Utilization of SmartNav technology in cochlear implantation: optimizing efficiency in assessment of electrode placement

Abstract

Objectives

Proper electrode placement is essential for favorable hearing outcomes following cochlear implantation. Though often used, traditional intraoperative X-ray imaging is time consuming, exposes patients and staff to radiation, and poses interpretational challenges. The Nucleus® SmartNav System, utilizes electrode voltage telemetry (EVT) to analyze the positioning of the electrode array intraoperatively. This study investigates the efficacy of SmartNav in optimizing the efficiency and accuracy of assessing electrode placement.

Methods

This prospective clinical study analyzed placement of 50 consecutive Cochlear Corporation cochlear implants conducted at a single institution between March of 2022 and June of 2023. Placement check of electrode array using SmartNav and X-ray was completed and individually assessed. A comparative analysis of SmartNav and X-ray completion times for electrode placement assessment was conducted.

Results

Subjects included nine ears with abnormal anatomy and three reimplants. SmartNav placement check required a total time of 2.12 min compared to X-ray imaging at 14.23 min (p = 1.6E-16, CI 95%). Both SmartNav and X-ray had excellent sensitivity of 100% in identifying appropriate electrode position (p = 1.0). Tip fold-over was identified using both modalities in 3 cases with noted easier interpretation using SmartNav.

Conclusion

The Nucleus® SmartNav System significantly outperformed traditional X-ray imaging, offering a faster and more straightforward approach to assessing electrode positioning during cochlear implant surgery, thereby enhancing surgical efficiency and patient safety.

Keywords:

• Cochlear Implant
• Nucleus® Smartnav System
• Smartnav
• Intraoperative Imaging
• Cochlear Implant Surgery
• X-ray
• Electrode Placement

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analyzed during this study are available at Harvard Dataverse https://doi.org/10.7910/DVN/QA9UIQ

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Additional information

Funding

This work was supported by Cochlear [Grant Number 202110200].

Notes on contributors

Jaimee Cooper

Jaimee Cooper is a rising MSIV at New York Medical College.

Katrina R. Stidham

Katrina R. Stidham, M.D. is the Chief of Neurotology at WMCHealth, and the Director of the Cochlear Implant Center at WMCHealth.

Samantha Morgan

Samantha Morgan AuD is an Audiologist at WIHD and a clinical audiologist at the Cochlear Implant Center at WMCHealth.

Mindy Schmelzer

Mindy Schmelzer AuD is the Director of Audiology at WIHD and the Cochlear Implant Center at WMCHealth.

Regina Albinus

Regina Albinus, M.S. CCC-A is an audiologist at WIHD and WMCHealth.