
Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany.
Philipp
P
Mittmann
Arneborg
A
Ernst
Ingo
I
Todt
D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D017097:Electric Impedance; D004566:Electrodes; D004567:Electrodes, Implanted; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D012533:Scala Tympani / Q000000981:diagnostic imaging; D054738:Scala Vestibuli / Q000000981:diagnostic imaging; D013686:Telemetry; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome