Impedance Measures During in vitro Cochlear Implantation Predict Array Positioning.

Abstract

Improper electrode placement during cochlear implant (CI) insertion can adversely affect speech perception outcomes. However, the intraoperative methods to determine positioning are limited. Because measures of electrode impedance can be made quickly, the goal of this study was to assess the relationship between CI impedance and proximity to adjacent structures. An Advanced Bionics CI array was inserted into a clear, plastic cochlea one electrode contact at a time in a saline bath (nine trials). At each insertion depth, response to biphasic current pulses was used to calculate access resistance (Ra), polarization resistance (Rp), and polarization capacitance (Cp). These measures were correlated to actual proximity as assessed by microscopy using linear regression models. Impedance increased with insertion depth and proximity to the inner wall. Specifically, Ra increased, Cp decreased, and Rp slightly increased. Incorporating all impedance measures afforded a prediction model (r = 0.88) while optimizing for sub-mm positioning afforded a model with 78.3% specificity. Impedance in vitro greatly changes with electrode insertion depth and proximity to adjacent structures in a predicable manner. Assessing proximity of the CI to adjacent structures is a significant first step in qualifying the electrode-neural interface. This information should aid in CI fitting, which should help maximize hearing and speech outcomes with a CI. Additionally, knowledge of the relationship between impedance and positioning could have utility in other tissue implants in the brain, retina, or spinal cord.