scholarly journals Image-Based Planning of Minimally Traumatic Inner Ear Access for Robotic Cochlear Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Fabian Mueller ◽  
Jan Hermann ◽  
Stefan Weber ◽  
Gabriela O'Toole Bom Braga ◽  
Vedat Topsakal
Keyword(s):  
Inner Ear ◽  
Cochlear Implantation ◽  
Round Window ◽  
Solution Space ◽  
Round Window Membrane ◽  
Pareto Optimal ◽  
Soft Constraints ◽  
Facial Recess ◽  
Safety Margins ◽  
Micro Slicing

Objective: During robotic cochlear implantation, an image-guided robotic system provides keyhole access to the scala tympani of the cochlea to allow insertion of the cochlear implant array. To standardize minimally traumatic robotic access to the cochlea, additional hard and soft constraints for inner ear access were proposed during trajectory planning. This extension of the planning strategy aims to provide a trajectory that preserves the anatomical and functional integrity of critical intra-cochlear structures during robotic execution and allows implantation with minimal insertion angles and risk of scala deviation.Methods: The OpenEar dataset consists of a library with eight three-dimensional models of the human temporal bone based on computed tomography and micro-slicing. Soft constraints for inner ear access planning were introduced that aim to minimize the angle of cochlear approach, minimize the risk of scala deviation and maximize the distance to critical intra-cochlear structures such as the osseous spiral lamina. For all cases, a solution space of Pareto-optimal trajectories to the round window was generated. The trajectories satisfy the hard constraints, specifically the anatomical safety margins, and optimize the aforementioned soft constraints. With user-defined priorities, a trajectory was parameterized and analyzed in a virtual surgical procedure.Results: In seven out of eight cases, a solution space was found with the trajectories safely passing through the facial recess. The solution space was Pareto-optimal with respect to the soft constraints of the inner ear access. In one case, the facial recess was too narrow to plan a trajectory that would pass the nerves at a sufficient distance with the intended drill diameter. With the soft constraints introduced, the optimal target region was determined to be in the antero-inferior region of the round window membrane.Conclusion: A trend could be identified that a position between the antero-inferior border and the center of the round window membrane appears to be a favorable target position for cochlear tunnel-based access through the facial recess. The planning concept presented and the results obtained therewith have implications for planning strategies for robotic surgical procedures to the inner ear that aim for minimally traumatic cochlear access and electrode array implantation.

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 Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature

2019 ◽  
Vol 23 (03) ◽  
pp. e281-e291 ◽  
Author(s):  
Shraddha Jain ◽  
PT Deshmukh ◽  
Pooja Lakhotia ◽  
Sanika Kalambe ◽  
Deepshikha Chandravanshi ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Round Window Membrane ◽  
Chorda Tympani Nerve ◽  
Maximum Width ◽  
Facial Recess ◽  
Average Maximum ◽  
Mean Width ◽  
The Mean ◽  
Temporal Bones

Introduction Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR. Objective The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery. Methods Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters. Results The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24–3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm. Conclusion The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.

scholarly journals A gyógyszeres kezelésre nem javuló hirtelen halláscsökkenés lépcsőzetes sebészi terápiája

2021 ◽  
Vol 162 (51) ◽  
pp. 2055-2060
Keyword(s):  
Hearing Loss ◽  
Inner Ear ◽  
Hearing Aids ◽  
Cochlear Implantation ◽  
Early Stage ◽  
Round Window ◽  
Complete Recovery ◽  
Round Window Membrane ◽  
Systemic Steroid ◽  
Profound Hearing Loss

Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsődleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezőként felmerül a perilymphafistula lehetősége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép műtéti kezelése a dobüreg feltárását követően a belső fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelő hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmű okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követően exploratív tympanotomiát végeztünk, melynek során a belső fül ablakait obliteráltuk. Hallásjavulást ezt követően sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az előzetes kerekablak-obliteráció nem zárja ki a későbbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055–2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055–2060.

scholarly journals Cochlear Implantation Following Explorative Tympanotomy in Patients With Sudden Sensorineural Hearing Loss: Surgical Features and Audiological Outcomes

2021 ◽  
pp. 014556132110091
Author(s):  
Robin Rupp ◽  
Joachim Hornung ◽  
Matthias Balk ◽  
Matti Sievert ◽  
Sarina Müller ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Connective Tissue ◽  
Sensorineural Hearing Loss ◽  
Cochlear Implantation ◽  
Round Window ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Round Window Membrane ◽  
Hearing Results ◽  
Round Window Niche

Objective: To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. Methods: Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. Results: Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. Conclusion: Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.

scholarly journals Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Yann Nguyen ◽  
Francesca Yoshie Russo ◽  
Isabelle Mosnier ◽  
Evelyne Ferrary ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Inner Ear ◽  
Round Window ◽  
Bone Conduction ◽  
Hearing Threshold ◽  
Round Window Membrane ◽  
Prospective Clinical Study ◽  
Local Skin ◽  
Local Skin Reaction ◽  
Bone Conduction Hearing

Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery.Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC) skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance.Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study.Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

Inner Ear Pathology and Otitis Media

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 249-253 ◽  
Author(s):  
Michael M. Paparella ◽  
Marcos V. Goycoolea ◽  
William L. Meyerhoff
Keyword(s):  
Inner Ear ◽  
Otitis Media ◽  
Round Window ◽  
Round Window Membrane

Insidious inner ear complications of otitis media have been and are being studied in our laboratory. The purpose of this paper is to review these studies, coordinate, capsulize and highlight the results with emphasis on the transport role of the round window membrane.

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.

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

2017 ◽  
Vol 274 (8) ◽  
pp. 3049-3056 ◽  
Author(s):  
Marjan Mirsalehi ◽  
Saleh Mohebbi ◽  
Mahsa Ghajarzadeh ◽  
Thomas Lenarz ◽  
Omid Majdani
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Hearing Preservation ◽  
Round Window Membrane

Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation

2019 ◽  
Vol 24 (4) ◽  
pp. 183-190
Author(s):  
Ting-Hua Yang ◽  
Yi-Ho Young
Keyword(s):  
Clinical Practice ◽  
Inner Ear ◽  
Morphological Study ◽  
Antifungal Agents ◽  
Clinical Investigation ◽  
Round Window ◽  
Round Window Membrane ◽  
Potential Candidate ◽  
Potential Treatment ◽  
Total Dosage

Background: Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. Objectives: The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. Methods: Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. Results: All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. Conclusion: The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.

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