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Cochlear implant electrode array misplacement: a cautionary case report

  • E Muzzi (a1) (a2), P Boscolo-Rizzo (a3), R Santarelli (a1) and M A Beltrame (a4)

To report a series of pitfalls and complications in a case of cochlear implantation.


Case report.


An 11-year-old boy affected by auditory neuropathy underwent cochlear implantation. Intra-operative assessment was apparently consistent with correct insertion of the electrode array into the cochlea. However, subsequent high resolution computed tomography revealed that the entire electrode array was curled up within the vestibule. Revision surgery was complicated by cerebrospinal fluid leakage. A straight probe was repeatedly inserted into the internal auditory canal, before conversion to a canal wall down procedure and appropriate positioning of the electrode array.


In this case, mild anteriorisation of the facial nerve created an awkward insertion angle for the electrode array via the retro-facial route, which may have triggered the described series of adverse events.

Corresponding author
Address for correspondence: Dr Enrico Muzzi, Audiology and Phoniatrics Service, Department of Medical and Surgical Specialties, University of Padua School of Medicine, Treviso Regional Hospital, Piazza Ospedale, 1-31100 Treviso, Italy Fax: +39 0422 322351 E-mail:
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1 R Jain , SK Mukherji . Cochlear implant failure: imaging evaluation of the electrode course. Clin Radiol 2003;58:288–93

2 CL Runge-Samuelson , S Drake , PA Wackym . Quantitative analysis of electrically evoked auditory brainstem responses in implanted children with auditory neuropathy/dyssynchrony. Otol Neurotol 2008;29:174–8

3 JT Roland Jr. A model for cochlear implant electrode insertion and force evaluation: results with a new electrode design and insertion technique. Laryngoscope 2005;115:1325–39

4 RA Tange , W Grolman , A Maat . Intracochlear misdirected implantation of a cochlear implant. Acta Otolaryngol 2006;126:650–2

5 BJ Copeland , HC Pillsbury , CA Buchman . Prospective evaluation of intraoperative cochlear implant radiographs. Otol Neurotol 2004;25:295–7

6 H Pau , A Parker , H Sanli , WP Gibson . Displacement of electrodes of a cochlear implant into the vestibular system: intra- and postoperative electrophysiological analyses. Acta Otolaryngol 2005;125:1116–18

7 MA Beltrame , GN Frau , M Shanks , P Robinson , I Anderson . Double posterior labyrinthotomy technique: results in three Med-El patients with common cavity. Otol Neurotol 2005;26:177–82

8 CC Huang , CY Lin , JL Wu . Retrofacial approach of cochlear implantation in inner ear malformation with aberrant facial nerve: a case report. Auris Nasus Larynx 2006;33:179–82

11 T Sorrentino , M Coté , E Eter , ML Laborde , N Cochard , O Deguine Cochlear reimplantations: technical and surgical failures. Acta Otolaryngol 2009;129:380–4

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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