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

## TL;DR

This study shows that SmartNav technology can detect cochlear implant electrode tip fold-over as effectively as X-ray, without radiation or long anesthesia.

## Contribution

SmartNav provides a novel, radiation-free alternative to X-ray for real-time detection of electrode tip fold-over during cochlear implantation.

## Key findings

- SmartNav detected all 8 tip fold-over cases confirmed by X-ray with 100% sensitivity and 99.21% specificity.
- SmartNav identified a subtle distal kink that X-ray might have missed.
- The technology performed reliably in cochlear nerve deficiency cases and under local anesthesia.

## Abstract

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.

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.

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.

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.