Abstract
PurposeAssessment of the cochlear implant (CI) electrode array position using flat-detector computed tomography (FDCT) to test dependence of postoperative outcome on intracochlear electrode position.MethodsA total of 102 patients implanted with 107 CIs underwent FDCT. Electrode position was rated as 1) scala tympani, 2) scala vestibuli, 3) scalar dislocation and 4) no deconvolution. Two independent neuroradiologists rated all image data sets twice and the scalar position was verified by a third neuroradiologist. Presurgical and postsurgical speech audiometry by the Freiburg monosyllabic test was used to evaluate auditory outcome after 6 months of speech rehabilitation.ResultsElectrode array position was assessed by FDCT in 107 CIs. Of the electrodes 60 were detected in the scala tympani, 21 in the scala vestibuli, 24 electrode arrays showed scalar dislocation and 2 electrodes were not placed in an intracochlear position. There was no significant difference in rehabilitation outcomes between scala tympani and scala vestibuli inserted patients. Rehabilitation was also possible in patients with dislocated electrodes.ConclusionThe use of FDCT is a reliable diagnostic method to determine the position of the electrode array. In our study cohort, the electrode position had no significant impact on postoperative outcome except for non-deconvoluted electrode arrays.
Highlights
Cochlear implants (CIs) enable the restoration of hearing in patients with severe hearing loss or deafness
Assessment of electrode array position was successful for each CI and 60 (56.1%) electrode arrays were positioned in the scala tympani (ST)
High interrater and intrarater reliability in our study indicate a good reliability of this imaging technique, which is necessary in postoperative imaging to validate the intrascalar position of the electrode array; our results indicate that it can be challenging to detect scalar dislocation despite the higher resolution of flat-detector computed tomography (FDCT)
Summary
Cochlear implants (CIs) enable the restoration of hearing in patients with severe hearing loss or deafness. There is ongoing discussion on how the scalar positioning of CI electrodes affects the quality of. ST insertion has been described as minimally traumatic [3]. This is necessary to protect the fine bony structures such as the osseous spiral lamina and to prevent neuronal degeneration. Earlier clinical studies have reported optimal auditory outcome with ST insertions, and lower outcome scores have been associated with a greater number of electrode contacts in the scala vestibuli (SV) [4, 5]. Since ST implantation is not possible in every case, for example in cases of cochlear ossification or malformation, some authors reported similar good rehabilitation results with SV insertions [6, 7]. One pediatric study showed that the speech performance did not correlate to the intracochlear positioning (ST versus SV) [8]
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