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High Density Event-related Potential Data Acquisition in Cognitive Neuroscience
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Lessons learned in delayed identification of a misplaced electrode array in the vestibule.

Huey Ting Diong1, Yuhan Wong2,3, Shermaine Png1

  • 1Department of Audiology, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.

Journal of Otology
|January 8, 2025
PubMed
Summary

A cochlear implant electrode array was misplaced in the vestibule, causing poor speech performance despite normal hearing. Delayed identification occurred because the patient lacked typical vestibular symptoms.

Keywords:
Cochlear implantationElectrode misplacementNeural response telemetryPoor CI outcomeVestibule

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Audiology

Background:

  • Cochlear implantation is a common treatment for profound hearing loss.
  • Accurate electrode placement is crucial for optimal device function.
  • Electrode misplacement, particularly in the vestibule, can lead to suboptimal outcomes.

Purpose of the Study:

  • To report a case of cochlear implantation with electrode array misplacement in the vestibule.
  • To investigate the reasons for the delayed identification of this misplacement.
  • To highlight the importance of considering atypical presentations in cochlear implant recipients.

Main Methods:

  • A 23-year-old male with single-sided deafness underwent cochlear implantation.
  • Intraoperative assessment and postoperative audiological evaluations were performed.
  • High-resolution computed tomography (HRCT) and neural response telemetry (NRT) were utilized for diagnosis.
  • Revision surgery was conducted.

Main Results:

  • The electrode array was found entirely within the vestibule on HRCT.
  • The patient exhibited poor speech performance despite good aided hearing thresholds.
  • Retrospective NRT analysis showed subtle response differences.
  • The patient did not present with vestibular symptoms due to pre-existing otolithic weakness.

Conclusions:

  • Delayed identification of electrode misplacement can occur, even without typical vestibular symptoms.
  • Atypical presentations necessitate thorough investigation, including advanced imaging and electrophysiological testing.
  • Further research is needed to understand outcomes in cases of electrode misplacement within the vestibule.