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Characterization of Tip Fold-Over Using Fluoroscopy and Intracochlear Pressure in Cadaver Specimens.

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Cochlear implant tip fold-over events were characterized into three subtypes. Elevated pressures during insertion indicate electrode twisting, potentially impacting speech perception.

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Area of Science:

  • Otolaryngology
  • Biomedical Engineering
  • Neurosurgery

Background:

  • Cochlear implant (CI) array malpositioning, including tip fold-over, can negatively affect speech perception and lead to adverse events.
  • Tip fold-over is more common with perimodiolar electrodes but has been poorly understood due to limited data on electrode mechanics within the cochlea.

Purpose of the Study:

  • To characterize the mechanical behaviors of cochlear implant tip fold-over events.
  • To analyze the insertion pressure profiles associated with tip fold-over events.

Main Methods:

  • Cadaveric human heads were used for surgical preparation.
  • Intracochlear pressures were measured using fiberoptic sensors in the scala vestibuli and tympani.
  • Perimodiolar CI electrodes (Cochlear Slim-Modiolar, CI532) were inserted via the round window under fluoroscopic guidance.

Main Results:

  • Three distinct tip fold-over subtypes were identified: anterior-posterior C-shaped, medial-lateral C-shaped, and S-shaped roll-overs.
  • The highest transient pressures were observed during anterior-posterior and S-type fold-overs, correlating with electrode rotation or twisting.
  • Elevated pressure transients preceded and accompanied tip fold-over events, linked to electrode twisting.

Conclusions:

  • The study identified and characterized at least three subtypes of cochlear implant tip fold-over.
  • Elevated intracochlear pressures and electrode twisting are associated with tip fold-over events.
  • Subtyping tip fold-over may facilitate intraoperative identification and improve patient outcomes, though further research on intracochlear electrode movement is needed.