A Protocol for Imaging of Cochlear Implantation.

Abstract

Correct electrode placement is a challenge of cochlear implant surgery, which occurs because electrode position cannot be directly visualized. This work aims to 1) develop a protocol for a practical, consistent, single view plain radiograph able to be used to confirm cochlear implantation, 2) confirm its usefulness on patients, and 3) confirm its usefulness for identifying misplaced electrodes in cadaveric ears. Imaging procedure and quality improvement initiative. Tertiary academic hospital. Cadaveric ears, and patients undergoing cochlear implantation. An intraoperative imaging protocol was developed specifying patient head position, machine position, and exposure setting. This was tested to confirm proper cochlear implantation in patients, including one revision case. This technique allowed the electrode placement to be reliably identified in patients of all ages. Its usefulness for identifying maligned electrodes (partial insertion, and insertion into the vestibule or hypotympanum) was confirmed using four cadaveric hemi-heads. Ability to accurately identify correct or incorrect electrode insertion based on radiographic images. After adjusting radiographic exposure to account for the embalming process of the cadaveric heads, this new protocol was confirmed to be able to identify incorrect placement. This was also successfully used to confirm proper placement of cochlear implants in patients. Following a standardized radiographic protocol for cochlear implantation is a quick and easy method for checking electrode position.Supplemental Digital Content, http://links.lww.com/MAO/B253.