Apical Electrode Placement to Augment Intracochlear Current in Patients With an Ossified Cochlea and Incomplete Electrode Array Insertion

Objective: To describe a novel surgical technique utilizing the placement of an apical ground electrode to facilitate intracochlear current modulation in patients with cochlear ossification and incomplete electrode array insertion. Patients: Patients with incomplete standard electrode array insertion due to cochlear ossification. Intervention: Standard cochlear implant (CI) electrode array insertion, in addition to the placement of the extracochlear ground electrode into the cochlear apex to enable current steering through areas of cochlear ossification and towards the cochlear apex. Main outcome measures: Procedural safety and patient-reported perceptual differences between programming configurations utilizing the apical ground. Results: Placement of an apical ground electrode was safe and feasible in 3 patients with complex ossified cochlea and was able to augment sound perception, and improve performance, after adjustments to device programming. Conclusions: Apical ground electrode placement represents a technically achievable adjunct in selected patients with ossified cochlea and incomplete electrode array insertion. This approach may expand the functional stimulation field utilizing intracochlear current modulation to improve patient performance.