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Related Experiment Video

Updated: Jun 27, 2026

Testing a Cochlear Implant Electrode Insertion Training System for Optimal Electrode Array Placement in Different Inner Ear Anatomies

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Transtympanic electrode positioning: manubrium is a poor guide.

Norman Wendell Todd¹

¹Department of Otolaryngology-Head and Neck Surgery, Temporal Bone Laboratory, Emory University, Atlanta, Georgia 30322, USA. ntodd@emory.edu

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology

|December 19, 2008

Summary

Electrode placement for electrocochleography using the manubrium as a guide is highly variable. This study found that the transtympanic electrode position relative to the round window niche is unpredictable.

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Published on: August 4, 2023

Area of Science:

Otorhinolaryngology
Neuroscience
Biomedical Engineering

Background:

Transtympanic electrodes are crucial for electrocochleography and electrically evoked auditory brainstem response.
Significant response variability exists among healthy subjects during these procedures.
The manubrium serves as a common landmark for electrode placement, but its accuracy is questioned.

Purpose of the Study:

To investigate the variability of transtympanic electrode placement relative to the round window niche.
To test the hypothesis that electrode position is widely variable when using the manubrium as a guide.

Main Methods:

Postmortem anatomic dissection of 41 adult human temporal bones.
Drill marks created at two manubrium-based positions in the mesotympanum.
Measurement of distances from electrode sites to the round window niche.

Main Results:

Distances to the round window niche varied significantly (0.8–3.5 mm and 1.8–4.5 mm).
One electrode site frequently entered hypotympanic trabeculations (81%) or the jugular plate (6%).
Electrode site position was not clearly correlated with manubrium orientation or mastoid size.

Conclusions:

Transtympanic electrode placement guided by the manubrium is not accurately predictable relative to the round window niche.
This unpredictability may contribute to response variability in electrophysiological testing.