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Intra-operative skull X-ray for misdirection of the cochlear implant array into the vestibular labyrinth

Published online by Cambridge University Press:  28 August 2015

A M Hassan ,
R Patel  and
M Redleaf
A M Hassan*
Affiliation:
College of Medicine, University of Illinois at Chicago, Illinois, USA
R Patel
Affiliation:
York ENT Surgical Consultants, Hinsdale, Illinois, USA
M Redleaf
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Illinois at Chicago, USA
*
Address for correspondence: Mr Ahmad M Hassan, College of Medicine, University of Illinois at Chicago, 808 S Wood St, Chicago, IL 60612, USA E-mail: ahassa8@uic.edu
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Abstract

Objectives:

This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray.

Methods:

The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging.

Results:

There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray.

Conclusion:

These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.

Keywords

Cochlear ImplantationCochlear ImplantsCochleaSemicircular CanalsVestibular Labyrinth
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 9 , September 2015 , pp. 923 - 927
Copyright
Copyright © JLO (1984) Limited 2015 

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