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 language | English (US) |
|---|---|
| Pages (from-to) | 169-176 |
| Number of pages | 8 |
| Journal | Otology and Neurotology |
| Volume | 33 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2012 |
| Externally published | Yes |
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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
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 journal › Article
}
TY - JOUR
T1 - An evidence-based algorithm for intraoperative monitoring during cochlear implantation
AU - Cosetti, Maura K.
AU - Troob, Scott
AU - Latzman, Jonathan M.
AU - Shapiro, William H.
AU - Roland, John Thomas
AU - Waltzman, Susan B.
PY - 2012/2
Y1 - 2012/2
N2 - 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.
AB - 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.
KW - Cochlear implants
KW - Electrode impedance
KW - Intraoperative imaging
KW - Intraoperative monitoring
KW - Neural responset elemetry
KW - Spread of excitation
UR - http://www.scopus.com/inward/record.url?scp=84856007404&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84856007404&partnerID=8YFLogxK
U2 - 10.1097/MAO.0b013e3182423175
DO - 10.1097/MAO.0b013e3182423175
M3 - Article
VL - 33
SP - 169
EP - 176
JO - Otology and Neurotology
JF - Otology and Neurotology
SN - 1531-7129
IS - 2
ER -