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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Utility of intraoperative and postoperative radiographs in pediatric cochlear implant surgery
Samantha Anne1, Jose Miguel Juarez2, Amber Shaffer2
1Cleveland Clinic, Cleveland, OH, USA.
Insights
Routine radiographs after pediatric cochlear implant surgery are unnecessary. Changes in management were only prompted by clinician suspicion or abnormal evoked compound action potential (ECAP) measurements, not routine imaging.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Imaging
Background:
- Post-operative plain film radiographs are common practice to confirm pediatric cochlear implant electrode placement.
- The necessity of routine radiographs in this population has been questioned.
Purpose of the Study:
- To evaluate the necessity of routine plain film radiographs for confirming electrode placement in pediatric cochlear implant cases.
Main Methods:
- A retrospective review of pediatric cochlear implant surgeries performed at two tertiary care academic centers between January 2003 and June 2015.
- Exclusion criteria included lack of intraoperative evoked compound action potential (ECAP) data or radiographs, and revision surgeries.
Main Results:
- Of 371 cochlear implants in 235 pediatric patients, 35/369 cases had radiographs due to intraoperative concern, with four abnormal findings leading to management changes.
- An additional case with difficult insertion and abnormal ECAP had a normal radiograph but altered management.
- Routine radiographs in 349/369 cases revealed only one abnormality that did not change management.
Conclusions:
- Abnormal electrode placement requiring management changes was identified through clinician suspicion or abnormal ECAP measurements prior to radiographic evaluation.
- Intraoperative radiographs are valuable when clinical suspicion exists.
- Routine post-operative radiographs in pediatric cochlear implant cases are unnecessary as they do not typically alter management.
Objective:
Routine plain film radiographs are often obtained to confirm proper placement of electrode after pediatric cochlear implant surgery. Objective is to evaluate necessity of routine radiographs in pediatric cochlear implant cases.
Study Design:
Retrospective review.
Setting:
Two tertiary care academic centers.
Subjects And Methods:
Review of all children that underwent cochlear implantation from January 2003 thru June 2015. Exclusions include patients without intraoperative evoked compound action potential (ECAP) data or radiographs and patients undergoing revision surgeries.
Results:
235 pediatric patients underwent 371 cochlear implants. ECAP measurements were not available in two cases and were excluded from study. Radiographs were obtained in 35/369 cases due to intraoperative concern and four had abnormal findings. All four cases underwent change in management. One other patient had an x-ray because of difficult insertion and abnormal ECAP. Radiograph was normal; however, incision was opened and electrodes inserted further. Overall, 5/369 cases had changes in management intraoperatively. In all five cases, abnormalities were suspected by clinician judgment or abnormal ECAP measurements. Routine radiographs were completed in 349/369 cases and one was abnormal. This patient had known partial insertion due to cochlear fibrosis from meningitis and abnormal radiograph did not result in change in management.
Conclusion:
Clinician suspicion and/or abnormal ECAP prompted suspicion for abnormal electrode placement prior to evaluation with radiograph in all cases in which change in management occurred. Intraoperative radiographs may be valuable in setting of clinical suspicion. Routine radiographs do not result in change in management and are, therefore, unnecessary.
