Effect of Round Window Opening Size on Residual Hearing Preservation in Cochlear Implantation

Objectives This study aims to compare the hearing preservation outcomes in cochlear implant surgery following slit versus full opening of the round window membrane. Setting Tertiary referral center. Study Design Comparative study. Subjects and Methods Seventy patients (mean, 26.3 years; range, 2-69 years) who underwent cochlear implantation via the round window approach were included in the study. Thirty-five subjects were prospectively enrolled for cochlear implantation via the open round window technique between August 2018 and January 2019. Thirty-five patients who underwent cochlear implantation from January 2017 to July 2018 via the slit round window opening, frequency matched by sex and age, were retrospectively enrolled. Pre- and postoperative thresholds were obtained. The percentage of hearing preservation was computed with the HEARRING Network formula and classified into complete, partial, and minimal hearing preservation. The results between the groups were compared and analyzed at 6 months postoperatively. Results The rate of complete hearing preservation in the open group was statistically significant ( P = .030) at 71.4% (n = 25) as compared with 45.7% (n = 16) in the slit group. Conclusions The widely opened round window may be an optional technique that surgeons can utilize to improve hearing preservation outcomes.

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Impact of the round window membrane accessibility on hearing preservation in adult cochlear implantation

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-017-4628-2 ◽

2017 ◽

Vol 274 (8) ◽

pp. 3049-3056 ◽

Cited By ~ 4

Author(s):

Marjan Mirsalehi ◽

Saleh Mohebbi ◽

Mahsa Ghajarzadeh ◽

Thomas Lenarz ◽

Omid Majdani

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Round Window Membrane

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The Effect of Systemic Steroid on Hearing Preservation After Cochlear Implantation via Round Window Approach

Otology & Neurotology ◽

10.1097/mao.0000000000001453 ◽

2017 ◽

Vol 38 (7) ◽

pp. 962-969 ◽

Cited By ~ 7

Author(s):

Mun Young Chang ◽

Yoon Chan Rah ◽

Jun Jae Choi ◽

Shin Wook Woo ◽

Yu-Jung Hwang ◽

...

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Systemic Steroid ◽

Window Approach

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Effects of Round Window Opening Size and Moisturized Electrodes on Intracochlear Pressure Related to the Insertion of a Cochlear Implant Electrode

Audiology and Neurotology Extra ◽

10.1159/000442515 ◽

2016 ◽

Vol 6 (1) ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

Ingo Todt ◽

Arneborg Ernst ◽

Philipp Mittmann

Keyword(s):

Cochlear Implant ◽

Round Window ◽

Pressure Change ◽

Hearing Preservation ◽

Round Window Membrane ◽

Cochlear Model ◽

Window Opening ◽

Hydrophilic Character ◽

Intracochlear Pressure ◽

Pressure Changes

Intracochlear pressure changes during the cochlear implant insertion are assumed to be an important contributor to hearing preservation. The aim was to observe intracochlear pressure changes by different round window opening sizes and different hydrophilic electrode conditions. The experiments were performed in a cochlear model with a micropressure sensor in the helicotrema area. Different artificial round window membrane and different moisturized electrode conditions were compared. A punctured round window causes a significantly higher and an indirect moisturized electrode condition a significantly lower intracochlear pressure change. The degree of round window opening and the hydrophilic character of an electrode during insertion affect the intracochlear pressure significantly in a model.

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Cochlear implantation and residual hearing preservation long-term follow-up of the first consecutively operated patients using the round window approach in Uppsala, Sweden

Cochlear Implants International ◽

10.1080/14670100.2020.1755102 ◽

2020 ◽

Vol 21 (5) ◽

pp. 246-259

Author(s):

Nadine Schart-Morén ◽

Elsa Erixon ◽

Hao Li ◽

Helge Rask-Andersen

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Residual Hearing ◽

Long Term Follow Up ◽

Window Approach

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Cochlear implant placement: round window approach

Neurosurgical FOCUS ◽

10.3171/2014.v1.focus13537 ◽

2014 ◽

Vol 36 (v1supplement) ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Douglas D. Backous

Keyword(s):

Clinical Trials ◽

Surgical Technique ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Round Window ◽

Hearing Preservation ◽

Residual Hearing ◽

Implant Placement ◽

Single Sided Deafness ◽

Window Approach

The indications for cochlear implantation continue to extend to patients with increased levels of residual hearing. Single-sided deafness and tinnitus are currently under various clinical trials as even further expansion of the application of cochlear implant device and programming technology is underway. This video details a round window and hearing preservation approach for cochlear implant placement, and incorporates the most recent advances in surgical technique.The video can be found here: http://youtu.be/bDqkbboXrU4.

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Radiological and surgical aspects of round window visibility during cochlear implantation: a retrospective analysis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06611-0 ◽

2021 ◽

Author(s):

Saad Jwair ◽

Job J. M. van Eijden ◽

Esther E. Blijleven ◽

Jan Willem Dankbaar ◽

Hans G. X. M. Thomeer

Keyword(s):

Cochlear Implant ◽

Round Window ◽

Ct Scans ◽

Round Window Membrane ◽

Chorda Tympani ◽

Chorda Tympani Nerve ◽

Cochlear Implant Surgery ◽

Window Approach ◽

Almost All ◽

Surgical Aspects

Abstract Purpose The round window approach has become the most preferred option for cochlear implant (CI) insertion, however, sometimes it may not be possible due to the (in)visibility of the round window membrane (RWM). We addressed the prevalence, consequences and indicators of difficult detection of the RWM in cochlear implant surgery. Methods This study retrospectively analysed the operative reports and preoperative high resolution axial-computed tomography (CT) scans of a consecutive cohort of patients who underwent a CI insertion. The main outcomes were surgical outcomes of the RW approach, and assessment of radiological markers. Results The operative reports showed that RWM insertion was feasible in 151 out of 153 patients. In 18% of the patients the RWM was difficult to visualize. All these patients had at least one intraoperative event. The chorda tympani nerve (CTN) or posterior canal wall was affected in 8% of the 153 patients and the fallopian canal in 6%. These patients had a facial-chorda tympani nerve distance on the CT scan that was considerably smaller than normal patients (1.5 mm vs 2.3 mm). In addition, a prediction line towards the anterolateral side of the RWM was found to be more prevalent in these patients’ CT scans (sensitivity 81%, specificity 63%). Conclusion The RW approach is feasible in almost all patients undergoing CI surgery. Difficult visualisation of the RWM seems to lead to at least one intraoperative event. Radiological measures showed that these patients had a smaller facial recess and a more anteriorly placed facial nerve, which can be used to better plan a safe insertion approach.

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Endoscopic visualisation of the round window during cochlear implantation

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000067 ◽

2020 ◽

Vol 134 (3) ◽

pp. 219-221 ◽

Cited By ~ 1

Author(s):

A Jain ◽

R Sharma ◽

J C Passey ◽

R Meher ◽

R Bansal

Keyword(s):

Middle Ear ◽

Cochlear Implantation ◽

Round Window ◽

Electrode Array ◽

Round Window Membrane ◽

Window Region ◽

Round Window Niche ◽

Window Approach ◽

Maximum Exposure

AbstractBackgroundEndoscopes provide a magnified view of the middle ear and visualisation of hidden areas. Otoendoscopes facilitate excellent visualisation of the round window niche during cochlear implantation.ObjectiveTo compare microscopic and endoscopic visualisation of the round window membrane during cochlear implantation in 20 patients.MethodsTwenty patients who underwent cochlear implantation were included in the study. After maximum exposure of the round window, the accessibility of the round window membrane was graded according to the St Thomas Hospital classification, first by microscope and then by endoscope.ResultsWith the use of the endoscope, visualisation of the round window membrane improved in all the patients as compared to the microscope. The electrode array was inserted via a round window or extended round window approach in all but two cases; the latter cases required bony cochleostomy because of unfavourable anatomy.ConclusionThe main benefit of endoscope-assisted cochlear implantation is improved visibility of the round window region.

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