Identifying Slim Modiolar Electrode Tip Fold‐Over With Intracochlear Electrocochleography

Objective To evaluate the predictive value of intracochlear electrocochleography (ECochG) for identifying tip fold‐over during cochlear implantation (CI) using the slim modiolar electrode (SME) array. Study Design Prospective cohort study. Setting Tertiary referral center. Methods From July 2022 to June 2023, 142 patients, including adults and children, underwent intracochlear ECochG monitoring during and after SME placement. Tone‐bursts were presented from 250 Hz to 2 kHz at 108 to 114 dB HL. A fast Fourier transform (FFT) allowed for frequency‐specific evaluation of ECochG response. ECochG patterns during insertion and postinsertion were evaluated using sensitivity and specificity analysis to predict tip fold‐over. Intraoperative plain radiographs served as a reference standard. Results Fifteen tip fold‐over cases occurred (10.6%) with significant ECochG response (>2 µV). Sixty‐one cases without tip fold‐over occurred (43.0%) with significant ECochG response. All tip fold‐overs had both a nontonotopic postinsertion sweep and nonrobust active insertion pattern. No patients with robust insertion or tonotopic sweep patterns had tip fold‐over. Sensitivity of detecting tip fold‐over when having both nonrobust insertion and nontonotopic sweep patterns was 100% (95% confidence inteval [CI] 78.2%‐100%), specificity was 68.9% (95% CI 55.7%‐80.1%), and the overall accuracy was 72.0% (95% CI 60.5%‐81.7%). Conclusion Intracochlear ECochG monitoring during cochlear implantation with the SME can be a valuable tool for identifying properly positioned electrode arrays. In cases where ECochG patterns are nonrobust on insertion and nontonotopic for electrode sweeps, there may be a concern for tip fold‐over, and intraoperative imaging is necessary to confirm proper insertion.