Curvature analysis of CI electrode arrays: a novel approach to categorize perimodiolar positions without anatomical landmarks.

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Perimodiolar electrode arrays may be positioned regular, over-inserted or under-inserted into the cochlea depending on the cochlear size and shape. The study aimed to examine whether there are differences between these groups in the local curvature along the intracochlear array. Individual curvature variables were developed to categorize the groups and the relationship between the curvature and the angular insertion depth at the electrode tip was analyzed. The curvature along the intracochlear array was measured in the CBCT image of 85 perimodiolar electrodes of a single type. The mean curvature and the ratio of the mean curvature at contacts E14-16 to the mean curvature at E7-8 (bowing ratio) were calculated across the array, and its true positive rate (TPR) and false positive rate (FPR) were calculated to establish optimal threshold values to categorize the groups. 68.2% of the cases were categorized as regular positioned, 22.4% had an over-insertion and 9.4% had an under-insertion. The mean curvature was significantly weaker with under-insertion (< 342°) than with normal insertion depth (≥ 342°). With an over-insertion, the bowing ratio was < 1 and otherwise > 1. Both the mean curvature and bowing ratio were found to have an optimal threshold value with high TPR (= 1.00) and low FPR (≤ 0.06) for categorizing under-insertion and over-insertion, respectively. Curvature analysis is a useful tool to assess if a perimodiolar electrode array has been inserted deep enough into the cochlea. Independent of critical anatomical landmarks, over-inserted arrays and under-inserted arrays could be well categorized by using individual curvature variables. The results need to be validated using additional data sets.