Tip fold-over in cochlear implantation: case series
MG Zuniga, A Rivas, A Hedley-Williams… - Otology & …, 2017 - journals.lww.com
Otology & neurotology, 2017•journals.lww.com
Objective: To describe the incidence, clinical presentation, and performance of cochlear
implant (CI) recipients with tip fold-over. Study Design: Retrospective case series. Setting:
Tertiary referral center. Patients: CI recipients who underwent postoperative computed
tomography (CT) scanning. Intervention (s): Tip fold-over was identified tomographically
using previously validated software that identifies the electrode array. Electrophysiologic
testing including spread of excitation or electric field imaging (EFI) was measured on those …
implant (CI) recipients with tip fold-over. Study Design: Retrospective case series. Setting:
Tertiary referral center. Patients: CI recipients who underwent postoperative computed
tomography (CT) scanning. Intervention (s): Tip fold-over was identified tomographically
using previously validated software that identifies the electrode array. Electrophysiologic
testing including spread of excitation or electric field imaging (EFI) was measured on those …
Abstract
Objective:
To describe the incidence, clinical presentation, and performance of cochlear implant (CI) recipients with tip fold-over.
Study Design:
Retrospective case series.
Setting:
Tertiary referral center.
Patients:
CI recipients who underwent postoperative computed tomography (CT) scanning.
Intervention (s):
Tip fold-over was identified tomographically using previously validated software that identifies the electrode array. Electrophysiologic testing including spread of excitation or electric field imaging (EFI) was measured on those with fold-over.
Main Outcome Measure (s):
Location of the fold-over; audiological performance pre and postselective deactivation of fold-over electrodes.
Results:
Three hundred three ears of 235 CI recipients had postoperative CTs available for review. Six (1.98%) had tip fold-over with 5/6 right-sided ears. Tip fold-over occurred predominantly at 270 degrees and was associated with precurved electrodes (5/6). Patients did not report audiological complaints during initial activation. In one patient, the electrode array remained within the scala tympani with preserved residual hearing despite the fold-over. Spread of excitation supported tip fold-over, but the predictive value was not clear. EFI predicted location of the fold-over with clear predictive value in one patient. At an average follow-up of 11 months, three subjects underwent deactivation of the overlapping electrodes with two of them showing marked audiological improvement.
Conclusion:
In a large academic center with experienced surgeons, tip fold-over occurred at a rate of 1.98% but was not immediately identifiable clinically. CT imaging definitively showed tip fold-over. Deactivating involved electrodes may improve performance possibly avoiding revision surgery. EFI may be highly predictive of tip fold-over and can be run intraoperatively, potentially obviating the need for intraop fluoroscopy.
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