Round Window Insertion in Veria Technique of Cochlear Implantation: An Essential Modification

Background: Cochlear implantation (CI) has revolutionized the treatment of sensorineural deafness. The aim of the study was to compare auditory based performance in cochlear implants who underwent round window insertion and cochleostomy.Methods: Ambispective cohort study was done among the children who underwent perilingual cochlear implant in a tertiary care hospital for period of 1 year. Children who satisfied the inclusion criteria were selected and randomly subdivided into 2 groups: group A- round window insertion and group B-cochleostomy. Pre- and post-operative pure tone average (PTA) and residual hearing preserved were evaluated among the cochleostomy and round window insertion groups separately. Post-operatively, children were evaluated, from three months to 1 year from the activation of cochlear implant, with the use of scores such as Category of Auditory Performance (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility rating (SIR) and Meaningful use of speech scale (MUSS score) to measure speech production skills by auditory verbal therapist. Results: A total of 80 patients were included in the study. Complete hearing preservation (within 10 dB) was significantly high in round window insertion group compared to cochleostomy technique (p<0.001). None the subjects had complete loss of residual hearing. On evaluating the post CI performance, MAIS score in the round window insertion group (9.34, 18.21, 27.79) were significantly better compared to cochleostomy group during the 3 months, 6 months and 12 months follow-up.Conclusions: Round window insertion technique is significantly more successful in complete hearing preservation at low frequencies compared to cochleostomy technique. Among the auditory scores, only MAIS in the round window insertion group was found to be significantly better compared to cochleostomy group.

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Cochlear Implantation with Round Window Insertion in Children with Otitis Media with Effusion

ORL ◽

10.1159/000360007 ◽

2014 ◽

Vol 76 (1) ◽

pp. 13-18 ◽

Cited By ~ 3

Author(s):

Jia-Qiang Sun ◽

Jing-Wu Sun ◽

Xiao-Yan Hou

Keyword(s):

Otitis Media ◽

Cochlear Implantation ◽

Otitis Media With Effusion ◽

Round Window ◽

Round Window Insertion

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(11) The impact of Transtympanic Steroid Application in Round Window Insertion on Hearing Preservation in Cochlear Implantation: Preliminary Experiences of a Prospective Study

Otolaryngology ◽

10.1016/j.otohns.2010.08.044 ◽

2010 ◽

Vol 143 (5) ◽

pp. S46-S46

Author(s):

Jafri Kuthubutheen ◽

Ranjeeta Ambett ◽

Gunesh Rajan

Keyword(s):

Prospective Study ◽

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

A Prospective Study ◽

The Impact ◽

Round Window Insertion

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Cochlear Implantation Following Explorative Tympanotomy in Patients With Sudden Sensorineural Hearing Loss: Surgical Features and Audiological Outcomes

Ear Nose & Throat Journal ◽

10.1177/01455613211009141 ◽

2021 ◽

pp. 014556132110091

Author(s):

Robin Rupp ◽

Joachim Hornung ◽

Matthias Balk ◽

Matti Sievert ◽

Sarina Müller ◽

...

Keyword(s):

Hearing Loss ◽

Connective Tissue ◽

Sensorineural Hearing Loss ◽

Cochlear Implantation ◽

Round Window ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Round Window Membrane ◽

Hearing Results ◽

Round Window Niche

Objective: To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. Methods: Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. Results: Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. Conclusion: Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.

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Surgical considerations during cochlear implantation: the utility of temporal bone computed tomography

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000232 ◽

2021 ◽

pp. 1-8

Author(s):

Beomcho Jun ◽

Sunwha Song

Keyword(s):

Computed Tomography ◽

Temporal Bone ◽

Cochlear Implantation ◽

Round Window ◽

Three Dimensional ◽

Electrode Placement ◽

Posterior Tympanotomy ◽

Electrode Insertion ◽

Window Approach ◽

Bone Structures

Abstract Objective This paper describes the construction of portals for electrode placement during cochlear implantation and emphasises the utility of pre-operative temporal bone three-dimensional computed tomography. Methods Temporal bone three-dimensional computed tomography was used to plan portal creation for electrode insertion. Results Pre-operative temporal bone three-dimensional computed tomography can be used to determine the orientation of temporal bone structures, which is important for mastoidectomy, posterior tympanotomy and cochleostomy, and when using the round window approach. Conclusion It is essential to create appropriate portals (from the mastoid cortex to the cochlea) in a step-by-step manner, to ensure the safe insertion of electrodes into the scala tympani. Pre-operative three-dimensional temporal bone computed tomography is invaluable in this respect.

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Morphological classification of crista fenestra of round window corridor during pediatric cochlear implantation

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2021.110816 ◽

2021 ◽

pp. 110816

Author(s):

Saad Elzayat ◽

Hitham H. Elfarargy ◽

Islam Soltan ◽

Mona A. Abdel-Kareem ◽

Maurizio Barbara ◽

...

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Morphological Classification

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Methylprednisolone Applied Directly to the Round Window Reduces Dizziness after Cochlear Implantation: A Randomized Clinical Trial

Audiology and Neurotology ◽

10.1159/000322137 ◽

2011 ◽

Vol 16 (5) ◽

pp. 289-303 ◽

Cited By ~ 30

Author(s):

J.C. Enticott ◽

H.T. Eastwood ◽

R.J. Briggs ◽

R.C. Dowell ◽

S.J. O’Leary

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Cochlear Implantation ◽

Round Window

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Comparison of Round Window Anatomy between Pediatric and Adult Population: A Perspective from Cochlear Implantation Surgery

Journal of Institute of Medicine ◽

10.3126/jiom.v42i3.37573 ◽

2020 ◽

Vol 42 (3) ◽

pp. 23-25

Author(s):

Rabindra B Pradhananga ◽

Bigyan R Gyawali ◽

Pabina Rayamajhi

Keyword(s):

Cochlear Implantation ◽

Adult Population ◽

Round Window ◽

Round Window Membrane ◽

Institute Of Medicine ◽

Statistical Association ◽

Complex Anatomy ◽

Wide Range ◽

Posterior Tympanotomy ◽

Round Window Niche

Introduction The round window is thought to be an ideal port for inserting electrodes during cochlear implantation. Considering its complex anatomy with an individual variation, this study aims to review the anatomy of round window based on the visibility of round window niche and round window membrane via posterior tympanotomy in pediatric and adult population who underwent cochlear implantation. MethodsThis was a retrospective observational study conducted at the Department of ENT-HNS, Institute of Medicine, Kathmandu, Nepal. Surgical notes of adult (>15 years) and pediatric cases (<15years) who underwent primary cochlear implantation from January 2015 to January 2018 were assessed for different grading of round window niche and round window membrane visibility via posterior tympanotomy. Cases with revision surgery and with incomplete documentation of intra-operative findings were excluded from the study. Statistical analysis was done using SPSS software version 25. We used Chi-square and Fisher’s exact tests to analyze the statistical association. ResultsType B round window niche (partially visible) was the most common variant seen in the pediatric group while in adults, both Type B (partially visible) and Type C (fully visible) round window niche were common. Compared to the adults, the pediatric group had good visibility of RWM. However, there was no statistical association between these observations. ConclusionThe round window has a wide range of anatomical variations with different levels of visibility of RWN and RWM in the different age groups. Although statistically insignificant, RWM visibility seemed to be better in pediatric cases compared to adults.

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