Pre-operative assessment of facial recess width in paediatric cochlear implant recipients: a radiological study

Optimal imaging protocols for cochlear implantation have yet to be determined. Pre-operative computed tomography (CT) and magnetic resonance image (MRI) scans are used to assess cochlear anatomy and patency, to delineate surgical access, and to aid in choice of side for implantation. However, opinion still differs as to which modality provides more information in pre-operative assessment, or if, indeed, a combination of the two is superior.The first 88 patients on the Irish National Cochlear Implant Programme (NCIP) were retrospectively studied to determine the accuracy of pre-operative CT and MRI in predicting abnormalities at the time of surgery. Correlation with surgical findings was determined in three separate groups of patients (those who had CT only, those who had MRI only, and those who had both CT and MRI performed).Of the 24 patients that had both CT and MRI performed, both modalities had a 79 per cent correlation with surgical findings. CT and MRI reports concurred in 75 per cent of cases. Specificity and negative predictive value were high (86 per cent and 90 per cent, respectively). CT alone (47 cases) correlated with surgery in 39 cases (83 per cent); MRI alone (17 cases) correlated in 15 cases (88 per cent).The findings of this study suggest that CT and MRI are effective at predicting normal inner ear anatomy, and thus at predicting the patient and the cochlea most suitable for implantation. Both modalities are useful in determining the side of implantation, thus avoiding potential surgical difficulties in cases of unilateral abnormalities. There was no significant difference between the ability of MRI and CT to detect abnormalities at the time of surgery. In this series the combination of CT and MRI has not been shown to be superior to either modality used alone, although anecdotal evidence to the contrary was noted.

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Mono-syllabic word test score as a pre-operative assessment criterion for cochlear implant candidature in adults with acquired hearing loss

Cochlear Implants International ◽

10.1080/14670100.2016.1151636 ◽

2016 ◽

Vol 17 (sup1) ◽

pp. 13-16 ◽

Cited By ~ 1

Author(s):

Maire Doran ◽

Louise Jenkinson

Keyword(s):

Hearing Loss ◽

Cochlear Implant ◽

Test Score ◽

Assessment Criterion ◽

Word Test ◽

Acquired Hearing Loss ◽

Operative Assessment

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The Value of Preoperative Speech-Language Pathology Counseling for Candidates for Cochlear Implants

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00010 ◽

2020 ◽

Vol 5 (4) ◽

pp. 946-950

Author(s):

Lindsay Zombek

Keyword(s):

Cochlear Implant ◽

Cochlear Implants ◽

The United States ◽

Postoperative Management ◽

Insurance Companies ◽

Aural Rehabilitation ◽

Speech Language Pathologist ◽

Language Pathology ◽

Operative Assessment ◽

Rehabilitation Assessment

Purpose This article identifies benefits of pre-operative counseling as part of an aural rehabilitation assessment with a speech-language pathologist as part of adult candidacy for cochlear implants. Aural rehabilitation assessment is not mandated by the Food and Drug Administration in the United States, by some insurance companies, nor consistently by cochlear implant centers as part of cochlear implant candidacy. Although these entities do not require an aural rehabilitation assessment pre-operatively, this assessment and counseling opportunity may offer benefits beyond its contributions to the actual candidacy determination. The perceived benefits of the aural rehabilitation counseling will be discussed. Method A retrospective review was conducted of adults who did and did not receive counseling by a speech-language pathologist as part of their candidacy determination for a cochlear implant. Results Benefits of pre-operative counseling were found to include realistic expectations and motivation for postoperative management, established rapport with the postoperative therapist, determination of candidates’ personal goals ahead of initiation of aural rehabilitation, and increased rates of enrollment in postoperative aural rehabilitation. Conclusion Pre-operative assessment and counseling by aural rehabilitation practitioners may provide benefits and warrant inclusion in pre-operative cochlear implant candidacy determination.

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Evaluation of the Facial Recess and Cochlea on the Temporal Bone of Stillbirths regarding the Percutaneous Cochlear Implant

International Archives of Otorhinolaryngology ◽

10.1055/s-0037-1606612 ◽

2017 ◽

Vol 22 (03) ◽

pp. 260-265

Author(s):

Gabriela Braga ◽

Eloisa Gebrim ◽

Ramya Balachandran ◽

Jack Noble ◽

Robert Labadie ◽

...

Keyword(s):

Computed Tomography ◽

Facial Nerve ◽

Cochlear Implant ◽

Tympanic Membrane ◽

Temporal Bone ◽

Middle Ear ◽

Ossicular Chain ◽

Facial Recess ◽

Ct Evaluation ◽

Temporal Bone Anatomy

Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71 mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.

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Problems and Complications of Cochlear Implant Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894870960s104 ◽

1987 ◽

Vol 96 (1_suppl) ◽

pp. 14-15 ◽

Cited By ~ 6

Author(s):

N. L. Cohen ◽

R. Rosenberg ◽

S. Goldstein

Keyword(s):

Cochlear Implant ◽

Middle Ear ◽

Scala Tympani ◽

Careful Planning ◽

Implant Surgery ◽

Facial Recess ◽

Scalp Flap ◽

Cochlear Implant Surgery ◽

Potential Problems ◽

Attention To Detail

As with any operation, problems and complications may arise with cochlear implant surgery. These may be associated with the scalp flap, mastoid, facial recess, middle ear, or scala tympani. We describe a number of these potential problems and suggest means of avoiding or dealing with them. With careful planning and meticulous attention to detail, complications associated with cochlear implant surgery can be minimized.

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A Revision Surgery for Cochlear Implantation in a Case of Incomplete Partition Type I

Journal of the American Academy of Audiology ◽

10.3766/jaaa.15107 ◽

2016 ◽

Vol 27 (10) ◽

pp. 846-850 ◽

Cited By ~ 2

Author(s):

Habib G. Rizk ◽

Francesca Hagood ◽

Meredith A. Holcomb ◽

Ted A. Meyer

Keyword(s):

Cochlear Implant ◽

Inner Ear ◽

Revision Surgery ◽

Cochlear Implantation ◽

Type I ◽

Facial Recess ◽

Long Term Follow Up ◽

Incomplete Partition

Background: Patients with cochlear malformations were long considered poor candidates for cochlear implantation (CI), and surgical approaches different than the standard facial recess approach were used to access the inner ear. There is no previous long-term follow-up of a patient with significantly malformed inner ear operated through an untraditional route and requiring a revision surgery. Purpose: This case provides a long-term follow-up from the initial surgery, a short-term follow-up from the revision surgery, and it illustrates the evolving classification of inner ear malformations as well as the potential problems associated with nonstandard approaches to the cochlea. Research Design: A case report. Intervention: Herein, we report a case of revision CI in a patient with incomplete partition type I, through the round window via a facial recess approach, 18 yr after an initial implantation via a transmastoid labyrinthotomy approach. Results: The patient had an uncomplicated surgery, and after activation, she noted auditory perception on all electrodes without facial stimulation. A sound field sound awareness threshold was obtained at 15 dB HL. Conclusions: As the prior generation of cochlear implant recipients ages, the probability of a revision surgery for various causes increases. Cochlear implant surgeons should be aware of the potential pitfalls associated in these often challenging cases.

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Cochlear Implant Electrode Array Exposure: A Delayed Complication

Ear Nose & Throat Journal ◽

10.1177/014556131709600708 ◽

2017 ◽

Vol 96 (7) ◽

pp. E40-E43 ◽

Cited By ~ 1

Author(s):

Christina Mishu ◽

David A. Klodd ◽

Miriam Redleaf

Keyword(s):

Cochlear Implant ◽

Tympanic Membrane ◽

Late Complication ◽

Electrode Array ◽

Electrode Arrays ◽

Facial Recess ◽

External Canal ◽

Delayed Complication ◽

Relative Migration

Exposure of the cochlear implant electrode array as a late complication has been reported rarely in the literature. A retrospective analysis revealed 4 patients presenting with exposure of their cochlear implant electrode arrays from 2 to 17 years after implantation. Data collected from these 4 patients were surgical implantation approach, type of implant, age at implant, interval between implant and complication, surgical correction of the problem, pathology at the time of correction, and length of follow-up after intervention. All 4 patients presented with otitis or mastoiditis. Each had undergone a transmastoid approach with facial recess and cochleostomy and full implant insertion. In 3 cases, the tympanic membrane had retracted to expose the electrode array. In 1 patient, the electrode array had eroded through the external canal, lateral to the facial recess. The exposed arrays were addressed surgically, including explantation/reimplantation for 1 patient. Cochlear implant electrode arrays can become exposed by relative migration of the array and the tympanic membrane. Implant surgeons and audiologists need to be aware of the possibility of this complication. Closure of the ear canal appears to be the most effective surgical intervention.

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Computed tomography versus magnetic resonance imaging in paediatric cochlear implant assessment: a pilot study and our experience at Great Ormond Street Hospital

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000440 ◽

2018 ◽

Vol 132 (06) ◽

pp. 529-533 ◽

Cited By ~ 1

Author(s):

H Kanona ◽

K Stephenson ◽

F D'Arco ◽

K Rajput ◽

L Cochrane ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Cochlear Implant ◽

Temporal Bone ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

High Resolution Computed Tomography ◽

Street Hospital ◽

Operative Assessment

AbstractBackgroundTo date, there is a lack of consensus regarding the use of both computed tomography and magnetic resonance imaging in the pre-operative assessment of cochlear implant candidates.MethodsTwenty-five patients underwent high-resolution computed tomography and magnetic resonance imaging. ‘Control scores’ describing the expected visualisation of specific features by computed tomography and magnetic resonance imaging were established. An independent radiological review of all computed tomography and magnetic resonance imaging scan features was then compared to the control scores and the findings recorded.ResultsAgreement with control scores occurred in 83 per cent (20 out of 24) of computed tomography scans and 91 per cent (21 out of 23) of magnetic resonance imaging scans. Radiological abnormalities were demonstrated in 16 per cent of brain scans and 18 per cent of temporal bone investigations.ConclusionAssessment in the paediatric setting constitutes a special situation given the likelihood of congenital temporal bone abnormalities and associated co-morbidities that may be relevant to surgery and prognosis following cochlear implantation. Both computed tomography and magnetic resonance imaging contribute valuable information and remain necessary in paediatric cochlear implant pre-operative assessment.

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