Elektrodenträger-Fehllage in Bezug zu Morphologie, Design, Chirurgie, Revision und Outcome – was können wir aus der Vergangenheit und was aus der Software-basierten Zukunft lernen?

Objectives: This study investigates whether electrode array (EA) kinking, tip fold-over (TFO), or partial insertion are influenced by cochlear morphology, EA design, and surgeon expertise, and how these factors impact the need for revision surgeries and outcomes. It also evaluates whether software-based planning (Otoplan) can improve these aspects.

Methods: A retrospective analysis of 1333 ears (2003–2023) was conducted using various EA types from Cochlear™, MED-EL, and Advanced Bionics. Digital volume tomography assessed cochlear morphology and EA position, focusing on kinking, TFO, and partial insertion. Surgical protocols and outcomes were compared, including retrospective Otoplan evaluations for MED-EL arrays.

Results: Partial insertion occurred in 2.5% of MED-EL arrays and 0.6% of Slim Straight arrays (Cochlear™), with fewer cases in Flex arrays compared to their predecessors. Otoplan either confirmed surgeons' choices or recommended longer EAs. TFO (1.8%) and kinking occurred only in perimodiolar EAs. All TFO cases were revised, while partial insertion and kinking were not. Surgeon expertise reduced misplacements over time and no significant differences in speech perception were observed after revisions for TFO or partial insertion.

Conclusion: Due to optimized EA design, surgical experience, and improved quality control, the occurrence of partial insertion in straight MED-EL EAs is significantly decreasing and can be further optimized by preoperative Otoplan evaluation. Partial insertion may not require revision if speech perception is unaffected. To avoid TFO in perimodiolar EAs, surgical experience is crucial. However, the use of transimpedance matrix, SmartNav and intraoperative imaging is recommended to provide the option for direct revision if necessary.

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