Importance: With expanded patient criteria to include patients at extremes of age including babies ≥ 9 months and elderly patients often with co-morbidities, it is increasingly important to shorten anesthetic time to decrease risk to patients undergoing cochlear implant surgery. Placement check is recommended for slim modiolar electrodes which have a potential for tip fold-over. However, intraoperative X-rays can often be time consuming and difficult to interpret.

Objectives: The primary objective of this study is to assess the difference in anesthetic time for completion of SmartNav for placement check compared to conventional intraoperative X-rays. The secondary objective is to compare reliability of SmartNav to X-ray in identifying tip fold over.

Methods: Prospective study evaluating all patients undergoing cochlear implantation with a CochlearAmericas CI632,CI622 or CI612 device were included. Placement check using SmartNav was completed immediately after insertion and conventional X-ray was performed. Time to complete placement check using Smartnav versus time to call for, complete and read X-ray was recorded. Comparison of recorded tip fold over using both modalities was made.

Results: Time for completion of SmartNav was significantly shorter (average 12 minutes) than intraoperative Xray and with much less variability (range 2.6 min SmartNav and 26 min Xray). In 3 cases of identified tip fold over on x-ray, all were accurately identified on SmartNav, and in at least one case was more reliably identified on SmartNav than X-ray.

Conclusion: Utilization of SmartNav for placement check of electrode array significantly decreases anesthetic time for patients undergoing cochlear implantation. SmartNav is as reliable as X-ray and insome cases may be easier to interpret than plain film Xrays.