Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2012
An evidence-based algorithm for intraoperative monitoring during cochlear implantation.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Cosetti Maura K, Troob Scott H, Latzman Jonathan M, Shapiro William H, Roland John Thomas, Waltzman Susan B
Аннотация
OBJECTIVE: To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI).
STUDY DESIGN: Retrospective review.
SETTING: Tertiary referral center.
PATIENTS: A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included.
INTERVENTION: Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography.
MAIN OUTCOME MEASURE: Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position.
RESULTS: No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device.
CONCLUSION: Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.
STUDY DESIGN: Retrospective review.
SETTING: Tertiary referral center.
PATIENTS: A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included.
INTERVENTION: Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography.
MAIN OUTCOME MEASURE: Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position.
RESULTS: No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device.
CONCLUSION: Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.
Предметные рубрики MeSH
Action PotentialsAdolescentAdultAgedAged, 80 and overAlgorithmsChildChild, PreschoolCochleaCochlear ImplantationCochlear ImplantsElectric ImpedanceElectrodesElectroencephalographyElectrophysiological PhenomenaEvidence-Based MedicineFemaleHumansInfantMaleMastoidMiddle AgedMonitoring, IntraoperativeOtologic Surgical ProceduresRadiographyRetrospective StudiesSoftwareTelemetryTympanoplastyYoung Adult