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An unusual occurrence in cochlear implantation surgery: misplaced electrode

Published online by Cambridge University Press:  04 November 2008

R Ramalingam ,
K K Ramalingam  and
H S Padmaja
R Ramalingam
Affiliation:
Head and Neck department of the KKR, ENT Hospital and Research Institute, Chennai, India
K K Ramalingam*
Affiliation:
Head and Neck department of the KKR, ENT Hospital and Research Institute, Chennai, India
H S Padmaja
Affiliation:
Head and Neck department of the KKR, ENT Hospital and Research Institute, Chennai, India
*
Address for correspondence: Prof K K Ramalingam, KKR ENT Hospital and Research Institute (P) Ltd, 274 Poonamallee High Road, Kilpauk, Chennai 600010, India. Fax: 91 44 26412727 E-mail: kkrenthospital@gmail.com
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Abstract

Objective:

To highlight the possibility of misplacement of electrodes during cochlear implantation surgery, to stress the importance of routine neural response telemetry, and also to emphasise the value of conventional radiography in confirming electrode positioning in the immediate post-operative period.

Case report:

A two-year-old boy presented with bilateral, profound, sensorineural hearing loss and underwent conventional cochlear implantation surgery. During insertion of the implant, there was doubt regarding the direction of passage of the electrode array. Instead of the usual smooth passage of the electrode, some resistance was felt. Neural response telemetry, performed at the end of the procedure, showed absent responses. A confirmatory X-ray in Stenver's view confirmed the extra-cochlear positioning of the electrodes in the superior semicircular canal. The wound was reopened, the electrode array removed and the cochleostomy was positioned a little more antero-inferiorly on the promontory with respect to the round window. Correct insertion of the electrode was then performed without difficulty.

Conclusion:

The misplacement of electrodes during cochlear implantation surgery is rare but can occur. Neural response telemetry and conventional radiography are invaluable in assessing the placement of the electrode intra-operatively. Conventional radiographs are very cost-effective and aid in confirming the position of the electrode array.

Keywords

Cochlear ImplantsComplicationsRadiologyTelemetry
Type
Online Only Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 1 , January 2009 , e4
Copyright
Copyright © JLO (1984) Limited 2008

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