Utility of Intraoperative Radiographs in Pediatric Cochlear Implant Surgery

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Pediatric cochlear implantation (CI) aims to restore hearing in children with severe to profound hearing loss.
• Accurate electrode placement is critical for optimal CI outcomes.
• Intraoperative assessment of electrode position is essential to prevent complications.

Purpose of the Study:

• To evaluate the diagnostic role of intraoperative radiographs in confirming electrode position after pediatric cochlear implantation (CI).
• To assess the association between specific electrode types and the risk of malposition.
• To determine the impact of intraoperative imaging on surgical management.

Main Methods:

• Retrospective chart review of pediatric CI cases over a 13-year period at a single tertiary care center.
• Analysis of 492 procedures in 326 patients, focusing on electrode position and surgical interventions.
• Comparison of electrode malposition rates and management changes between Cochlear's Slim Modiolar and Contour Advance (CA) electrodes.

Main Results:

• Seven cases (1.4%) required intraoperative electrode reinsertion due to malposition.
• Intraoperative X-rays identified malposition in 6 of the 7 cases.
• The Slim Modiolar electrode was associated with a significantly higher incidence of abnormal X-rays (4%) and malposition compared to the CA electrode (0.3%).
• Electrode fold-over was identified on X-ray in all 4 cases involving the Slim Modiolar electrode requiring reinsertion.

Conclusions:

• Intraoperative radiographs are effective in identifying electrode malposition during pediatric CI.
• The Slim Modiolar electrode presents a higher risk of malposition, particularly electrode fold-over, compared to the CA electrode.
• Routine use of intraoperative skull X-rays is recommended to confirm electrode position, especially with the Slim Modiolar electrode, to ensure optimal surgical outcomes.