Assessment of Angular Insertion-Depth of Bilateral Cochlear Implants Using Plain X-ray Scans.

Meirav Sokolov, Ofir Zavdy, Eyal Raveh, David Ulanovski, Yoseph Attias, Ohad Hilly

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate in cochlear implant patients, the feasibility and reliability of angular depth of insertion (aDOI) measurements using plain x-ray scans.Study Design: Retrospective study where three observers independently evaluated and compared intraoperative anterior-posterior and oblique x-ray scans.Setting: A tertiary pediatric medical center.Patients: Included were 50 children (100 ears) who underwent bilateral simultaneous cochlear implantation during 2008 to 2015.Main Outcome Measures: Inter-rater agreement of aDOI measured in plain x-ray scans; effect of head position on measured aDOI; and symmetry of aDOI between patients' ears in bilateral simultaneous cochlear implantations.Results: Differences in the average aDOI measurements among the three observers ranged between 2 and 7 degrees. There was high inter-rater agreement (R = 0.99, p < 0.01) among all observers, and strong correlations between each pair of observers (0.92-0.99). Head rotation of 45 degrees (between the two views) resulted in a median difference in aDOI of 14 degrees, with excellent correlation among the observers. The rate of asymmetry was high, with a median difference of 39 degrees and up to 220 degrees between ears.Conclusions: Assessment of aDOI using intraoperative plain x-rays is efficient and reliable. The effect of head positioning on measurement is small. Further studies are needed to evaluate the effect of aDOI and insertion symmetry on functional outcomes.
Original languageEnglish
Pages (from-to)1363-1368
Number of pages6
JournalOtology and Neurotology
Issue number10
StatePublished - 1 Dec 2020

ASJC Scopus subject areas

  • Clinical Neurology
  • Sensory Systems
  • Otorhinolaryngology


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