The Influence of Intraoperative Testing on Surgical Decision-making During Cochlear Implantation.

OBJECTIVE

To review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

PATIENTS

A total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon from 2010 to 2015.

INTERVENTION

Intraoperative electrophysiologic monitoring including evoked compound action potentials and electrical impedances.

MAIN OUTCOME MEASURES

Whether surgical management was changed based on intraoperative testing.

RESULTS

In only 2 of 266 patients (0.8%), the back-up device was used due to findings on intraoperative testing. In three patients (1.1%), X-ray was performed intraoperatively to confirm intracochlear electrode placement, which was found to be normal in all patients.

CONCLUSION

Our data suggest that with respect to CI in children and adults in straightforward cases (e.g., normal anatomy, nondifficult insertion, etc.), routine intraoperative evoked compound action potentials, impedances, and imaging rarely influence surgical decision-making in our clinic and may have limited usefulness in these patients. The implications of this are discussed and a review of the literature is presented.