Introduction
The slim modiolar electrode (SME) (Cochlear Company, Sydney, Australia) represent the latest design of ME in clinical use. Compared to the previous MEs, the SME is considerably thinner resulting in a 60 % smaller volume which is achieved by replacing the inner stylet by external sheath. Compared to previous perimodiolar elecrode designs the SME seems to achieve better structure preservation in cochlea. In addition, it generally positions near modiolus just beneath the osseus spiral lamina. The SME was introduced in our clinic during the year 2016 in both, adult and child patients. We present the 5-year results from our clinic with the SME.
Materials and Methods
Patients implanted with an SME between May 2016 and June 2021 were included to the study. 77 cases (67 patients, 19 unilateral patients under 18-years) who had undergone CI surgery with the SME. Mean age at the time of surgery were 41.3-years (range from 0.8 to 81.7 years. Insertion results were evaluated from postoperative Cone-Beam Computed-Tomography images when available. Hearing results were evaluated with the Finnish matrix sentence test (FMST) and from patients with residual hearing the results were gathered.
Results
63 insertions through the RW and twelve though the ERW. Two insertions were made through cochleostomy opening, one due the suspected cusher and the second because of the posterior location of the RW in relation to facial recess. The mean IDA for insertions was 386 (range 149; 440). There were 2 tip fold overs in postoperative CB-CT. In both cases there were coincidental scala dislocation in CBCT.  In addition, two tip fold overs were detected in intraoperative measurements and successfully reinserted during the same operation. FMST results were available from 47 patients. Preoperatively the mean SRT was -0.4 dB (SNR) and at one year follow-up -5.3 dB (SNR). The mean change in SNR was -5.2 dB (SNR) (range -19.7; 1.2).
Conclusion
The SME is feasible and relatively atraumatic for normal anatomy with patent scala tympani. Due to the array’s softness and modiolar design, tip fold-over is a relatively common complication.

**Introduction**
The slim modiolar electrode (SME) (Cochlear Company, Sydney, Australia) represent the latest design of ME in clinical use. Compared to the previous MEs, the SME is considerably thinner resulting in a 60 % smaller volume which is achieved by replacing the inner stylet by external sheath. Compared to previous perimodiolar elecrode designs the SME seems to achieve better structure preservation in cochlea. In addition, it generally positions near modiolus just beneath the osseus spiral lamina. The SME was introduced in our clinic during the year 2016 in both, adult and child patients. We present the 5-year results from our clinic with the SME.
**Materials and Methods**
Patients implanted with an SME between May 2016 and June 2021 were included to the study. 77 cases (67 patients, 19 unilateral patients under 18-years) who had undergone CI surgery with the SME. Mean age at the time of surgery were 41.3-years (range from 0.8 to 81.7 years. Insertion results were evaluated from postoperative Cone-Beam Computed-Tomography images when available. Hearing results were evaluated with the Finnish matrix sentence test (FMST) and from patients with residual hearing the results were gathered.
**Results**
63 insertions through the RW and twelve though the ERW. Two insertions were made through cochleostomy opening, one due the suspected cusher and the second because of the posterior location of the RW in relation to facial recess. The mean IDA for insertions was 386 (range 149; 440). There were 2 tip fold overs in postoperative CB-CT. In both cases there were coincidental scala dislocation in CBCT.  In addition, two tip fold overs were detected in intraoperative measurements and successfully reinserted during the same operation. FMST results were available from 47 patients. Preoperatively the mean SRT was -0.4 dB (SNR) and at one year follow-up -5.3 dB (SNR). The mean change in SNR was -5.2 dB (SNR) (range -19.7; 1.2).
**Conclusion**
The SME is feasible and relatively atraumatic for normal anatomy with patent scala tympani. Due to the array’s softness and modiolar design, tip fold-over is a relatively common complication.

Insertion results of single institution with the Slim Modiolar Electrode from 5-year period

It is with great pleasure and enthusiasm, that on behalf of the Cochlear Implant centers of the Radboud UMC in Nijmegen and Erasmus MC Sophia Children’s Hospital in Rotterdam to invite you to attend the 16th European Symposium on Pediatric Cochlear Implantation to Rotterdam, the Netherlands in 2023.

Yours sincerely, on behalf of the CI Centers at Radboud UMC and Erasmus MC,