An evidence-based algorithm for intraoperative monitoring during cochlear implantation

Maura K. Cosetti, Scott Troob, Jonathan M. Latzman, William H. Shapiro, John Thomas Roland, Susan B. Waltzman

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVE: To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI). STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included. INTERVENTION: Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography. MAIN OUTCOME MEASURE: Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position. RESULTS: No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device. CONCLUSION: Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.

Original languageEnglish (US)
Pages (from-to)169-176
Number of pages8
JournalOtology and Neurotology
Volume33
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Fingerprint

Intraoperative Monitoring
Cochlear Implantation
Electrodes
Electric Impedance
Equipment and Supplies
Motion Pictures
Radiography
Telemetry
Cochlea
Tertiary Care Centers
Anatomy
Decision Making

Keywords

  • Cochlear implants
  • Electrode impedance
  • Intraoperative imaging
  • Intraoperative monitoring
  • Neural responset elemetry
  • Spread of excitation

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems
  • Medicine(all)

Cite this

Cosetti, M. K., Troob, S., Latzman, J. M., Shapiro, W. H., Roland, J. T., & Waltzman, S. B. (2012). An evidence-based algorithm for intraoperative monitoring during cochlear implantation. Otology and Neurotology, 33(2), 169-176. https://doi.org/10.1097/MAO.0b013e3182423175

An evidence-based algorithm for intraoperative monitoring during cochlear implantation. / Cosetti, Maura K.; Troob, Scott; Latzman, Jonathan M.; Shapiro, William H.; Roland, John Thomas; Waltzman, Susan B.

In: Otology and Neurotology, Vol. 33, No. 2, 02.2012, p. 169-176.

Research output: Contribution to journalArticle

Cosetti, MK, Troob, S, Latzman, JM, Shapiro, WH, Roland, JT & Waltzman, SB 2012, 'An evidence-based algorithm for intraoperative monitoring during cochlear implantation', Otology and Neurotology, vol. 33, no. 2, pp. 169-176. https://doi.org/10.1097/MAO.0b013e3182423175
Cosetti, Maura K. ; Troob, Scott ; Latzman, Jonathan M. ; Shapiro, William H. ; Roland, John Thomas ; Waltzman, Susan B. / An evidence-based algorithm for intraoperative monitoring during cochlear implantation. In: Otology and Neurotology. 2012 ; Vol. 33, No. 2. pp. 169-176.
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