electrode failures (electrode migration, misplacement, etc.,)

[hadron]

@Nikki

@jamesluk had revision surgery due to misplacement of the Flex28. His story starts at beginning of this thread.

[jamesluk]

Hi Nikki,

 

I had a revision surgery in late April -- done by a different surgeon with more experience. Dr. took picture to prove that the device is properly inserted. I will know the result this fall when I activate the new device as I am travelling.

[Mary Beth]

Wishing you the best James

[Hila]

3 hours ago, jamesluk said:

Hi Nikki,

 

I had a revision surgery in late April -- done by a different surgeon with more experience. Dr. took picture to prove that the device is properly inserted. I will know the result this fall when I activate the new device as I am travelling.

Hi James,  

Thank you for sharing your experience here. I did read throughout before adding bc the similarities were striking.   Possibly, I'll  get my revision surgery before I get a chance to hear from you about your activation in the fall, but it'd be fantastic to hear how it went.  Best wishes! 

[hadron]

Hi Nikki,

Sorry to hear you are having issues.

Perhaps Leigh can help you find someone whom has gone through revision surgery.

@leighf

[Hila]

Thank you @hadron

[Hila]

I was intrigued to know more about the connection between electrode position in the cochlea and speech recognition.  

[hadron]

I was thinking that it may not be misplacement. This usually occurs when the electrode array is not inserted in the scala tympani. The preferred placement inside the cochlea. I believe James did have electrode misplacemenr.

You may instead have partial insertion of the electrode away. There are several reasons why partial insertion occurs. Ask your surgeon if a partial insertion occurred and what caused it.

Below is as link to a paper which discusses partial insertion.

https://www.karger.com/Article/FullText/316445

Sent from my LG-H871 using Tapatalk
 

[jamesluk]

hadron is probably right. As I had the last two electrodes placed outside the cochlear window so they didn't touch the cochlear.It is hard to program the device with misplacement. As for me, I hear very high-pitched sound with little speech recognition. So I needed a revision surgery and hope it will work after activation. Good luck to all.

[hadron]

The scala tympani is the ideal place for electrode array insertion. The Round Window is an important landmark and is rarely absent. Failure to identify the round window can result in inadvertent misplacement of the electrode array into the scala vestibule or entirely outside the turns of the cochlea. Locations of inadvertent misplacement of the electrode array include the semi circular canals, vestibule, Eustachian tube and the interior auditory canal.

For @jamesluk the electrode array was mispositioned and electrodes 11 and 12 were entirely outside the turns of the cochlea and far from the neurons they needed to interact with to understand speech. Electrodes 1-10 were inside the cochlea but electrodes 11 and 12 may of fractured off. With revision surgery a more experienced surgeon fully inserted the electrode array into the scala tympani.

In @Nikki the electrode array was also mispositioned with at least 3 electrodes entirely outside the turns of the cochlea. The rest of the electrodes are partially in the cochlea with none past the first curve. As in the previous case  the electrodes ended up far from the neurons they needed to interact with to understand speech. This sounds very similar to Jamesluk where the distal part of the electrode array may have fractured off leading to mispositioning.

In  @Jdashiell the electrode array was probably inserted into the scala tympani but it did a tip flip, which essentially means it folded over itself. Thus only half the electrodes were inserted. Unfortunately it appears this happened twice. May be due to inexperience of surgeon.

[Hila]

@hadronI was able to see in the imaging that at least 3 electrodes are outside the cochlea. The rest are inserted partially, none past the first curve. Forgive me for not catching up on all the anatomical terms just yet.  

  

[hadron]

@Nikki I updated the post. Thanks. Includes new figures.

[Kara of Canada]

This is horrible Nikki and everyone! I hope you all get this issue resolved with your revision. 

[MED-EL Moderator]

On 8/5/2017 at 10:12 PM, hadron said:

Hi Nikki,

Sorry to hear you are having issues.

Perhaps Leigh can help you find someone whom has gone through revision surgery.

@leighf

Hi Nikki,

Thank you for reaching out to the HearPeers community and I'm sorry to hear about your experience. It seems like you are already in close communication with your CI Team, and I would suggest continuing to do so, and to stay in close contact with your local MED-EL Representative. If you like, I can ask your Representative to keep an eye out for others in the US who may have had a similar experience and who may be able to share advice with you.

Wishing you all the best and please do let us know if we can assist in any way further.

Kind regards,

Leigh

HearPeers Support Team

[Hila]

Thank you @hadronand @leighf!

[hadron]

Good luck Nikki. Keep us posted.

Sent from my LG-H871 using Tapatalk

[hadron]

@Sumi Xavier. In this thread 3 cases of electrode failure requiring reimplantation.

[Ivana Marinac]

I would add also a possibility that these cochleas has calcified over the time - we do not know much about the primary source of @Nikki and @Jdashiell hearing loss. 

In these cochleas, it's hard to implant the electrode without stop. Definitely, a CT scan show what's going on.

[Jdashiell]

Well another CT scan revealed the second left implant electrodes got as far as the first turn in the cochlea, then flipped around on itself. 

So the new surgeon and I are agreed on another surgery (3x on left ear) to remove the implant and work on implanting another MedEl Flex28 (preferred!) and will have a backup implant with Cochlear America (stiffer, IF necessary). I am OK with two different processors if the end result is improved hearing. But I REALLY want to stay with MedEl - 1 type, one FineTuner, easier life. 

My surgeon is experienced 

[Ivana Marinac]

That's a rare "luck" - I have seen example of this flipping for the first time this spring on the congress. 

Did you speak about classic series, standard electrode or even the compressed one if there is a hurdle on its way?

 

[Mary Beth]

@Jdashiell

 

I have my fingers crossed for you Joe!  I needed a stiffer electrode array in my right ear so they used the Med El medium array, which is 24 mm in length.  I have the flex 28 in my left ear.  Both work great alone and together.  Having one implant brand does make life easier for us.  

Sure hope third time is the charm.  You deserve it!

[Mary Beth]

@Jdashiell

 

When is your surgery so we can keep you in our thoughts for a very successful, fully inserted electrode array?

[Jdashiell]

I meet my surgeon this Friday and hope to know then or soon after. I want this to happen asap so sometime in September or October. The sooner the better!

[hadron]

@Jdashiell hard to believe you had another fold over. Next time is the charm.

[Mary Beth]

@Jdashiell

 

Please keep us posted Joe.