Scalar position in cochlear implant surgery and outcome in residual hearing and the vestibular system

Abstract

Objective: To evaluate the effect of the intracochlear electrode position on the residual hearing and VNG- and cVEMP responses. Design: Prospective pilot study. Study sample: Thirteen adult patients who underwent unilateral cochlear implant surgery were examined with high-resolution rotational tomography after cochlear implantation. All subjects were also tested with VNG, and 12 of the subjects were tested with cVEMP and audiometry before and after surgery. Results: We found that although the electrode was originally planned to be positioned inside the scala tympani, only 8 of 13 had full insertion into the scala tympani. Loss of cVEMP response occurred to the same extent in the group with full scala tympani positioning and the group with scala vestibuli involvement. There was a non-significant difference in the loss of caloric response and residual hearing between the two groups. Interscalar dislocation of the electrode inside the cochlea was observed in two patients. A higher loss of residual hearing could be seen in the group with electrode dislocation between the scalae. Conclusions: Our findings indicate that intracochlear electrode dislocation is a possible cause to loss of residual hearing during cochlear implantation but cannot be the sole cause of postoperative vestibular loss.

Key Words::

• Cochlear implant
• vertigo
• scalar position
• scala tympani
• flat panel-CT
• cVEMP
• VNG
• residual hearing

Acknowledgements

The authors thank diagnostic radiographer Hilde Sofie Korslund, and the Intervention Centre, Oslo University Hospital for valuable help in the performing and reconstruction of flat panel CT scans.

Declaration of interest: The authors report no conflicts of interest. The authors are responsible for the content and writing of the paper.