Knörle Esther, Vazzana Caterina, Stöver Timo, Helbig Silke
Department of Otorhinolaryngology, Head and Neck Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, D-60590, Frankfurt am Main, Germany.
Eur Arch Otorhinolaryngol. 2025 Jul;282(7):3449-3456. doi: 10.1007/s00405-025-09235-w. Epub 2025 Feb 1.
To assess whether increasing experience with implantation of a thin preformed electrode array for perimodiolar insertion reduces the incidence of tip fold-over (TFO).
The retrospective study included 100 patients who received a cochlear implant (CI) with the Slim Modiolar (SM) electrode array (Cochlear, Sydney, Australia) at a university CI centre between November 2015 and December 2022. Postoperative radiological imaging was performed to verify electrode position. Surgical reports and radiological images were reviewed and the incidence of TFO was analyzed for three experienced CI surgeons. In addition, the incidence of intraoperative measurements showing evidence of electrode malposition and the mean duration of surgery over time were documented.
129 SM implantations in 100 patients were included. In seven cases (5.4%) TFO was radiologically detected and successfully revised. In eight cases (6.2%), electrophysiological measurements indicated misplacement and the position was corrected during the same surgery. For one surgeon, five out of 67 implantations (7.5%) were affected by TFO, with the frequency of this complication decreasing over time. The average surgery time for all surgeons was 122.2 (± 44.2) minutes, with two surgeons showing a decrease over time.
The results show a tendency that the SM electrodes can be implanted with a lower complication rate and faster over time. Therefore, it can be assumed that the implantation of the SM electrode requires a certain amount of practice, even for experienced surgeons. As intraoperative electrophysiological measurements detected 71.4% of all radiologically confirmed TFOs, their use is highly recommended.
评估增加使用预成型细电极阵列进行蜗周植入的经验是否会降低电极尖端折叠（TFO）的发生率。
这项回顾性研究纳入了2015年11月至2022年12月期间在某大学人工耳蜗（CI）中心接受使用细蜗轴（SM）电极阵列（澳大利亚悉尼科利耳公司）进行人工耳蜗植入的100例患者。术后进行放射影像学检查以确认电极位置。回顾手术报告和放射影像，分析三位经验丰富的CI外科医生的TFO发生率。此外，记录术中测量显示电极位置不当的发生率以及随时间推移的平均手术时长。
纳入100例患者的129次SM植入手术。在7例（5.4%）中通过放射影像学检测到TFO并成功进行了修正。在8例（6.2%）中，电生理测量表明位置不当并在同一次手术中进行了纠正。对于一位外科医生，67例植入手术中有5例（7.5%）受到TFO影响，该并发症的发生率随时间下降。所有外科医生的平均手术时间为122.2（±44.2）分钟，两位外科医生的手术时间随时间有所下降。
结果显示出一种趋势，即随着时间推移，SM电极能够以更低的并发症发生率且更快地进行植入。因此，可以认为即使对于经验丰富的外科医生，植入SM电极也需要一定量的实践。由于术中电生理测量检测到了所有经放射影像学证实的TFO中的71.4%，强烈推荐使用它们。
