Early experience with next-generation wireless technology for detecting cochlear implant electrode tip fold-over and placement without X-ray: nucleus SmartNav

Purpose To evaluate the effectiveness of the SmartNav technology in detection of the well-known phenomenon of tip fold-over (TFO) during cochlear implantation (CI) using slim modiolar electrode (SME), comparing it to intraoperative X-ray imaging. Method In 134 ears with normal anatomy that underwent CI using SME at a tertiary center, SmartNav results were compared to intraoperative X-ray findings, with X-ray used as the gold standard for verifying TFO. Results SmartNav identified all 8 TFO cases (100% sensitivity, 99.21% specificity) confirmed by X-ray, including one with subtle distal kinking that X-ray could have missed. Additionally, SmartNav technology was effective in cases with cochlear nerve deficiency and performed reliably under local anesthesia and in revision surgeries. Conclusion SmartNav offers a highly sensitive and reliable method for detecting TFO during CI at least in normal cochlear anatomy, dramatically reducing the need for intraoperative X-ray, thereby decreasing anesthesia time and eliminating radiation exposure.