scholarly journals Herniation of the Mastoid Segment of the Facial Nerve During Cochlear Implantation Surgery

2021 ◽  
pp. 014556132110516
Author(s):  
Mohammad Almohammad ◽  
Tala Tasabehji ◽  
Abdulrahman Awad ◽  
Ibrahem Hanafi
Keyword(s):  
Facial Nerve ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
Round Window ◽  
Posterior Wall ◽  
Case Presentation ◽  
Posterior Tympanotomy ◽  
Bilateral Sensorineural Hearing Loss ◽  
The Right ◽  
Electrical Stimuli

Background: We aim to report a rare case of a herniated mastoid segment of the facial nerve that was accidently discovered during cochlear implantation surgery and how altering the surgery plan could achieve the implantation while preserving the nerve. Case presentation: A four-year-old girl presented with profound bilateral sensorineural hearing loss that did not completely resolve after 2 years of using hearing aids was scheduled for cochlear implantation surgery in the right ear. During surgery, a herniated mastoid segment of the facial nerve took an anterior course and obstructed the access to the round window. Conclusion: When a traditional posterior tympanotomy approach in cochlear implantation surgery is limited in cases of a herniated facial nerve, a tunnel created near the inferior part of the posterior wall of the auditory canal provided safe insertion of the electrode. It also permitted placement of a piece of fascia between the electrode and the facial nerve, therefore, protecting the facial nerve from electrical stimuli.

scholarly journals HRCT Correlation with Round Window Identification during Cochlear Implantation in Children

2014 ◽  
Vol 4 ◽  
pp. 70 ◽  
Author(s):  
Sai Kiran Pendem ◽  
Rajeswaran Rangasami ◽  
Ravi Kumar Arunachalam ◽  
Venkata Sai Pulivadulu Mohanarangam ◽  
Paarthipan Natarajan
Keyword(s):  
Temporal Bone ◽  
Cochlear Implantation ◽  
Round Window ◽  
Oval Window ◽  
Significant Difference ◽  
Posterior Tympanotomy ◽  
Hrct Temporal Bone ◽  
Round Window Niche ◽  
The Right ◽  
A Prospective Study

Objective: To determine the accuracy of High Resolution Computer Tomography (HRCT) temporal bone measurements in predicting the actual visualization of round window niche as viewed through posterior tympanotomy (i.e. facial recess). Materials and Methods: This is a prospective study of 37 cochlear implant candidates, aged between 1and 6 years, who were referred for HRCT temporal bone during the period December 2013 to July 2014. Cochlear implantation was done in 37 children (25 in the right ear and 12 in the left ear). The distance between the short process of incus and the round window niche and the distance between the oval window and the round window niche were measured preoperatively on sub-millimeter (0.7 mm) HRCT images. We classified the visibility of round window niche based on the surgical view (i.e. through posterior tympanotomy) during surgery into three types: 1) Type 1- fully visible, 2) Type 2- partially visible, and 3) Type 3- difficult to visualize. The preoperative HRCT measurements were used to predict the type of visualization of round window niche before surgery and correlated with the findings during surgery. Results: The mean and standard deviation for the distance between the short process of incus and the round window niche and for the distance between the oval window and the round window niche for Types 1, 2, and 3 were 8.5 ± 0.2 mm and 3.2 ± 0.2 mm, 8.0 ± 0.4 mm and 3.8 ± 0.2 mm, 7.5 ± 0.2 mm and 4.4 ± 0.2 mm respectively, and showed statistically significant difference (P < 0.01) between them. The preoperative HRCT measurements had a sensitivity and specificity of 92.3% and 96.2%, respectively, in determining the actual visualization of round window niche. Conclusion: This study shows preoperative HRCT temporal bone measurements are useful in predicting the actual visualization of round window niche as viewed through posterior tympanotomy.

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.

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

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.

scholarly journals Preoperative Evaluation and Surgical Outcome of Cochlear Implantation in NIENT

2020 ◽  
Vol 26 (2) ◽  
pp. 128-135
Author(s):  
Md Zakaria Sarker ◽  
Muhammad Rafiqul Islam ◽  
Utpal Kumar Dutta ◽  
Debabrota Roy ◽  
AHM Ferdows Nur ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Psychosocial Development ◽  
Cochlear Implantation ◽  
Preoperative Evaluation ◽  
Round Window ◽  
Round Window Membrane ◽  
Safe Procedure ◽  
Female Ratio ◽  
Facial Recess

Background: Sensory neural hearing loss (SNHL) is the most common congenital sensory deficit, with an incidence of one to three per 1000 live births. Acoustic deprivation during the first 3 years of life can hinder speech and language acquisition with significant negative consequences on a child’s educational and psychosocial development. The gold standard intervention for permanent severe to profound hearing loss is cochlear implantation. Cochlear implant (CI); is a semi implantable electronic device that bypass the cochlea. Objectives: An observational study was carried out on 40 cases of pre-lingual deaf to find out the causes of pre-lingual deaf, to evaluate the preoperative procedures to set ideal criteria for pre -lingual cochlear implantation and to evaluate surgical procedure and outcome of cochlear implantations. Methods: Evaluation of the candidates included patient medical history, general health checkup, ENT examination, audiometric evaluation, CT and MRI scans, psychological profile of the candidate. A limited cortical mastoidectomy was performed. The facial recess was opened using the fossa of incudis as an initial landmark. The round window niche was visualized through the facial recess about 2 mm inferior to the stapes. A cochleostomy created by drilling over the basal turn of the cochlea anterior and inferior to the annulus of the round window membrane. The electrode array was then carefully inserted through the fenestra into the scala tympani of the cochlea. Electrophysiological testing (Neural Response Telemetry: NRT) was performed to verify the correct placement of active electrodes. Resulst: Among them 22 (55%) were male and 18 (45%) were female. Male female ratio was 1.2:1. Age distribution at implantation was 3.3±1.054(SD). Average hearing loss was 96.4±5.3(SD) dB and in aided audiogram was 63.7±4.6(SD) dB. Overall complications occurred in 10 (25%) cases. Transient facial nerve paresis in 2 (5%), injury of tympanic membrane in 1(2.5%), seroma 4(10%) and delayed otitis media in 1(2.5%) were observed. Major postoperative complications occurred in 2 cases including facial nerve palsy in 1(2.5%) case and spontaneous device failure in 1(2.5%) case. Conclusion: The result of this survey was find out the risk factor of congenital hearing loss. With a thorough preoperative evaluation, we can select proper candidates for CI which is a reliable and safe procedure with a low percentage of severe complication. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 128-135

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

scholarly journals Surgical anatomy of the round window with special reference to cochlear implantation

1987 ◽  
Vol 101 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Burkhard K. H. Franz ◽  
Graeme M. Clark ◽  
David M. Bloom
Keyword(s):  
Cochlear Implant ◽  
Special Reference ◽  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Anatomy ◽  
Round Window Membrane ◽  
Scala Tympani ◽  
Good View ◽  
Posterior Tympanotomy ◽  
Round Window Niche

AbstractWhen the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

scholarly journals Surgeon Oriented Preoperative Radiologic Evaluation in Cochlear Implantation - Our experience with a Proposed Checklist

2018 ◽  
Vol 23 (02) ◽  
pp. 137-141 ◽  
Author(s):  
Mahmoud Mandour ◽  
Mohammed Tomoum ◽  
Saad El Zayat ◽  
Hisham Hamad ◽  
Mohamed Amer
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Cochlear Implantation ◽  
Round Window ◽  
Special Focus ◽  
Radiologic Evaluation ◽  
Cortical Mastoidectomy ◽  
Temporal Bone Ct ◽  
Operative Findings ◽  
Key Steps

Introduction Preoperative temporal bone imaging studies have been routinely performed prior to cochlear implantation. Radiologists need to report these examinations with special focus on the surgeon's expectations. Objectives To provide a basic structured format, in the form of a checklist, for reporting preoperative computed tomography (CT) and to its clinical impact on operative findings. Methods The preoperative temporal bone CT scans of 47 patients were analyzed and reported according to the proposed checklist. Intraoperative assessment of mastoidectomy, posterior tympanotomy and round window access was done by the surgeon in a blinded fashion and were correlated with the radiological findings to assess its significance. Results The proposed radiological checklist was reliable in assessing operative difficulty during cochlear implantation. Contracted mastoid and lower tegmen position were associated with a greater difficulty of the cortical mastoidectomy. Presence of an air cell around the facial nerve (FN) was predictive of easier facial recess access exposure. Facial nerve location and posterior external auditory canal (EAC) wall inclination were predictive of difficult round window (RW) accessibility. Conclusion Certain parameters on the preoperative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.

Current indications for cochlear implantation in adults and children

2019 ◽  
Vol 73 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Witold Szyfter ◽  
Michał Karlik ◽  
Alicja Sekula ◽  
Simon Harris ◽  
Wojciech Gawęcki
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
Pure Tone Audiometry ◽  
Sensorineural Hearing ◽  
Profound Hearing Loss ◽  
Unilateral Deafness ◽  
Bilateral Sensorineural Hearing Loss ◽  
Asymmetric Hearing Loss

Introduction: Surgical treatment of deafness by cochlear implants is used for more than 40 years, and during this period permanently, gradual and significant expansion of indications for this surgery has been observed. Material and methods: In our Department in the years 1994-2018 1480 cochlear implantations were performed, both in adults (647) and in children (883). In this study current indications and the rules for eligibility of patients based on 25 years of experience are presented. Results: Indications for cochlear implantation in adults are: 1) bilateral postlingual deafness, 2) bilateral sensorineural hearing loss - in pure tone audiometry > 70 dB HL (average 500-4000 Hz) and in speech audiometry in hearing aids understanding < 50% of words for the intensity of the stimulus 65 dB, in the absence of the benefits of hearing aids, 3) bilateral profound hearing loss for high frequency with good hearing for low frequency, in the absence of the benefits of hearing aids, 4) some cases of asymmetric hearing loss with intensive tinnitus in the deaf ear. An indication in children is bilateral sensorineural hearing loss > 80dB HL confirmed by hearing tests, after about 6 months of rehabilitation with the use of hearing aids. Discussion: Although cochlear implantation is used for more than 40 years, the indications for this treatment underlies constant modifications. They concern the age of eligible patients, implantation in patients with partially preserved hearing, as well as treatment for patients with difficult anatomical conditions. In many countries, bilateral implantations are commonly performed, and more and more centers recommend this treatment in the case of unilateral deafness or asymmetric hearing loss, especially with the accompanying tinnitus in the deaf ear.

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