An Evidence-Based Algorithm for Intraoperative Monitoring During Cochlear Implantation

Cosetti, Maura K.; Troob, Scott H.; Latzman, Jonathan M.; Shapiro, William H.; Roland, J. Thomas; Waltzman, Susan B.

doi:10.1097/mao.0b013e3182423175

Cited by 87 publications

(83 citation statements)

References 27 publications

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“…This is a technique that clinicians should utilize in the presence of intraoperative or postoperative electrode abnormalities, particularly OCs [13]. Our results are in agreement with that reported by Cosetti et al [10] who found that air bubbles are the commonest cause of abnormal intraoperative impedance.…”

Section: Discussionsupporting

confidence: 95%

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An evidence-based guide for intraoperative cochlear implant backup use

Khater

Moustafa

Said

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionsupporting

confidence: 95%

“…multielectrode array misplacement can be corrected intraoperatively once the surgeon is aware of it while the patient is still under anesthesia [10].…”

mentioning

confidence: 99%

An evidence-based guide for intraoperative cochlear implant backup use

Khater

Moustafa

Said

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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“…The findings of our study argue for routine radiographic position checks because intraoperative findings only have a limited predictive value. This conclusion is in accordance to surgeons who rank radiographic position checks as so important that they perform intraoperative position checks, for example, (9,10), which have the added advantage that instant corrections of electrode position can be performed.…”

Section: Discussionsupporting

confidence: 86%

Value of Routine Plain X-Ray Position Checks after Cochlear Implantation

Dirr¹,

Hempel²,

Krause³

et al. 2013

Otology &Amp; Neurotology

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Objective: To analyze the value of a routine x-ray position check after cochlear implantation and to assess if an increased resistance during electrode insertion is a sufficient predictor of electrode misplacement. Study Design: Retrospective data collection. Setting: University hospital. Methods: Plain x-rays (Stenvers' projection) and the respective surgery reports of 218 patients having received cochlear implantation (243 ears) were analyzed for possible electrode misplacements and intraoperative conspicuities during electrode insertion. Results: Electrode misplacement (tip-over, loop, kinking, scalar transition, and incomplete insertion) was observed in 8% of the entire study cohort, but only in 5% if cases with inner ear dysplasia or labyrinthine ossification (n = 28) were excluded from analysis. Intraoperatively, an increased resistance during electrode insertion was found in 16% but only in 8% when cases with inner ear dysplasia or labyrinthine ossification were excluded. The intraoperative finding of an increased resistance during electrode insertion had a sensitivity of 55% and a specificity of 88% for predicting radiographically confirmed electrode misplacements (positive predictive value, 29%; negative predicting value, 96%). Conclusion: Nearly half of the cases of electrode misplacement would have been overlooked if radiographic position checks would have been done only in patients with intraoperative conspicuities during electrode insertion. This finding advocates routine radiographic position checks, although electrode misplacements are relatively rare in patients with regular inner ear anatomy.

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“…A digital copy of the film is saved in the patient record. A study of 288 surgeries using Nucleus CIs done at our institution (Cosetti et al, 2012) showed five instances of tip rollover or extracochlear electrode placement, which were all corrected after being detected in the intraoperative X-ray.…”

Section: Methodsmentioning

confidence: 99%

The Relationship Between Insertion Angles, Default Frequency Allocations, and Spiral Ganglion Place Pitch in Cochlear Implants

et al. 2015

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Objectives Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hz, but the electrode arrays are not designed to reach the most apical regions of the cochlea which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States. Design The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from x-rays. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer’s default frequency-to-electrode allocation. Results Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e. the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models. Conclusions A mismatch was observed between the predicted frequency and default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.

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An Evidence-Based Algorithm for Intraoperative Monitoring During Cochlear Implantation

Cited by 87 publications

References 27 publications

An evidence-based guide for intraoperative cochlear implant backup use

An evidence-based guide for intraoperative cochlear implant backup use

Value of Routine Plain X-Ray Position Checks after Cochlear Implantation

The Relationship Between Insertion Angles, Default Frequency Allocations, and Spiral Ganglion Place Pitch in Cochlear Implants

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