Displacement of electrodes of a cochlear implant into the vestibular system: Intra- and postoperative electrophysiological analyses

Pau, Henry; Parker, Alison E.; Sanli, Halit; Gibson, W. P. R.

doi:10.1080/00016480510038554

Cited by 27 publications

(21 citation statements)

References 2 publications

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“…In that case, the electrode array was misinserted into the lateral semicircular canal, passing the vestibule; however, intraoperative measurements showed impedance and ECAP responses, suggesting a reasonable function of the inner ear and of the implant [8]. Pau et al reported a case of displacement of electrodes into the vestibule in a 68-year-old man with progressive hearing loss and a normal inner ear [9]. An uneventful right cochlear implant surgery was performed.…”

Section: Discussionmentioning

confidence: 93%

“…Therefore, accidental insertion of an electrode array into the vestibule of a morphologically normal inner ear results in anacusis and vestibular symptoms such as vertigo or disequilibrium [7][8][9]. Tange et al reported a case of electrode misinsertion into the vestibular system in a 55-year-old man without IEM.…”

Section: Discussionmentioning

confidence: 96%

“…However, the immediate intraoperative EABR indicated that only electrodes 14-22 were responding to electrical stimulation, whereas ECAP indicated satisfactory full insertion of the array. He experienced severe vertigo when the implant was switched on 3 weeks after surgery, and a CT scan showed herniation of the middle electrodes into the vestibule [9]. A normal response in the ECAP test cannot guarantee that an electrode array has been accurately inserted into the cochlea, because a vestibular action potential can be recorded in cases of electrode misinsertion into the vestibule.…”

Section: Discussionmentioning

confidence: 98%

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Cochlear implantation in children with cochlear aplasia

Jeong

Kim

2012

Acta Oto-Laryngologica

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The implanted children with cochlear aplasia accounted for 2% of those with inner ear malformations and 0.4% of all pediatric cochlear implantees. They showed audiological responses in preoperative electrophysiologic tests, and the eighth nerve was present in magnetic resonance imaging. The electrode array was inserted into the vestibule through an oval window after removing the stapes or through a transmastoid labyrinthotomy site. Electrical compound action potential and electrical auditory brainstem response tests showed clear neural responses after implantation. The hearing thresholds of the implanted ear improved to 25 dB HL and the children achieved significant open set speech perception abilities.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

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Cochlear implantation in children with cochlear aplasia

Jeong

Kim

2012

Acta Oto-Laryngologica

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“…However, whether the ECAP recording technology developed for cochlear implants can be applied to vestibular implantation has not been systematically studied. In a previous case report of a human patient [36] vestibular ECAPs were recorded when the electrodes of a cochlear implant were accidentally misdirected into the vestibular part of the labyrinth. If ECAPs could be reliably evoked from a vestibular implant, the method would have two potential advantages relative to measuring EEMs.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the Electrically Evoked Compound Action Potential of the Vestibular Nerve

Nie¹,

Bierer²,

Ling³

et al. 2011

Otology &Amp; Neurotology

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Objective We recorded intra-operative and post-operative electrically-evoked compound action potentials (ECAPs) in rhesus monkeys implanted with a vestibular neurostimulator. The objectives were to correlate the generation of slow-phase nystagmus or eye twitches induced by electrical stimulation of the implanted semicircular canal with the presence or absence of the vestibular ECAP responses, and to assess the effectiveness of ECAP monitoring during surgery to guide surgical insertion of electrode arrays into the canals. Design Four rhesus monkeys (a total of seven canals) were implanted with a vestibular neurostimulator modified from the Nucleus Freedom™ cochlear implant. ECAP recordings were obtained during surgery or at various intervals post-surgery using the Neural Response Telemetry™ feature of the clinical Custom Sound EP™ software. Eye movements during electrical stimulation of individual canals were recorded with a scleral search coil system in the same animals. Results Measurable vestibular ECAPs were observed intra-operatively or post-operatively in three implanted animals. Robust and sustained ECAPs were obtained in three monkeys at the test intervals of 0, 7, or >100 days post implantation surgery. In all three animals, stimulation with electrical pulse trains produced measurable eye movements in a direction consistent with the vestibulo-ocular reflex from the implanted semicircular canal. In contrast, electrically-evoked eye movements could not be measured in three of the seven implanted canals none of which produced distinct vestibular ECAPs. In two animals, ECAP waveforms were systematically monitored during surgery and the procedure proved crucial to the success of vestibular implantation. Conclusions Vestibular ECAPs exhibit similar morphology and growth characteristics to cochlear ECAPs from human cochlear implant patients. The ECAP measure is well correlated with the functional activation of eye movements by electrical stimulation post implantation surgery. The intra-operative ECAP recording technique is an efficient tool to guide the placement of electrode array into the semicircular canals.

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“…Previous research by Lassig et al (5) showed that the reason for revision was an electrode array positioning problem in 13% of 58 patients undergoing revision surgery. Others have published case reports describing electrode arrays that deviate toward the vestibulum (6,7). Both foldover of the electrode array and the depth of insertion are also major factors for eventual speech perception (1,2,4,8).…”

mentioning

confidence: 99%