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Alexander Müller1, Miriam H Kropp1, Parwis Mir-Salim1

  • 1Hörzentrum Berlin (HZB), Klinik für HNO, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland.

Zeitschrift Fur Medizinische Physik
|September 9, 2020
PubMed
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An automated cochlear implant (CI) tip-fold-over (TFO) screening using electrode 22 measurements reliably identifies electrode array misplacements. This method avoids radiation exposure and offers high accuracy for intraoperative assessment.

Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Cochlear implantation (CI) can result in electrode array tip-fold-over (TFO), a misalignment requiring detection.
  • Current detection methods include post-operative X-rays (gold standard) exposing patients to radiation, or spread of excitation (SOE) measurements needing expertise.
  • An automated screening aims for reliable, low-effort intraoperative assessment of CI electrode array position.

Purpose of the Study:

  • To evaluate an automated screening procedure for detecting tip-fold-over (TFO) in cochlear implant (CI) electrode arrays.
  • To assess the feasibility and accuracy of intraoperative TFO screening with minimal patient effort and radiation exposure.

Main Methods:

  • A bi-centric study involving over 100 adult patients undergoing cochlear implantation (CI) with Cochlear™ Nucleus® implants.
Keywords:
Bildgebende DiagnostikCochlea ImplantatCochlea implantECAPImaging diagnosticScreeningSpread of ExcitationTip fold-overTip-Foldover

Related Experiment Videos

  • Intraoperative tip-fold-over (TFO) screening using electrically evoked compound action potential (ECAP) AutoNRT™ and spread of excitation (SOE) measurements on electrodes 13 and 22.
  • Automated evaluation of SOE data for dichotomous classification (normal/abnormal), with X-ray as the reference method.

    • Main Results:

    • The intraoperative TFO screening was applicable in approximately 80% of cases.
    • Accuracy for SOE measurements was 63.9% (electrode 13) and 95.4% (electrode 22), with classification errors of 36.1% and 4.6%, respectively.
    • Sensitivity for detecting radiologically proven TFOs was 100%, with specificity exceeding 95% when using electrode 22.

    Conclusions:

    • Intraoperative TFO screening using measurements at electrode 22 effectively distinguishes correct from incorrect CI electrode array positions.
    • This automated method offers a reliable, radiation-free alternative for intraoperative assessment.
    • Cases not definitively classified by screening may still require further imaging for confirmation.