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Scalar localization of the electrode array using the cone beam computed tomography: A comparative
study between straight and periomodiolar precurved electrode array
Schmerber S. , Boyer E. , Attye A. , Lefournier V. , Escude B. , Karkas A.
University Hospital of Grenoble, Otology, Neurotology, Auditory Implants, Grenoble, France, 2Clinique Pasteur, 31000, Toulouse, France
Objectives: To compare the fidelity of conebeam x-ray CT (CBCT) in vivo imaging in characterizing cochlear
implant insertion between a straight electrode array and a precurved perimodiolar electrode array.
Materials: Fifty one adults patients and 60 implants were included in the investigation (nine patients had a
bilateral implantation), 27 women and 26 men. The mean age was 49.9 years old (18 - 89). All subjects had
binaural deafness or severe sensorineural hearing loss in non-malformed cochleas.
Thirty patients were implanted with a Cochlear N24RE(CA) implant (Cochlear Corp., Sydney, Australia) fitted
with the Advance Off-Stylet (AOS) electrode insertion technique.
Thirty patients were implanted with a MED-EL (GmbH, Innsbruck, Austria) Flexsoft standard (9 implants),
Flexsoft 28 (18 implants) and Flexsoft 24 (3 implants).
In all subjects, round window insertion technique had been applied by the same surgeon using a pure round
window full insertion, i.e. through a vertical micro incision in the anterior quadrant of the RW membrane.
Complete insertion within the round window had been performed in all cases. For this study, approval by the
ethics committee of the university hospital was obtained.
Radiological procedure: Post-operative CBCT imaging was performed with a NewTom 5G (NewTom, Verona,
Italy). The system used a 200 x 25 mm flat panel detector at 650 mm from the radiation source. The 360°
rotation of the X-ray tube took 18s. Tube voltage was 110kV, with a 19 mA charge at the terminals. Total
filtrations were 2 mm and pitch 125 µm, with field of view corresponding to a 12 x 7.5 cm diameter cylinder.
Images were reconstructed in 125 µm isometric voxels and obtained in axial, coronal and sagittal planes, using
the software provided by NewTom.
Image Analysis: CBCT imaging of the temporal bones was reviewed by three independent neuroradiologists who
were blinded to the details of the electrode insertion, electrode orientation and insertion depth. Evaluation of the
3D imaging included an assessment of the scala implanted and Basilar membrane disruption.
Results: The results were collelated within the 3 neuroradiologists in 56 out of 60 implants. A rereading was
performed for 4 mismatches by the three neuroradiologists. In the perimodiolar electrode array group (Cochlear)
(n= 30) a disruption of the basilar membrane was observed in 2 cases and an elevation of basilar membrane in 7
other cases. In the straight electrode array group (MED-EL) (n = 30), no disruption of the basilar membrane was
observed and an elevation of the basilar membrane was observed in 3 cases with standard Mendel electrodes.
Conclusion: CBCT is a fast and accurate examination in the postoperative imaging of cochlear implants that
enables to control the scala position of the electrode array. A straight flexible electrode array has a higher
chance of a strict scala tympani positioning than a perimodiolar precurved electrode array.