scholarly journals Endoscopic-assisted epitympanic approach: a feasible technique for cochlear implantation

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Mohamed Mostafa Badr-El-dine ◽  
Mohamed Fawzy Fathalla ◽  
Mohamed Eid ◽  
Ahmed Mohamed Mehanna
Keyword(s):  
Cochlear Implantation ◽  
Comparison Group ◽  
Round Window ◽  
Management Strategies ◽  
Insertion Depth ◽  
Statistical Significant Difference ◽  
Endoscopic Control ◽  
Significant Difference ◽  
Posterior Tympanotomy ◽  
Safe Approach

Abstract Background The aim of this study is to discuss the detailed surgical steps of the endoscopic-assisted epi-tympanic approach (EAEA) to the round window (RW) as a safe, precise, and reliable approach for cochlear implantation (CI) and also to evaluate possible problems and limitations faced, their management strategies, and how to overcome. Results This study was carried on 40 patients admitted for cochlear implantation (CI). The patients were divided into two equal groups; the first group underwent CI via the endoscopic-assisted epitympanic approach (EAEA), while the second group was a comparison group and underwent CI via the classic posterior tympanotomy. There was a statistical significant difference as regards scalar location of CI electrodes; all EAEA cases were inserted through ST in comparison to 45% of conventional cases. There was no statistical significant difference as regards linear and angular insertion depth between the two groups. The EAEA group needed shorter time to finish the procedure taking from 90 to 195 min, whereas the conventional group consumed longer time ranging from 120 to 185 min; a difference that was found to be statistically significant. No facial nerve injury was reported in the endoscopic approach. Conclusions Endoscope-assisted epitympanic approach (EAEA) is a reliable and safe approach for soft surgery CI. Visualization of the RW and insertion of the electrode under endoscopic control was significantly reliable and successful in all cases.

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 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 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 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.

Spectral resolution and speech perception after cochlear implantation using the round window versus cochleostomy technique

2021 ◽  
pp. 1-5
Author(s):  
B Demir ◽  
M Yüksel ◽  
A Atılgan ◽  
A Ciprut ◽  
C Batman
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Spectral Resolution ◽  
Cochlear Implantation ◽  
Round Window ◽  
Group Differences ◽  
Window Technique ◽  
Significant Difference ◽  
Electrode Insertion ◽  
Better Than

Abstract Objective To evaluate the spectral resolution achieved with a cochlear implant in users who were implanted using round window route electrode insertion versus a traditional cochleostomy technique. Methods Twenty-six patients were classified into two groups according to the surgical approach: one group (n = 13) underwent cochlear implantation via the round window technique and the other group (n = 13) underwent surgery via cochleostomy. Results A statistically significant difference was found in spectral ripple discrimination scores between the round window and cochleostomy groups. The round window group performed almost two times better than the cochleostomy group. Differences between Turkish matrix sentence test scores were not statistically significant. Conclusion The spectral ripple discrimination scores of patients who had undergone round window cochlear implant electrode insertion were superior to those of patients whose cochlear implants were inserted using a classical cochleostomy technique.

COMPARATIVE STUDY BETWEEN SUPRAMEATAL APPROACH AND POSTERIOR TYMPANOTOMY APPROACH IN COCHLEAR IMPLANTATION

2014 ◽  
Vol 20 (4) ◽  
pp. 1-10
Author(s):  
Alaa El-Din El-Feky ◽  
Mohamed Mubashir ◽  
Badr Eldin mostafa ◽  
Yasser fouad
Keyword(s):  
Comparative Study ◽  
Cochlear Implantation ◽  
Posterior Tympanotomy
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