Scalar Localization by Cone-Beam Computed Tomography of Cochlear Implant Carriers: A Comparative Study Between Straight and Periomodiolar Precurved Electrode Arrays

Objective: To compare the incidence of dislocation of precurved versus straight flexible cochlear implant electrode arrays using cone-beam computed tomography (CBCT) image analyses. Study Design: Consecutive nonrandomized case-comparison study. Settings: Tertiary referral center. Patients: Analyses of patients' CBCT images after cochlear implant surgery. Intervention(s): Precurved and straight flexible electrode arrays from two different manufacturers were implanted. A round window insertion was performed in most cases. Two cases necessitated a cochleostomy. The patients' CBCT images were reconstructed in the coronal oblique, sagittal oblique, and axial oblique section. Main Outcome Measures: The insertion depth angle and the incidence of dislocation from the scala tympani to the scala vestibuli were determined. Results: The CBCT images and the incidence of dislocation were analyzed in 54 patients (61 electrode arrays). Thirty-one patients were implanted with a precurved perimodiolar electrode array and 30 patients with a straight flexible electrode array. A total of nine (15%) scalar dislocations were observed in both groups. Eight (26%) scalar dislocations were observed in the precurved array group and one (3%) in the straight array group. Dislocation occurred at an insertion depth angle between 170 and 190 degrees in the precurved array group and at approximately 370 degrees in the straight array group. Conclusion: With precurved arrays, dislocation usually occurs in the ascending part of the basal turn of the cochlea. With straight flexible electrode arrays, the incidence of dislocation was lower, and it seems that straight flexible arrays have a higher chance of a confined position within the scala tympani than perimodiolar precurved arrays.