Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-06T03:56:23.678Z Has data issue: false hasContentIssue false
  • English
  • Français

Intra-operative skull X-ray for misdirection of the cochlear implant array into the vestibular labyrinth

Published online by Cambridge University Press:  28 August 2015

A M Hassan ,
R Patel  and
M Redleaf
A M Hassan*
Affiliation:
College of Medicine, University of Illinois at Chicago, Illinois, USA
R Patel
Affiliation:
York ENT Surgical Consultants, Hinsdale, Illinois, USA
M Redleaf
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Illinois at Chicago, USA
*
Address for correspondence: Mr Ahmad M Hassan, College of Medicine, University of Illinois at Chicago, 808 S Wood St, Chicago, IL 60612, USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

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.

Conclusion:

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.

Keywords

Cochlear ImplantationCochlear ImplantsCochleaSemicircular CanalsVestibular Labyrinth
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 9 , September 2015 , pp. 923 - 927
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1National Institute on Deafness and Other Communication Disorders (NIDCD). Cochlear Implants. In: http://www.nidcd.nih.gov/health/hearing/coch.asp [3 December 2012]Google Scholar
2Carlson, ML, Driscoll, CL, Gifford, RH, McMenomey, SO. Cochlear implantation: current and future device options. Otolaryngol Clin North Am 2012;45:221–48CrossRefGoogle ScholarPubMed
3Magnus, B, Rivas, A, Tsai, BS, Haynes, DS, Roland, JT. Surgical techniques in cochlear implants. Otolaryngol Clin North Am 2012;45:69–80Google Scholar
4Flint, PW, Haughey, BH, Niparko, JK, Richardson, MA, Lund, VJ, Robbins, KT et al. , eds. Cummings Otolaryngology – Head and Neck Surgery, 5th edn.Philadelphia: Mosby/Elsevier, 2010;2237Google Scholar
5Cohen, NL, Roland, JT, Fishman, A. Surgical technique for the nucleus contour cochlear implant. Ear Hear 2002;23(1 suppl):59–66SCrossRefGoogle ScholarPubMed
6Balkany, TJ, Whitley, M, Shapira, Y, Angeli, S, Brown, K, Eter, E et al. The temporalis pocket technique for cochlear implantation: an anatomic and clinical study. Otol Neurotol 2009;30:903–7CrossRefGoogle ScholarPubMed
7MED-EL Surgical Manual, version 1. Durham, NC: US Med-El, 1998;15Google Scholar
8Copeland, BJ, Pillsbury, HC, Buchman, CA. Prospective evaluation of intraoperative cochlear implant radiographs. Otol Neurotol 2004;25:295–7CrossRefGoogle ScholarPubMed
9Coelho, DH, Waltzman, SB, Roland, JT Jr. Implanting common cavity malformations using intraoperative fluoroscopy. Otol Neurotol 2008;29:914–19CrossRefGoogle ScholarPubMed
10Fishman, AJ, Roland, JT Jr, Alexiades, G, Mierzwinski, J, Cohen, NL. Fluoroscopically assisted cochlear implantation. Otol Neurotol 2003;24:882–6CrossRefGoogle ScholarPubMed
11Yuan, YY, Song, YS, Chai, CM, Shen, WD, Han, WJ, Liu, J et al. Intraoperative CT-guided cochlear implantation in congenital ear deformity. Acta Otolaryngol 2012;132:951–8CrossRefGoogle ScholarPubMed
12Shpizner, BA, Holliday, RA, Roland, JT, Cohen, NL, Waltzman, SB, Shapiro, WH. Postoperative imaging of the multichannel cochlear implant. AJNR Am J Neuroradiol 1995;16:1517–24Google ScholarPubMed
13Shapiro, WH, Bradham, TS. Cochlear implant programming. Otolaryngol Clin North Am 2012;45:111–27CrossRefGoogle ScholarPubMed
14Mason, S. Electrophysiologic and objective monitoring of the cochlear implant during surgery: implementation, audit, and outcomes. Int J Audiol 2004;43:S33–8Google ScholarPubMed
15Tange, RA, Grolman, W, Maat, A. Intracochlear misdirected implantation of a cochlear implant. Acta Otolaryngol 2006;126:650–2CrossRefGoogle ScholarPubMed
16Fishman, A. Imaging and anatomy for cochlear implants. Otolaryngol Clin North Am 2012;45:1–24CrossRefGoogle ScholarPubMed
17Mecca, MA, Wagle, W, Lupinetti, A, Parnew, S. Complication of cochlear implant surgery. AJNR Am J Neuroradiol 2003;24:2089–91Google Scholar
18Muzzi, E, Boscolo-Rizzo, P, Santarelli, R. Cochlear implant electrode array misplacement: a cautionary case report. J Laryngol Otol 2012;126:414–17CrossRefGoogle ScholarPubMed
19Ramalingam, R, Ramalingam, KK, Padmaja, HS. An unusual occurrence in cochlear implant surgery: misplaced electrode. J Laryngol Otol 2009;123:e4CrossRefGoogle ScholarPubMed
20Rotteveel, LJ, Proops, DW, Ramsden, RT. Cochlear implantation in 53 patients with otosclerosis: demographics, computed tomographic scanning, surgery, and complications. Otol Neurotol 2004;25:943–52CrossRefGoogle ScholarPubMed
21Viccaro, M, Covelli, E, De Seta, E, Balsamo, G, Filipo, R. The importance of intra-operative imaging during cochlear implant surgery. Cochlear Implants Int 2009;10:198–202CrossRefGoogle ScholarPubMed
22Sorrentino, T, Cote, M, Eter, E, Laborde, ML, Cochard, N, Deguine, O et al. Cochlear reimplantations: technical and surgical failures. Acta Otolaryngol 2009;129:380–4CrossRefGoogle ScholarPubMed
23Ying, YM, Lin, JW, Oghalai, JS, Williamson, RA. Cochlear implant electrode misplacement: incidence, evaluation and management. Laryngoscope 2013;123:757–66CrossRefGoogle ScholarPubMed
24Cosetti, MK, Troob, SH, Latzman, JM, Shapiro, WH, Roland, JT Jr, Waltzman, SB. An evidence-based algorithm for intraoperative monitoring during cochlear implantation. Otol Neurotol 2012;33:169–76CrossRefGoogle ScholarPubMed