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

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.

Automated Registration-Based Temporal Bone Computed Tomography Segmentation for Applications in Neurotologic Surgery

2021 ◽  
pp. 019459982110449
Author(s):  
Andy S. Ding ◽  
Alexander Lu ◽  
Zhaoshuo Li ◽  
Deepa Galaiya ◽  
Jeffrey H. Siewerdsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Ground Truth ◽  
Ct Images ◽  
Cone Beam ◽  
Data Set ◽  
Registration Method ◽  
Temporal Bone Ct ◽  
Temporal Bone Anatomy

Objective This study investigates the accuracy of an automated method to rapidly segment relevant temporal bone anatomy from cone beam computed tomography (CT) images. Implementation of this segmentation pipeline has potential to improve surgical safety and decrease operative time by augmenting preoperative planning and interfacing with image-guided robotic surgical systems. Study Design Descriptive study of predicted segmentations. Setting Academic institution. Methods We have developed a computational pipeline based on the symmetric normalization registration method that predicts segmentations of anatomic structures in temporal bone CT scans using a labeled atlas. To evaluate accuracy, we created a data set by manually labeling relevant anatomic structures (eg, ossicles, labyrinth, facial nerve, external auditory canal, dura) for 16 deidentified high-resolution cone beam temporal bone CT images. Automated segmentations from this pipeline were compared against ground-truth manual segmentations by using modified Hausdorff distances and Dice scores. Runtimes were documented to determine the computational requirements of this method. Results Modified Hausdorff distances and Dice scores between predicted and ground-truth labels were as follows: malleus (0.100 ± 0.054 mm; Dice, 0.827 ± 0.068), incus (0.100 ± 0.033 mm; Dice, 0.837 ± 0.068), stapes (0.157 ± 0.048 mm; Dice, 0.358 ± 0.100), labyrinth (0.169 ± 0.100 mm; Dice, 0.838 ± 0.060), and facial nerve (0.522 ± 0.278 mm; Dice, 0.567 ± 0.130). A quad-core 16GB RAM workstation completed this segmentation pipeline in 10 minutes. Conclusions We demonstrated submillimeter accuracy for automated segmentation of temporal bone anatomy when compared against hand-segmented ground truth using our template registration pipeline. This method is not dependent on the training data volume that plagues many complex deep learning models. Favorable runtime and low computational requirements underscore this method’s translational potential.

scholarly journals Pintail Comb Injury as a Rare Cause of Penetrating Temporal Bone Trauma With Facial Paralysis

2020 ◽  
pp. 014556132096893
Author(s):  
Dylan Jacob Cooper ◽  
Stanley Pelosi
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Tympanic Membrane ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Middle Ear ◽  
Complete Resolution ◽  
Bone Trauma ◽  
Nerve Dysfunction

We present a case of novel penetrating temporal bone trauma with a pintail comb causing facial paralysis. We describe a 42-year-old woman with acute facial paralysis, hearing loss, and dizziness following accidental tympanic membrane puncture. The patient underwent middle ear exploration with tympanoplasty and was found to have an intact but severely edematous facial nerve. The patient demonstrated less than 90% degeneration under electroneuronography and was treated medically without decompression, and by 6 months had exhibited complete resolution of facial nerve dysfunction with normal hearing. This case report highlights a unique cause of penetrating temporal bone trauma and supports the utility of electroneuronography in predicting the likelihood of recovery and need for decompression in patients where the facial nerve has obvious signs of trauma but remains grossly intact.

scholarly journals High Resolution Computed Tomography (HRCT) Imaging Findings of Oval Window Atresia with Surgical Correlation

2020 ◽  
Vol 49 (6) ◽  
pp. 346-353
Author(s):  
Hau Wei Khoo ◽  
Chih Ching Choong ◽  
Seng Beng Yeo ◽  
Julian PN Goh ◽  
Tiong Yong Tan
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Facial Nerve ◽  
Middle Ear ◽  
Ossicular Chain ◽  
Oval Window ◽  
Imaging Findings ◽  
High Resolution Computed Tomography ◽  
Facial Nerve Canal ◽  
Temporal Bones

Introduction: Isolated oval window atresia (OWA) is a rare cause of congenital conductive middle ear deafness and may be overlooked owing to the normal appearance of the external ear. This anomaly has been previously described, although the published numbers with both imaging and surgical findings are few. Our aim is to correlate the imaging features of OWA with intraoperative findings. Materials and Methods: This is a single-centre retrospective evaluation of patients who were diagnosed with OWA and who received surgery from January 1999 to July 2006. No new case was diagnosed after 2006 to the time of preparation of this manuscript. High resolution computed tomography (HRCT) imaging of the temporal bones of the patients were retrospectively evaluated by 2 head and neck radiologists. Images were evaluated for the absence of the oval window, ossicular chain abnormalities, position of the facial nerve canal, and other malformations. Imaging findings were then correlated with surgical findings. Results: A total of 9 ears in 7 patients (two of whom with bilateral lesions) had surgery for OWA. All patients had concomitant findings of absent stapes footplate with normal, deformed or absent stapes superstructure and an inferiorly displaced facial nerve canal. HRCT was sensitive in identifying OWA and associated ossicular chain and facial nerve abnormalities, which were documented surgically. Conclusion: OWA is a rare entity that can be diagnosed with certainty on HRCT, best visualised on coronal plane. Imaging findings of associated middle ear abnormalities, position of the facial nerve canal, which is invariably mal-positioned, and associated deformity of the incus are important for presurgical planning and consent. Ann Acad Med Singapore 2020;49:285–93 Ann Acad Med Singapore 2020;49:346–53 Key words: Absent oval window, Conductive hearing loss, Temporal bone

Comparison of the application of artificial ossicles and autologous ossicles in the reconstruction of a damaged ossicular chain

2018 ◽  
Vol 132 (10) ◽  
pp. 885-890
Author(s):  
L Zhao ◽  
J Li ◽  
S Gong
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Pure Tone ◽  
Bone Fractures ◽  
Pure Tone Audiometry ◽  
Ossicular Chain ◽  
Facial Nerve Paralysis ◽  
Temporal Bone Fracture ◽  
Nerve Paralysis ◽  
Ossicular Reconstruction

AbstractObjectiveTo evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain.MethodsForty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results.ResultsThe titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air–bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air–bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively.ConclusionOssicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.

Ossicular Chain Reconstruction in a Developing Country

2018 ◽  
Vol 127 (5) ◽  
pp. 306-311 ◽  
Author(s):  
Es-Hak Bedri ◽  
Miriam Redleaf
Keyword(s):  
Tympanic Membrane ◽  
Developing Country ◽  
Middle Ear ◽  
Granulation Tissue ◽  
Ossicular Chain ◽  
Single Stage ◽  
Limited Resources ◽  
Closure Rate ◽  
Average Improvement ◽  
Ossicular Chain Reconstruction

Objectives: In Ethiopia, 2-stage operations with middle ear prostheses are economically unfavorable. We hypothesized that single-stage autologous ossiculoplasty results in acceptable tympanic membrane (TM) and hearing improvements in a setting of limited resources. Methods: One hundred eighty-eight patients (197 ears) who underwent 1-stage autologous ossiculoplasty for ossicular dysfunction are presented. All but 14 of these ears also had perforations of the TM. Conditions of the middle ear were granulation tissue, ossicular disruption only, tympanosclerosis, and cholesteatoma. Reconstructions of the ossicular chain were performed with autologous ossicles only. Results: The closure rate of TM perforations was 95%. Preoperative air bone gaps were 27 to 60 dB (mean [SD] = 44 [7] dB); postoperative air bone gaps were 0 to 50 dB (average [SD] = 23 [10] dB), for an average improvement of 21 dB across all reconstruction types ( P < .001). The largest favorable changes in air bone gaps were with incus and malleus columellas from the footplate to the TM (33 and 23 dB, respectively) ( P < .001). No patient had worsening of sensorineural hearing levels or extrusion of the reconstructed ossicles. Conclusion: Autologous ossiculoplasty performed well in this setting. Acceptable TM closure rates and improvement of air bone gaps were seen in 1-stage operations without the use of prostheses.

scholarly journals Facial nerve anomalies in paediatric cochlear implant candidates: radiological evaluation

2016 ◽  
Vol 131 (1) ◽  
pp. 26-31 ◽  
Author(s):  
F B Palabiyik ◽  
K Hacikurt ◽  
Z Yazici
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
High Resolution ◽  
Facial Nerve ◽  
Cochlear Implant ◽  
Inner Ear ◽  
Resonance Imaging ◽  
High Resolution Computed Tomography ◽  
Ear Anomalies

AbstractBackground:Pre-operative radiological identification of facial nerve anomalies can help prevent intra-operative facial nerve injury during cochlear implantation. This study aimed to evaluate the incidence and configuration of facial nerve anomalies and their concurrence with inner-ear anomalies in cochlear implant candidates.Methods:Inner-ear and concomitant facial nerve anomalies were evaluated by magnetic resonance imaging and temporal high-resolution computed tomography in 48 children with congenital sensorineural hearing loss who were cochlear implant candidates.Results:Inner-ear anomalies were present in 11 out of 48 patients (23 per cent) and concomitant facial nerve anomalies were present on 7 sides in 4 patients (7 per cent of the total). Facial nerve anomalies were accompanied by cochlear or vestibular malformation.Conclusion:Potential facial nerve abnormalities should always be considered in patients with inner-ear anomalies. Pre-operative facial nerve imaging can increase the surgeon's confidence to plan and perform cochlear implantation. Magnetic resonance imaging should be used to detect inner-ear anomalies; if these are identified, temporal high-resolution computed tomography should be used to evaluate the facial nerve.

scholarly journals Study on the Prosthesis Structural Design and Vibration Characteristics Based on the Conduction Effect of Human Middle Ear

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wu Ren ◽  
Huijuan Yan ◽  
Yi Yu ◽  
Jinghong Ren ◽  
Jinlong Chang ◽  
...  
Keyword(s):  
Frequency Response ◽  
Inner Ear ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Transmission Function ◽  
Ossicular Chain ◽  
Sound Signal ◽  
Sound Perception ◽  
Response Characteristics ◽  
Middle Ear Prosthesis

As a bridge from the sound signal in the air to the sound perception of the inner ear auditory receptor, the tympanic membrane and ossicular chain of the middle ear transform the sound signal in the outer ear through two gas-solid and solid-liquid conversions. In addition, through the lever principle formed by three auditory ossicle structure, the sound was concentrated and amplified to the inner ear. However, the sound transmission function of the middle ear will be decreased by disease, genetic, or trauma. Hence, using middle ear prosthesis to replace the damaged ossicles can restore the conduction function. The function realization of middle ear prosthesis depends on the vibration response of the prosthesis from the tympanic membrane to the stapes plate on the human auditory perception frequency, which is affected by the way the prosthesis combined with the tympanic membrane, the material, and the geometric shape. In this study, reasonable prosthetic structures had been designed for different types of ossicular chain injuries, and the frequency response characteristics were analyzed by the finite element method then. Moreover, in order to achieve better vibration frequency response, a ball structure was designed in the prosthesis to simulate its amplification function. The results showed that the middle ear prostheses constructed by different injury types can effectively transfer vibration energy. In particular, the first- and second-order resonant frequencies and response amplitudes are close to each other when ball structure models of different materials are added. Instead, the resonance frequency of the third stage formed by aluminum alloy ball materials is larger than that of the other two, which showed good response features.

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