An HRCT based scoring system to predict ease of electrode insertion in Cochlear Implantation

2021 ◽  
pp. 1-20
Author(s):  
Arindam Das ◽  
Mridul Janweja ◽  
Aryabrata Dubey ◽  
Sandipta Mitra ◽  
Arunabha Sengupta
Keyword(s):  
Cochlear Implantation ◽  
Scoring System ◽  
Electrode Insertion

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

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.

Outcome of Cochlear Implantation in Postmeningitis Profound Sensorineural Hearing Loss at Rajavithi Hospital

2021 ◽  
Vol 104 (2) ◽  
pp. 260-263
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Cochlear Implantation ◽  
Sensorineural Hearing ◽  
Preoperative Imaging ◽  
Profound Hearing Loss ◽  
Language Status ◽  
Auditory Performance ◽  
Electrode Insertion ◽  
One Year

Background: Bacterial meningitis is one of the major factors in the etiology of acquired sensorineural hearing loss in children and adults. Cochlear implantation in these patients is challenging because of inner ear ossification and fibrosis, and this procedure sometimes achieves poorer outcomes in this scenario than with other causes of sensorineural hearing loss. There has been little research into the factors affecting the outcomes of this procedure. Objective: To evaluate the outcomes of cochlear implantation in patients with postmeningitis profound sensorineural hearing loss and to evaluate the factors that affect the results. Materials and Methods: A retrospective review was conducted of thirty patients who were diagnosed with post meningitis profound hearing loss and underwent cochlear implantation at Rajavithi Hospital between 2001 and 2016. Preoperative language status, duration of deafness, preoperative imaging, and degree of electrode insertion were recorded. Categories of auditory performance-II test (CAP-II) was evaluated in all cases, one year postoperative. Results: Thirty postmeningitis deafness patients underwent cochlear implantation. The median age at diagnosis of meningitis and age at implantation were 41 years (range 1 to 75) and 49.50 years (range 3 to 75), respectively. The median duration of deafness was 12 months (range 4 to 300), and the overall mean CAP-II at one year after surgery was 5.47±2.21. The postlinguistic group had a significantly higher CAP-II score than the prelinguistic one (p=0.006). Electrodes were successfully totally inserted in 19 patients (63.3%) and partially inserted in 11 (36.7%). The average CAP-II score in the group with fully-inserted electrodes was significantly higher than in the group with partially-inserted electrodes (p=0.045). There was no correlation between CAP-II score and age at meningitis diagnosis (p=0.069), age at time of surgery (p=0.105), duration of deafness (p=0.506), or preoperative CT (p=0.228) or MRI abnormality (p=0.078). Conclusion: Cochlear implantation in patients with postmeningitis profound hearing loss had high success rates and favorable outcomes. Preoperative language status and degree of electrode insertion were factors that affected auditory performance results. Keywords: Cochlear implantation, Postmeningitis hearing loss, Sensorineural hearing loss, Meningitis, Rajavithi Hospital

scholarly journals Standard Programming of Retrograde Electrode Insertion via Middle-Turn Cochleostomy in Labyrinthitis Ossificans

2020 ◽  
pp. 014556132097486
Author(s):  
Mounika Reddy Y ◽  
Anjali Lepcha ◽  
Ann Mary Augustine ◽  
Ajay Philip ◽  
Philip Thomas
Keyword(s):  
Patient Preference ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Labyrinthitis Ossificans ◽  
Electrode Insertion

Successful cochlear implantation in the setting of labyrinthitis ossificans is challenging. Various surgical techniques are described to circumvent the region of ossification and retrograde insertion of the electrode array is one such option. While reverse programming is often recommended in the case of retrograde electrode insertion, we present our experience of retrograde electrode insertion for labyrinthitis ossificans, where standard programming was adopted due to patient preference and provided satisfactory outcomes.

scholarly journals Imaging of Electrode Position after Cochlear Implantation with Flat Panel CT

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Diana Arweiler-Harbeck ◽  
Christoph Mönninghoff ◽  
Jens Greve ◽  
Thomas Hoffmann ◽  
Sophia Göricke ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Electrode Position ◽  
Flat Panel ◽  
Volume Computed Tomography ◽  
Metal Artefacts ◽  
Flat Panel Ct ◽  
Electrode Insertion

Background. Postoperative imaging after cochlear implantation is usually performed by conventional cochlear view (X-ray) or by multislice computed tomography (MSCT). MSCT after cochlear implantation often provides multiple metal artefacts; thus, a more detailed view of the implant considering the given anatomy is desirable. A quite new method is flat panel volume computed tomography. The aim of the study was to evaluate the method’s clinical use. Material and Methods. After cochlear implantation with different implant types, flat panel CT scan (Philips Allura) was performed in 31 adult patients. Anatomical details, positioning, and resolution of the different electrode types (MedEL, Advanced Bionics, and Cochlear) were evaluated interdisciplinary (ENT/Neuroradiology). Results. In all 31 patients cochlear implant electrode array and topographical position could be distinguished exactly. Spatial resolution and the high degree of accuracy were superior to reported results of MSCT. Differentiation of cochlear scalae by identification of the osseous spiral lamina was possible in some cases. Scanning artefacts were low. Conclusion. Flat panel CT scan allows exact imaging independent of implant type. This is mandatory for detailed information on cochlear electrode position. It enables us to perform optimal auditory nerve stimulation and allows feed back on surgical quality concerning the method of electrode insertion.

scholarly journals A case report of cochlear implantation in patients with osteopetrosis: surgical approaches and auditory results

2021 ◽  
Author(s):  
Masoud Motasaddi Zarandy ◽  
Hakima Abdullah ◽  
Mina Motasaddi Zarandy ◽  
Mohammadreza Firouzifar ◽  
Farzad Moubedshahi
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Cochlear Implantation ◽  
Hearing Threshold ◽  
Sensorineural Hearing ◽  
Surgical Approaches ◽  
Nerve Dysfunction ◽  
Electrode Insertion ◽  
Bilateral Sensorineural Hearing Loss ◽  
The Right

Background: Osteopetrosis (OP) is a rare disease of the skeletal system that can be associated with complications such as bone fracture, nerve dysfunction and deafness due to increased bone density and reduced bone quality. In this regard and due to the challenge that it can cause for cochlear implantation (CI), in this study we aimed to report CI conducted on two patients with OP in Iran. The Case: Patients were two women diagnosed with OP and bilateral sensorineural hearing loss (SNHL) who underwent CI in the right ear. Preoperative PTA showed a hearing threshold decrease of more than 100 dB in both patients. A standard cochleostomy was performed in one patient and endoscopic surgery in the other patient through the external ear canal. One month after surgery, the hearing threshold improved b y 60−90 dB in both patients. No facial nerve palsy or implant extrusion/migration was observed after surgery. Conclusion: Although technically challenging, CI seems to be a safe and effective method to improve the SNHL in patients with OP. The path for electrode insertion should be tailored to meet the conditions and anatomy of patients. Keywords: Cochlear implantation; osteopetrosis; sensorineural hearing loss

Minimizing Intracochlear Pressure: Influence of the Insertion Sheath

2021 ◽  
pp. 1-6
Author(s):  
Ceyhun Ucta ◽  
Philipp Mittmann ◽  
Arneborg Ernst ◽  
Rainer Seidl ◽  
Gina Lauer
Keyword(s):  
Optical Sensor ◽  
Cochlear Implantation ◽  
Apical Part ◽  
Electrode Arrays ◽  
Insertion Technique ◽  
Cochlear Model ◽  
Electrode Insertion ◽  
Intracochlear Pressure ◽  
Pressure Changes

Objective: Atraumatic cochlear implantation (CI) and insertion of the electrode in particular are major goals of recent CI surgery. Perimodiolar electrode arrays need a stylet or exosheath for insertion. The sheath can influence the intracochlear pressure changes during insertion of the electrode. The aim of this study was to modify the insertion sheath to optimize intracochlear pressure changes. Methods: In an artifical cochlear model, 7 different modified insertion sheaths were used. The intracochlear pressure was measured with a micro-optical sensor in the apical part of the model cochlea. Results: Significant lower intracochlear pressure changes were observed when the apical part of the insertion sheath was either shortened or tapered. Modification of the stopper does influence the intracochlear pressure significantly. Conclusion: Modification of the insertion sheath leads to lower intracochlear pressure gain. The differences and impact on intracochlear pressure changes found in this study underline the importance of even subtle modifications of the electrode insertion technique.

Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans

2020 ◽  
pp. 019459982093474
Author(s):  
Danielle R. Trakimas ◽  
Renata M. Knoll ◽  
Melissa Castillo-Bustamante ◽  
Elliott D. Kozin ◽  
Aaron K. Remenschneider
Keyword(s):  
Temporal Bone ◽  
Retrospective Review ◽  
Cochlear Implantation ◽  
Spiral Ganglion ◽  
Continuous Extension ◽  
Tissue Formation ◽  
Basal Turn ◽  
Labyrinthitis Ossificans ◽  
Electrode Insertion ◽  
Ganglion Neurons

Objective Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). Study Design Retrospective review. Setting Academic institution. Methods Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. Results Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. Conclusion In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. Level of Evidence Retrospective review.

scholarly journals The Effect of Cochlear Size on Cochlear Implantation Outcomes

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jafri Kuthubutheen ◽  
Amandeep Grewal ◽  
Sean Symons ◽  
Julian Nedzelski ◽  
David Shipp ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Outer Wall ◽  
X Rays ◽  
Speech Discrimination ◽  
Insertion Depth ◽  
Basal Diameter ◽  
Cochlear Duct ◽  
Significant Difference ◽  
Cochlear Duct Length ◽  
Electrode Insertion

Objectives. To determine if cochlear duct length and cochlear basal diameter, measured using routinely available radiology software, affect hearing outcomes after cochlear implantation with two different length electrodes. Methods. 55 patients who received a Med-El Flex electrode were retrospectively reviewed. 34 patients received the Flex 31 electrode (31mm) and 21 patients received the Flex 28 electrode (28mm). Preoperative high-resolution CT scans of the temporal bone were reformatted in the axial and coronal plane. The basal diameter of the cochlear (A-value) and the outer-wall lengths of the cochlear duct were measured using readily available imaging software. Postoperative plane X-rays were used to determine the degree of electrode insertion and the number of electrodes within the cochlea and speech discrimination scores at 6 months were evaluated. Results. The cochlear metrics obtained were comparable with those previously published in the literature. There was no significant difference in the degree of insertion or speech outcomes between the two electrode lengths. However, when the group who had received the shorter electrode were analysed, there was an association seen between both cochlear duct length and cochlear diameter and speech outcomes. Conclusions. Cochlear size may be a factor in determining speech outcomes that cannot be explained solely by insertion depth or degrees of insertion. Further studies are required to determine if cochlear duct length is an independent predictor of speech outcomes.

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