title: Intra-operative skull X-ray for misdirection of the cochlear implant array into the vestibular labyrinth.
abstract: OBJECTIVE
  This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray.
  
  
  METHODS
  The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging.
  
  
  RESULTS
  There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray.
  
  
  CONCLUSIONS
  These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.
authors: College of Medicine,University of Illinois at Chicago,Illinois,USA.
authors: A M
authors: AM
authors: Hassan
authors: York ENT Surgical Consultants,Hinsdale,Illinois,USA.
authors: R
authors: R
authors: Patel
authors: Department of Otolaryngology - Head and Neck Surgery,University of Illinois at Chicago,USA.
authors: M
authors: M
authors: Redleaf
mesh_terms: D019929:Cochlear Implantation / Q000379:methods*; D003638:Deafness / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D004567:Electrodes, Implanted; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011474:Prosthesis Design; D012086:Reoperation; D012405:Round Window, Ear / Q000000981:diagnostic imaging* / Q000601:surgery*; D012665:Semicircular Canals / Q000000981:diagnostic imaging* / Q000601:surgery*; D013686:Telemetry; D014057:Tomography, X-Ray Computed
keywords: Cochlea; Cochlear Implantation; Cochlear Implants; Semicircular Canals; Vestibular Labyrinth