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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
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Tip Fold-over in Cochlear Implantation: Case Series.
M Geraldine Zuniga1, Alejandro Rivas, Andrea Hedley-Williams
1*Department of Otolaryngology Head and Neck Surgery †Department of Hearing and Speech Sciences ‡Department of Electrical Engineering and Computer Science, Vanderbilt University Medical Center, Nashville, Tennessee.
Summary
Cochlear implant (CI) tip fold-over occurred in 1.98% of patients and was not clinically apparent. Selective deactivation of folded electrodes improved hearing outcomes, suggesting a potential surgical benefit.
Area of Science:
- Otolaryngology
- Neurosurgery
- Biomedical Engineering
Background:
- Cochlear implantation (CI) is a common treatment for severe to profound hearing loss.
- Electrode array malpositioning, such as tip fold-over, can occur during CI surgery.
- The clinical impact and detection of CI tip fold-over require further investigation.
Purpose of the Study:
- To determine the incidence and clinical presentation of cochlear implant (CI) tip fold-over.
- To evaluate the performance of CI recipients with tip fold-over.
- To assess the effectiveness of selective electrode deactivation for managing tip fold-over.
Main Methods:
- Retrospective case series of 235 CI recipients undergoing postoperative computed tomography (CT) scans.
- Tip fold-over identified using specialized software; electrophysiologic testing (spread of excitation, electric field imaging [EFI]) performed.
- Audiological performance assessed pre- and post-selective deactivation of folded electrodes.
Main Results:
- Six ears (1.98%) exhibited tip fold-over, predominantly at 270 degrees and associated with precurved electrodes.
- No immediate audiological complaints were reported; CT imaging confirmed fold-over.
- Selective deactivation of folded electrodes led to marked audiological improvement in two of three patients.
Conclusions:
- CI tip fold-over is an infrequent but significant complication detectable by CT imaging.
- Selective electrode deactivation can improve audiological outcomes, potentially avoiding revision surgery.
- Electric field imaging (EFI) shows promise for intraoperative detection of tip fold-over.
