The Role of Routine Plain Film Imaging Post Cochlear Implantation

We aimed to evaluate the efficacy of routine post-op X-ray in cochlear implantation patients.

Retrospective chart review study.

Primary or revision cochlear implant patients who had routine postoperative X-ray (XR) or had planned postoperative computed tomography (CT) due to clinical concerns for array malposition.

All images were reviewed, and those were considered abnormal if there was a bent tip, kinking, incomplete insertion, or if the electrode array didn't follow the expected cochlear curvature. Postoperative CT scans were performed in patients with abnormal postoperation X-ray, or if there were abnormal surgical findings encountered during insertion which raised the suspicion for suboptimal placement.

A total of 195 patients with a mean age of 64.8 ± 18.9 years were included. XRs were performed in 188 patients and others had CT scan from the beginning. Only 2 out of 188 patients had abnormal findings on XR, which showed malposition of the electrode in one patient and a tip fold over and incomplete insertion in the other one. Both patients with abnormal findings had labyrinthitis ossificans. The patient with tip fold over ultimately underwent re-implantation. Another patient with incomplete insertion had required extended basal turn drilling during implantation, and no additional measures were taken.

Routine XR findings did not provide the reason for additional intervention, and its benefit for patients without demonstrable cochlear abnormalities was minimal. Post-op XR can be informative in selected high risk patients, but CT imaging is a reasonable alternative to better define anatomic array location in patients particularly at risk.