Electrode Migration in Patients with Perimodiolar Cochlear Implant Electrodes

Mittmann, Philipp; Rademacher, G.; Mutze, Sven; Ernst, Arneborg; Todt, Ingo

doi:10.1159/000435873

Cited by 22 publications

(15 citation statements)

References 24 publications

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“…Post-implantation migration is the second most common reason for revision cochlear implantation, emphasizing the clinical issues related to electrode migration ( Brown et al 2009 ; Connell et al 2008 ; Green et al 2004 ; Wang et al 2014 ). Prevalence of electrode migration varies from 7.4% to 29%, and seems to occur more frequently and to a greater extent in lateral-wall electrodes than perimodiolar electrodes ( Mittmann et al 2015 ; van der Marel et al 2012 ). It is suggested that these migrations mostly happen during perioperative conditions, for example, while closing the skin when minor manipulations of the implant might occur, or in the first few weeks postoperative when the electrode array is not yet immobilized by ossification or fibrous tissue ( van der Marel et al 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Detection of Extracochlear Electrodes in Cochlear Implants with Electric Field Imaging/Transimpedance Measurements:

et al. 2020

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Objectives: Extracochlear electrodes in cochlear implants (CI), defined as individual electrodes on the electrode array located outside of the cochlea, are not a rare phenomenon. The presence of extracochlear electrodes frequently goes unnoticed and could result in them being assigned stimulation frequencies that are either not delivered to, or stimulating neurons that overlap with intracochlear electrodes, potentially reducing performance. The current gold-standard for detection of extracochlear electrodes is computed tomography (CT), which is time-intensive, costly and involves radiation. It is hypothesized that a collection of Stimulation-Current-Induced Non-Stimulating Electrode Voltage recordings (SCINSEVs), commonly referred to as “transimpedance measurements (TIMs)” or electric field imaging (EFI), could be utilized to detect extracochlear electrodes even when contact impedances are low. An automated analysis tool is introduced for detection and quantification of extracochlear electrodes. Design: Eight fresh-frozen human cadaveric heads were implanted with the Advanced Bionics HiRes90K with a HiFocus 1J lateral-wall electrode. The cochlea was flushed with 1.0% saline through the lateral semicircular canal. Contact impedances and SCINSEVs were recorded for complete insertion and for 1 to 5 extracochlear electrodes. Measured conditions included: air in the middle ear (to simulate electrodes situated in the middle ear), 1.0% saline in the middle ear (to simulate intraoperative conditions with saline or blood in the middle ear), and soft tissue (temporal muscle) wrapped around the extracochlear electrodes (to simulate postoperative soft-tissue encapsulation of the electrodes). Intraoperative SCINSEVs from patients were collected, for clinical purposes during slow insertion of the electrode array, as well as from a patient postoperatively with known extracochlear electrodes. Results: Full insertion of the cochlear implant in the fresh-frozen human cadaveric heads with a flushed cochlea resulted in contact impedances in the range of 6.06 ± 2.99 kΩ (mean ± 2SD). Contact impedances were high when the extracochlear electrodes were located in air, but remained similar to intracochlear contact impedances when in saline or soft tissue. SCINSEVs showed a change in shape for the extracochlear electrodes in air, saline, and soft tissue. The automated analysis tool showed a specificity and sensitivity of 100% for detection of two or more extracochlear electrodes in saline and soft tissue. The quantification of two or more extracochlear electrodes was correct for 84% and 81% of the saline and soft tissue measurements, respectively. Conclusions: Our analysis of SCINSEVs (specifically the EFIs from this manufacturer) shows good potential as a detection tool for extracochlear electrodes, even when contact impedances remain similar to intracochlear values. SCINSEVs could potentially replace CT in the initial screening for e...

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Section: Introductionmentioning

confidence: 99%

Detection of Extracochlear Electrodes in Cochlear Implants with Electric Field Imaging/Transimpedance Measurements:

et al. 2020

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“…The electrode array position was reconstructed and evaluated from the postoperative CT imaging made in the first 24 h. Previous studies showed that a migration (25) or an extrusion of the electrode array is a complication that could be suspect when a gradual increase of the impedances is observed (26). In our study, there was no assessed a slight migration of the electrode array, however a postoperative CT scan was performed in case of an unexplained degradation or a persistence of poor hearing performance.…”

Section: Discussionmentioning

confidence: 92%

Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

et al. 2021

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Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot.Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot (RobOtol®, Collin, Bagneux, France) with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250–500–750 Hz, 500–1,000–2,000–3,000 Hz, and 3,000–4,000–8,000 Hz for low, mid, and high frequencies, respectively.Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies (p < 0.0001; Adjusted R2 = 0.64, polynomial non-linear regression). Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion (p = 0.018; Fisher's exact test).Conclusion: The restoration of high-frequency thresholds (3,000–4,000–8,000 Hz) by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced after a robot-assisted insertion.

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“…In a study conducted by Mittman et al has described those fixation techniques like fixation clips can be thought to minimize the risk of electrode migration or misplacement [7]. In one study by Kubo et al described that electrode extrusion is although rare complication but it can lead to re implantation surgery and it may occur after a few years from surgery but fixation of the electrode into split made in the buttress part may prevent electrode migration [22].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, electrode migration or extrusion is an important complication in CI surgery, which affects the hearing level, and induce facial nerve stimulation, that may require a revision. Electrode migration is defined as a complication due to gradually slip out of electrodes from cochlea or extrusion from the tympanic membrane [7] due to raise the level of impedance values in basal side electrodes. As well as, it can be due to cochlear ossification (Figure 1) [8].…”

Section: Introductionmentioning

confidence: 99%

Electrode Migration: A Review Article

Alkhodair¹

2020

GJO

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Cochlear implant (CI) is considered as safe, and effective surgical procedure for patients with Sensory Neural Hearing Loss (SNHL). The cochlear implant is an electronic device implanted behind the ear, with electrode arrays which are inserted into the Scala Tympani of the cochlea to stimulate the auditory pathway. The complications rate of cochlear implant surgery is very low, and more common in pediatrics. Furthermore, electrode migration is one of the complications which are defined as gradual slipping out of electrode from cochlea or extrusion from tympanic membrane. Data were being collected through search engines included PUBMED, Google Scholar, and BMJ. The process of sorting out of articles as per inclusion criteria which has an outcome related to electrode migration in post cochlear implant. After removal of duplicate studies, total of 12 articles were found eligible for review analysis. Electrode migration is more common as previously reported, it has shown that fixation techniques should be more reliable to avoid migration of electrode. The purpose of this study is to get a detailed review of electrode migration causes and prevalence in post cochlear implant patients and what factors can lead to migration intraoperative and post-operative cases.

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Electrode Migration in Patients with Perimodiolar Cochlear Implant Electrodes

Cited by 22 publications

References 24 publications

Detection of Extracochlear Electrodes in Cochlear Implants with Electric Field Imaging/Transimpedance Measurements:

Detection of Extracochlear Electrodes in Cochlear Implants with Electric Field Imaging/Transimpedance Measurements:

Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

Electrode Migration: A Review Article

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