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Johnson BR, Benaim EH, Thompson NJ, Marouf A, Dedmon MM, Anderson MR, Selleck AM, Brown KD, Dillon MT. Management of Cochlear Implant Electrode Arrays Misplaced in the Internal Auditory Canal: A Systematic Review. Otol Neurotol 2024; 45:e460-e467. [PMID: 38865720 DOI: 10.1097/mao.0000000000004222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Misplacement of electrode arrays in the internal auditory canal (IAC) presents a unique clinical challenge. Speech recognition is limited for cochlear implant (CI) users with misplaced arrays, and there are risks with revision surgery including facial and/or cochlear nerve injury. DATABASES REVIEWED PubMed, Embase, and Scopus. METHODS A literature search was performed from inception to September 2023. The search terms were designed to capture articles on misplaced arrays and the management options. Articles written in English that described cases of array misplacement into the IAC for children and adults were included. The level of evidence was assessed using Oxford Center for Evidence Based Medicine guidelines. Descriptive statistical analyses were performed. RESULTS Twenty-eight cases of arrays misplaced in the IAC were identified. Thirteen (46%) were patients with incomplete partition type 3 (IP3), and 7 (25%) were patients with common cavity (CC) malformations. Most misplaced arrays were identified postoperatively (19 cases; 68%). Of these cases, 11 (58%) were managed with array removal. No facial nerve injuries were reported with revision surgery. Eight cases (42%) were left in place. Several underwent mapping procedures in an attempt improve the sound quality with the CI. CONCLUSION Electrode array misplacement in the IAC is a rare complication that reportedly occurs predominately in cases with IP3 and CC malformations. Removal of misplaced arrays from the IAC reportedly has not been associated with facial nerve injuries. Cases identified with IAC misplacement postoperatively can potentially be managed with modified mapping techniques before proceeding with revision surgery.
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Affiliation(s)
- Benjamin R Johnson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ezer H Benaim
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas J Thompson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Azmi Marouf
- Department of Otolaryngology/Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Matthew M Dedmon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa R Anderson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret T Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hameed N, Keshri A, Manogaran RS, Muraleedharan M, Chidambaram KS, Jain R, Aqib M. Cochlear Implantation by Veria Technique in Abnormal Cochlea: Our Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:2646-2653. [PMID: 38883484 PMCID: PMC11169411 DOI: 10.1007/s12070-024-04492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
This study describes the clinical profile, operative findings, surgical technique, type of implant and complications encountered in implantation of abnormal cochlea by the transcanal (veria) technique in a tertiary care centre. This is a retrospective study done amongst 337 patients who underwent cochlear implantation by veria technique between January 2013 to August 2023. Based on pre-operative imaging with high-resolution computed tomography and magnetic resonance imaging the cochleovestibular malformations in this study were classified according to Sennaroglu classification and the cochlear ossification was graded from I to IV. Amongst the 337 patients who underwent cochlear implantation during the study period there were 79 cases (23.4%) with abnormalities of cochlea. This included 45 patients (13.4%) with congenital malformations, 20 patients (5.9%) with cochlear fibrosis and 14 patients (4.2%) with cochlear ossification. The commonest cochlear malformation was Incomplete Partition 2 which was present in 21 patients (46.7%). The other common malformations were cochlear hypoplasia (31.1%), Incomplete Partition 1(13.3%) and common cavity (8.9%). Out of the 20 patients with cochlear fibrosis, 17 patients had fibrosis only in the basal turn. Out of the 14 patients with cochlear ossification 8 patients (57.1%) had a grade 1 ossification, 2 patients (14.3%) had a grade 2 ossification and 4 patients (28.6%) had a grade 3 ossification. One of the patients required re-exploration for correcting the placement of electrode. The type of implant were chosen depending on individual malformation or length of ossification and fibrosis. In the past, inner ear anomalies were considered as a contraindication for cochlear implantation however it is now possible to implant most of these abnormal cochlea by careful planning, a modification of the surgical technique and the type of electrode used.
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Affiliation(s)
- Nazrin Hameed
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Keshri
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Rajat Jain
- King George Medical College, Lucknow, India
| | - Mohd Aqib
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Hamed N, Alajmi N, Alkoblan FI, Alghtani YA, Abdelsamad Y, Alhussien A, Alhajress RI, Alhabib SF. The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review. J Clin Med 2024; 13:2337. [PMID: 38673610 PMCID: PMC11050773 DOI: 10.3390/jcm13082337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.
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Affiliation(s)
- Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Norah Alajmi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Faisal Ibrahim Alkoblan
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yazeed Abdullah Alghtani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yassin Abdelsamad
- Research Department, MED-EL GmbH, P.O. Box 245, Riyadh 11411, Saudi Arabia;
| | - Ahmed Alhussien
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Rafeef Ibrahim Alhajress
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Salman F. Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
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Potdukhe K, Vishwakarma R, Rao S, Vishwakarma C. Audiological and Speech Outcomes of Cochlear Implantation in Inner Ear Malformation Compared to the Normal Inner Ear. Indian J Otolaryngol Head Neck Surg 2023; 75:1870-1875. [PMID: 37636621 PMCID: PMC10447326 DOI: 10.1007/s12070-023-03760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/30/2023] [Indexed: 08/29/2023] Open
Abstract
To compare the overall clinical outcomes of cochlear implantation in children with structural inner ear abnormalities, with results of implantation in children with radiologically 'normal' inner ears. To study the incidence and performance outcomes of cochlear implantation in children with inner ear malformations (IEMs). It is a retrospective case control study of 57 normal and 57 abnormal inner ear patients operated for cochlear implant between Jan 1, 2014 and Aug 1, 2017, by Veria technique. The age range was between 12 months and 15 years. The prevalence of IEMs was 13.8%. Of the 57 cases with IEMs, 33.3% were of enlarged vestibular acqueduct, 7% were of isolated Incomplete Partition type-2, 21.1% cases were of Mondini's dysplasia, 3.5% of Incomplete partition type-1 and 8.8% of cochlear nerve hypoplasia. Most commonly encountered malformation was EVA while IP-1 was the least common malformation. A CSF gusher was experienced in 11 cases. There was a statistically significant difference between the CAP and SIR scores of both IEM and control groups, both at 1 year and at 2 years (1 year CAP score p value < 0.001, 2 year CAP score p value 0.002 and 1 year SIR score, p value < 0.001, 2 year SIR score, p value 0.013). There was progressive improvement in the scores (of both groups) at the 2 year mark, compared to 1 year scores. Cochlear implantation is safe and surgically feasible in children with IEMs. However, the hearing outcome and speech perception outcomes are poor than those of patients with normal anatomy, with an exception seen in enlarged vestibular aqueduct.
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Affiliation(s)
- Krishna Potdukhe
- Department of Otorhinolaryngology, Civil Hospital Ahmedabad, B J Medical College, Ahmedabad, India
| | - Rajesh Vishwakarma
- Department of Otorhinolaryngology, Apollo Hospital, Ahmedabad, Ahmedabad, India
| | - Saketh Rao
- Department of Radiology, Civil Hospital Ahmedabad, B J Medical College, Ahmedabad, India
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Suri N, Sharma D, Singh A, Anand A, Ganesh J. Cochlear implantation in children with congenital inner ear malformations - Our experience. Int J Pediatr Otorhinolaryngol 2023; 168:111522. [PMID: 36990031 DOI: 10.1016/j.ijporl.2023.111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/17/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To share our experience of the surgical challenges faced in cochlear implanted patients with inner ear malformation and to assess the auditory and speech perception outcomes. MATERIAL AND METHOD Clinical records of 502 cochlear implant procedures were reviewed and data of 122 patients who had inner ear malformations were enrolled in the study. Their auditory and speech performances were evaluated post implantation for 3 years. RESULT Cerebrospinal fluid gusher was encountered during opening of cochlea in 42 patients (34.4%) and one patient was re-explored within 24 h. In 30.3% of cases facial anomaly was found. Significant improvement in average performance was seen in all malformation types except in cochlear hypoplasia at 12 months postoperatively. CONCLUSION Surgical challenges can be overcome with expertise and giving special attention to preoperative imaging. Our experience suggests that outcomes are favourable in patients with inner ear malformations too.
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Affiliation(s)
- Neeraj Suri
- Department of ENT, Gmers Medical College, Gandhinagar, Gujarat, India.
| | - Diva Sharma
- Department of ENT, Gmers Medical College, Gandhinagar, Gujarat, India.
| | - Anshu Singh
- Department of ENT, Gmers Medical College, Gandhinagar, Gujarat, India.
| | - Amitkumar Anand
- Department of Audiology, Apple Speech and Hearing Clinic, International Cochlear Implant Research Unit, Ahmedabad, India.
| | - Jayachandran Ganesh
- Department of Audiology, Apple Speech and Hearing Clinic, International Cochlear Implant Research Unit, Ahmedabad, India.
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Reddy YM, Lepcha A, Augustine AM, Philip A. Cochlear Implant in Klippel-Feil Syndrome: Challenges and Concerns. Indian J Otolaryngol Head Neck Surg 2022; 74:3901-3905. [PMID: 36742773 PMCID: PMC9895708 DOI: 10.1007/s12070-021-02728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Cochlear implantation (CI) can be safely performed in patients with syndromic hearing loss. Here we present a case of CI in a child with Klippel-Feil syndrome with various skeletal, extraskeletal, cochleovestibular and Arnold-Chiari malformations. Multidisciplinary approach and good preoperative imaging play a key role in planning for surgery.
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Affiliation(s)
- Y. Mounika Reddy
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anjali Lepcha
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ann Mary Augustine
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of Otolaryngology, Otology, Neurotology and Cochlear Implant Unit, Christian Medical College, Vellore, Tamil Nadu 632004 India
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Cochlear Implantation in Children with Enlarged Vestibular Aqueduct: A Systematic Review of Surgical Implications and Outcomes. Ear Hear 2022; 44:440-447. [PMID: 36397213 DOI: 10.1097/aud.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigated age at implantation, improvement in hearing and speech perception outcomes, as well as surgical complications in pediatric cochlear implant recipients with Pendred Syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA). DESIGN A systematic review of the literature between 1984 and 2021 was performed. Two independent reviewers performed abstract and full-text screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: English language, cochlear implant, age at implantation available, age <18 years, PS, Mondini malformation, and enlarged vestibular aqueduct. Full-text analysis was completed using the National Institute of Health assessment tool for case series and case-control studies. Studies were also graded according to the Oxford Centre for Evidence-Based Medicine grading system. RESULTS In total, 198 studies were identified and screened, and 55 studies were included for analysis. Audiological outcomes were available in 46 studies, and the four-frequency pure-tone audiogram average improved by 60 to 78 dB HL due to cochlear implantation. Auditory performance and speech intelligibility scores increased by 44%. The overall average implantation age was 60 months. The implantation age was 21 months lower in the studies where individuals were implanted after the year 2000 compared with those implanted before the year 2000. Perilymph gusher/oozing was the most common surgical incident reported, occurring in 187 of 1572 implantations. CONCLUSIONS In children with PS/NSEVA, cochlear implantation improves pure-tone average by 60 to 78 dB HL and capacity of auditory performance/speech intelligibility by 44%. The implantation age for these children has decreased during the last two decades but is still somewhat higher than reported for unselected pediatric cochlear implantation. Perilymph gusher/oozing is the most common surgical complication.
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Zhang L, Chen B, Kong Y, Liau N, Wei X, Shi Y, Chen J, Yang M, Dhanasingh A, Li Y. Analysis of Long-Term Cochlear Implantation Outcomes and Correlation With Imaging Characteristics in Patients With Common Cavity Deformity. Front Neurosci 2022; 16:857855. [PMID: 35401101 PMCID: PMC8983960 DOI: 10.3389/fnins.2022.857855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Object To investigate the long-term development of auditory and speech in patients with common cavity deformity (CCD) after cochlear implantation (CI) and its relationship to imaging characteristics. Methods Twenty-three CCD patients and 59 age- and sex-matched CI children with normal inner ear structure were recruited. The auditory and speech development of these two groups were evaluated at 0, 1, 3, 6, 12, and 18 months after CI activation using four parent reports questionnaires [Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), Meaningful Auditory Integration Scale/Infant-Toddler Meaningful Auditory Integration Scale (MAIS/ITMAIS), and Meaningful Use of Speech Scale (MUSS)]. Computed tomography-based 3-dimensional reconstruction of the surgical side of 18 CCD children was performed, the volume and surface area were calculated. Correlation analysis was performed on the imaging performance and post-operative outcomes. Results The percentages of MAIS/IT-MAIS scores and CAP scores at different evaluation time points are significantly different (p < 0.05). When comparing SIR results across time points, significant growth was observed in most of the comparisons. In addition, significant differences (p < 0.05) are observed among the percentages of MUSS scores at different time points except the comparison between 0 and 1 month after CI activation. Patients in the CCD group had poorer auditory and speech performances at different stages after CI compared with those in the control group. According to the reconstruction of CCD patients, the volume ranged from 12.21 to 291.96 mm3; the surface area ranged from 27.81 to 284.7 mm2. When the lumen surface area was <190.45 mm2 or the volume was <157.91 mm3, the survival time for CCD children to achieve a CAP score of 4 after CI was significantly shorter. Conclusion Cochlear implantation are less effective in CCD patients than in patients with normal inner ear structures, but they can still achieve significant improvement post-operatively. The morphology and size of the inner ear vary in CCD patients, which reflects the degree of inner ear development influences the outcome after CI surgery.
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Affiliation(s)
- Lifang Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Biao Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Ying Kong
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Ministry of Education, Capital Medical University, Beijing, China
| | - Natalia Liau
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xingmei Wei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Ying Shi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Jingyuan Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Mengge Yang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | | | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
- *Correspondence: Yongxin Li,
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Cochlear implantation in common cavity deformity: a systematic review. Eur Arch Otorhinolaryngol 2021; 279:37-48. [PMID: 34052873 DOI: 10.1007/s00405-021-06884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cochlear implantation became a valid hearing rehabilitation option in common cavity deformity. This study aimed to assess the audiological and speech outcomes of cochlear implantation in common cavity deformity patients and to address the surgical aspect used in this population. METHODS A comprehensive systematic literature review based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline from database inception through April 2020. Eighteen published articles including 138 patients with common cavity deformity met the inclusion criteria. These articles studied the surgical techniques and the audiological outcomes of cochlear implantation in patients with common cavity deformity in English language. RESULTS Trans-mastoid labyrinthotomy was the common surgical approach in these patients. The average speech intelligibility rating and categories of auditory performance scores in common cavity deformity were lower than in normal cochlea subjects (p < 0.05), and non-significant (p > 0.05) compared with other types of inner ear malformations. CONCLUSION Patients with common cavity deformity who underwent cochlear implantation showed a beneficial audiological and speech outcome. However, their performance is highly variable. Therefore, pre-operative counseling of the parents is necessary. The surgical approaches should be individualized according to clinical, radiological, and surgical findings.
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Khurayzi T, Almuhawas F, Alsanosi A, Abdelsamad Y, Doyle Ú, Dhanasingh A. A novel cochlear measurement that predicts inner-ear malformation. Sci Rep 2021; 11:7339. [PMID: 33795738 PMCID: PMC8016924 DOI: 10.1038/s41598-021-86741-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
The A-value used in cochlear duct length (CDL) estimation does not take malformed cochleae into consideration. The objective was to determine the A-value reported in the literature, to assess the accuracy of the A-value measurement and to evaluate a novel cochlear measurement in distinguishing malformed cochlea. High resolution Computer Tomography images in the oblique coronal plane/cochlear view of 74 human temporal bones were analyzed. The A-value and novel C-value measurement were evaluated as predictors of inner ear malformation type. The proximity of the facial nerve to the basal turn was evaluated subjectively. 26 publications report on the A-value; but they do not distinguish normal vs. malformed cochleae. The A-values of the normal cochleae compared to the cochleae with cochlear hypoplasia, incomplete partition (IP) type I, -type II, and -type III were significantly different. The A-value does not predict the C-value. The C-values of the normal cochleae compared to the cochleae with IP type I and IP type III were significantly different. The proximity of the facial nerve to the basal turn did not relate to the type of malformation. The A-value is different in normal vs. malformed cochleae. The novel C-value could be used to predict malformed anatomy, although it does not distinguish all malformation types.
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Affiliation(s)
- Tawfiq Khurayzi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia. .,King Fahad Central Hospital, Ministry of Health, Jizan, 82666, Saudi Arabia.
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia
| | - Abdulrahman Alsanosi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, 11411, Saudi Arabia
| | | | - Úna Doyle
- Research and Development Department, MED-EL GmbH, Innsbruck, Austria
| | - Anandhan Dhanasingh
- Research and Development Department, MED-EL GmbH, Innsbruck, Austria.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Ozkan HB, Cicek Cinar B, Yucel E, Sennaroglu G, Sennaroglu L. Audiological Performance in Children with Inner Ear Malformations Before and After Cochlear Implantation: A Cohort Study of 274 Patients. Clin Otolaryngol 2020; 46:154-160. [PMID: 32749771 DOI: 10.1111/coa.13625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Inner ear malformations (IEMs) are common in children with hearing loss. The different types of IEMs form a unique subgroup of cochlear implant (CI) candidates. We aimed to evaluate the auditory perception outcomes of CI in children with different types of IEMs and compare them with CI users without IEMs. METHODS The study included 274 CI users with and without IEMs as two groups (n = 137, each). Both groups' chronological age at implantation and duration of CI usage was matched (± 8 months). All subjects were evaluated pre-operatively and post-operatively by the Ling's sound test and the auditory perception test battery, which includes the Meaningful Auditory Integration Scale (MAIS), closed-set Pattern Perception Test (PPT) and open-set Sentence Recognition Test (SRT). Besides, children with IEMs were assessed for language development. RESULTS Progress in the IEMs' group differed according to the type of ear anomaly. CI users with enlarged vestibular aqueduct had the highest scores, while users with common cavity had the lowest. Children with IEMs performed well on the closed-set test while having difficulty with the open-set test. CONCLUSION Cochlear implantation outcomes are favourable in IEMs' patients with a cochlear nerve visible on magnetic resonance imaging. Our results indicate that it is critical to take the anatomical differences into account during follow-up and rehabilitation programmes. Each CI user should be evaluated according to his or her individual needs.
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Affiliation(s)
- Hilal Burcu Ozkan
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Betul Cicek Cinar
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Esra Yucel
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Gonca Sennaroglu
- Faculty of Health Sciences, Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore. Int J Otolaryngol 2019; 2019:6483714. [PMID: 31885597 PMCID: PMC6915011 DOI: 10.1155/2019/6483714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/26/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. Methods This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. Results A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1–18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7–10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery. Conclusion The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.
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Clarós P, Remjasz A, Clarós-Pujol A, Pujol C, Clarós A. Waardenburg syndrome: characteristics and long-term outcomes of paediatric cochlear implant recipients. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1630979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Pedro Clarós
- Cochlear Implant Centre, Clarós Clinic, Barcelona, Spain
| | - Agnieszka Remjasz
- Cochlear Implant Centre, Clarós Clinic, Barcelona, Spain
- Department of Otorhinolaryngology at Stefan Zeromski Specialist Hospital, Cracow, Poland
- Scholarship in Clarós Clinic, Barcelona, Spain
| | | | - Carmen Pujol
- Cochlear Implant Centre, Clarós Clinic, Barcelona, Spain
| | - Andrés Clarós
- Cochlear Implant Centre, Clarós Clinic, Barcelona, Spain
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Demir B, Cesur S, Sahin A, Binnetoglu A, Ciprut A, Batman C. Outcomes of cochlear implantation in children with inner ear malformations. Eur Arch Otorhinolaryngol 2019; 276:2397-2403. [PMID: 31111254 DOI: 10.1007/s00405-019-05475-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/14/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the surgical experience and auditory functions and progress of speech development of cochlear implantation in malformed ears. MATERIALS AND METHODS Between November 1995 and July 2017, thirty-seven patients (26 females and 11 males; mean age: 138.275 ± 96.24 months) with diverse anomalies of the inner ear were retrospectively examined for surgical and audiological results. Speech Intelligibility Rating (SIR), Categories of Auditory Perception (CAP), Pure Tone Average (PTA), Speech Intelligibility Rating (SRT), and Word Discrimination Score (WDS) were the audiological tests used to evaluate the efficacy of CI in the malformed inner ears. RESULTS CSF gusher was experienced by six patients (three with LVA (large vestibular aqueduct), one with IP (incomplete partition) I, and two with both IP II Mondini malformations and LVA). Two patients had transient facial paresis after surgery. All patients fully recovered within 6 months. The postoperative PTA, SRT, and WDS test results showed significant differences between progressive and congenital sensorineural hearing loss (p values < 0.05 for all). On the other hand, the postoperative CAP and SIR test results revealed no significant differences between the two groups. According to etiology, the PTA and SRT values were significantly lower in common cavity patients than the LVA patients (p values < 0.01); no significant differences were found among the other etiological groups. CONCLUSIONS Cochlear implantation is safe in children with inner ear malformations. However, the success rate is low compared to patients with normal anatomy in terms of audiological results; the most successful group of patients with inner ear malformation is large vestibular aqueduct.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey.
| | - Sıdıka Cesur
- Department of Audiology, Marmara University Pendik Training and Research Hospital, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
| | - Akın Sahin
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
| | - Adem Binnetoglu
- St. Elizabeth'S Medical Center, 736 Cambridge St, Brighton, MA, 02135, USA
| | - Ayca Ciprut
- Department of Audiology, Marmara University Pendik Training and Research Hospital, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
| | - Caglar Batman
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Mimar Sinan Caddesi No. 41, Fevzi Cakmak Mahallesi, Ust Kaynarca-Pendik, 34899, Istanbul, Turkey
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Subtotal Petrosectomy for Cochlear Implant Surgery. Response to Letter to the Editor. Otol Neurotol 2019; 40:695-697. [PMID: 31083109 DOI: 10.1097/mao.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brotto D, Avato I, Lovo E, Muraro E, Bovo R, Trevisi P, Martini A, Manara R. Epidemiologic, Imaging, Audiologic, Clinical, Surgical, and Prognostic Issues in Common Cavity Deformity. JAMA Otolaryngol Head Neck Surg 2019; 145:72-78. [DOI: 10.1001/jamaoto.2018.2839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Davide Brotto
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Irene Avato
- Department of Otorhinolaryngology, PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Elisa Lovo
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Eva Muraro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Patrizia Trevisi
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Alessandro Martini
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Renzo Manara
- Department of Neuroradiology, University of Salerno, Salerno, Italy
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Deep NL, Dowling EM, Jethanamest D, Carlson ML. Cochlear Implantation: An Overview. J Neurol Surg B Skull Base 2018; 80:169-177. [PMID: 30931225 DOI: 10.1055/s-0038-1669411] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
Abstract
A cochlear implant (CI) is a surgically implanted device for the treatment of severe to profound sensorineural hearing loss in children and adults. It works by transducing acoustic energy into an electrical signal, which is used to stimulate surviving spiral ganglion cells of the auditory nerve. The past 2 decades have witnessed an exponential rise in the number of CI surgeries performed. Continual developments in programming strategies, device design, and minimally traumatic surgical technique have demonstrated the safety and efficacy of CI surgery. As a result, candidacy guidelines have expanded to include both pre and postlingually deaf children as young as 1 year of age, and those with greater degrees of residual hearing. A growing proportion of patients are undergoing CI for off-label or nontraditional indications including single-sided deafness, retrocochlear hearing loss, asymmetrical sensorineural hearing loss (SNHL) in adults and children with at least 1 ear that is better than performance cut-off for age, and children less than 12 months of age. Herein, we review CI design, clinical evaluation, indications, operative technique, and outcomes. We also discuss the expanding indications for CI surgery as it relates to lateral skull base pathology, comparing CI to auditory brainstem implants, and address the concerns with obtaining magnetic resonance imaging (MRI) in CI recipients.
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Affiliation(s)
- Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
| | - Eric M Dowling
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Jethanamest
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, United States
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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The Association Between Modiolar Base Anomalies and Intraoperative Cerebrospinal Fluid Leakage in Patients With Incomplete Partition Type-II Anomaly: A Classification System and Presentation of 73 Cases. Otol Neurotol 2018; 39:e538-e542. [DOI: 10.1097/mao.0000000000001871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Melo AS, Martins J, Silva J, Quadros J, Paiva A. Cochlear implantation in children with anomalous cochleovestibular anatomy. Auris Nasus Larynx 2017; 44:509-516. [DOI: 10.1016/j.anl.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/11/2017] [Accepted: 02/03/2017] [Indexed: 11/15/2022]
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Incerti PV, Ching TYC, Hou S, Van Buynder P, Flynn C, Cowan R. Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation. Int J Audiol 2017; 57:S27-S40. [PMID: 28885072 DOI: 10.1080/14992027.2017.1370139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. DESIGN Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. STUDY SAMPLE One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer's defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. CONCLUSIONS Aetiology and age at implantation had significant effects on T-levels and C-levels.
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Affiliation(s)
- Paola V Incerti
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
| | - Teresa Y C Ching
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Sanna Hou
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Patricia Van Buynder
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Christopher Flynn
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia
| | - Robert Cowan
- b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
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Sun JQ, Sun JW, Hou XY. Cochlear implantation in Mondini's deformity: could the straight electrode array with length of 31 mm be fully inserted? Acta Otolaryngol 2017; 137:712-715. [PMID: 28498076 DOI: 10.1080/00016489.2017.1280849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSIONS The straight electrode array with length of 31 mm can be fully inserted using round window insertion in cochlear implantation with Mondini's deformity. It is a safe and effective process, but also a challenging task of the full implantation in children with Mondini's deformity. OBJECTIVE The aim of this study is to discuss whether the straight electrode array with a length of 31 mm could be fully inserted in cochlear implantation with Mondini's deformity. METHODS A chart review of 30 patients undergoing cochlear implantation with Mondini's deformity using the electrode array with length of 31 mm was undertaken from January 2012 and December 2015 in Anhui Provincial Hospital. RESULTS Full insertion of the straight electrode array with length of 31 mm were performed successfully in all patients with Mondini's deformity using round window insertion. Resistance was not encountered while introducing the electrodes. Ten of 30 patients had cerebrospinal fluid drainage during cochlear implantation. Cerebrospinal fluid drainage was controlled with small pieces of temporalis fascia packing round window in all patients. Intra-operative neural response telemetry was performed in all patients, and results were good. The result of X-ray showed proper placement of the cochlear implant electrode array. During surgery, no patients had experienced any immediate or delayed post-operative complications such as wound infection, intracranial complication, extrusion, or migration of the implant during an average follow-up period of 6-36 months.
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Affiliation(s)
- Jia-Qiang Sun
- Department of Otolaryngology-Head and Neck Surgery, Anhui provincial hospital, Hefei, Anhui Province, PR China
| | - Jing-Wu Sun
- Department of Otolaryngology-Head and Neck Surgery, Anhui provincial hospital, Hefei, Anhui Province, PR China
| | - Xiao-Yan Hou
- Department of Otolaryngology-Head and Neck Surgery, Anhui provincial hospital, Hefei, Anhui Province, PR China
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Wei X, Li Y, Fu QJ, Gong Y, Chen B, Chen J, Shi Y, Su Q, Cui D, Liu T. Slotted labyrinthotomy approach with customized electrode for patients with common cavity deformity. Laryngoscope 2017; 128:468-472. [PMID: 28498488 DOI: 10.1002/lary.26627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. STUDY DESIGN Retrospective review of 13 cochlear implant (CI) patients with CCD. METHODS Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. RESULTS The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P < .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P > .05). CONCLUSIONS For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. LEVEL OF EVIDENCE 4. Laryngoscope, 128:468-472, 2018.
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Affiliation(s)
- Xingmei Wei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A.
| | - Yue Gong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Biao Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Shi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiaotong Su
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Danmo Cui
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Farhood Z, Nguyen SA, Miller SC, Holcomb MA, Meyer TA, Rizk AHG. Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings. Otolaryngol Head Neck Surg 2017; 156:783-793. [DOI: 10.1177/0194599817696502] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories—closed-set words, open-set words, and open-set sentences—and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.
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Affiliation(s)
- Zachary Farhood
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University, St Louis, Missouri, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen C. Miller
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Meredith A. Holcomb
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - and Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Liu YK, Qi CL, Tang J, Jiang ML, Du L, Li ZH, Tan SH, Tang AZ. The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation. Acta Otolaryngol 2017; 137:119-126. [PMID: 27577263 DOI: 10.1080/00016489.2016.1221132] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION The cochlear length (CL) and cochlear height (CH) measured through MPR will provide for more accurate quantitative diagnosis of inner ear malformation, and are subsequently convenient for calculating cochlear duct length (CDL) before cochear implant. OBJECTIVES Qualitative and quantitative diagnosis of inner ear malformation in deaf patients through multiplanar reconstruction (MPR) was performed to provide a reference for cochlear implants. METHODS One hundred and two cases without sensorineural deafness and 560 patients with sensorineural deafness had MPR of temporal bone computed tomography performed to obtain the standardized cochlear-view and oblique coronal-view images. The inner ear radial lines were measured to formulate normal values for inner ear malformation diagnosing, and the CDL was estimated based on CL. RESULTS The normal range values of inner ear radial lines were measured and formulated, of which CL was 8.1-9.59 mm and CH was 3.28-3.90 mm. According to inner ear morphology and the normal values measured above, 61 cases of incomplete partition-type II (IP-II) and a high percentage (27/110, 24.5%) of hypoplasia of cochlea (HC) were diagnosed. The HC group was further divided into 1-turn, 1.5-turn, and 2-turn sub-groups, which had CDL of 15.98 ± 1.48 mm, 21.36 ± 0.96 mm, and 26.56 ± 0.60 mm, respectively.
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Affiliation(s)
- Yi-Kang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Cheng-Lin Qi
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Jie Tang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Mu-Liang Jiang
- Department of Radiology, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Long Du
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Zhen-Hua Li
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - Song-Hua Tan
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
| | - An-Zhou Tang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of GuangXi Medical University, NanNing, GuangXi, PR China
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Management of surgical difficulties during cochlear implant with inner ear anomalies. Int J Pediatr Otorhinolaryngol 2017; 92:45-49. [PMID: 28012532 DOI: 10.1016/j.ijporl.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/29/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the difficulties that can occur during cochlear implant surgery in patients with inner ear abnormalities and the management thereof. METHODS A retrospective chart review of 316 patients who received cochlear implants was conducted. The data collected included the types of inner ear anomalies, intraoperative findings, and the clinical management strategies. A review of the literature was also performed. RESULTS A total of 24 patients with inner ear malformations who underwent 28 total cochlear implant procedures were identified. The anomalies included isolated large vestibular aqueducts in 8 (33.3%) patients, isolated semicircular canal dysplasia in 8 (33.3%) patients, classical Mondini malformation in 7 (29.1%) patients, and cochlear hypoplasia in 1 (4.1%) patient. Four (14.2%) patients exhibited intraoperative cerebrospinal fluid (CSF) gushers. One patient experienced delayed facial nerve paralysis, and an electrode was partially inserted into one patient. In 2 (7.14%) cases, the surgeries were aborted because of difficulties. CONCLUSION Cochlear implantation for inner ear anomalies can be performed safely. Special attention should be given to preoperative imaging to anticipate the potential intraoperative risks that can occur in inner ear anomaly cases. Every surgery should be planned with a safe approach and specific requirements, e.g., regarding electrode type, and the surgeries must be performed by experienced surgeons who are capable of modifying their technique according to the surgical findings.
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Kim LS, Jeong SW, Huh MJ, Park YD. Cochlear Implantation in Children with Inner Ear Malformations. Ann Otol Rhinol Laryngol 2016; 115:205-14. [PMID: 16572611 DOI: 10.1177/000348940611500309] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to assess the outcomes of cochlear implantation in children with inner ear malformations (IEMs). Methods: A retrospective review of 212 children who received implants from September 1994 to May 2004 was performed. Forty-six of them had radiologic evidence of IEMs. The preoperative evaluations, intraoperative findings, postoperative complications, and performance outcomes were analyzed. For the comparative analysis of performance outcomes, the children with IEMs were matched and compared with children with a normal inner ear who had received implants. Statistical analysis was performed with a repeated-measures analysis of variance. Results: All of the children were studied with computed tomography and magnetic resonance imaging. Three-dimensional volume rendering of magnetic resonance images was performed in cases that were difficult to interpret because of structural complexity. The operative findings included aberrant facial nerves in 2 children and cerebrospinal fluid gushers in 22 children. Intraoperative fluoroscopic examination was performed to evaluate electrode placement. There were no serious postoperative complications. All children with IEMs achieved open-set speech perception abilities, except for the children with a narrow internal auditory canal (IAC), and showed progressive improvement of their speech perception abilities over time. There were no statistically significant differences in performance measured by the Common Phrases test between the 2 groups. Although the repeated-measures analysis of variance indicated that children with IEMs performed more poorly than those with a normal inner ear on the Phonetically Balanced Kindergarten test for phonemes, statistical significance was not found at 2 years after implantation. The children with a narrow IAC benefited from the implantation and used the device every day, although their speech perception abilities were limited. Conclusions: The results of the present study show that cochlear implantation can be performed relatively safely in deaf children with IEMs and that they receive considerable benefit from their implants. Substantial benefit can be expected from implantation in children with most kinds of IEMs, except for a narrow IAC, which is often associated with limited results.
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Affiliation(s)
- Lee-Suk Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
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CSF Gusher in Cochlear Implant Surgery–does it affect surgical outcomes? Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133 Suppl 1:S21-4. [DOI: 10.1016/j.anorl.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/17/2016] [Accepted: 04/28/2016] [Indexed: 11/17/2022]
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Vaid S, Vaid N, Manikoth M, Zope A. Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery. Indian J Otolaryngol Head Neck Surg 2015; 67:150-8. [PMID: 26075170 PMCID: PMC4460095 DOI: 10.1007/s12070-015-0858-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022] Open
Abstract
This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10-point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.
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Affiliation(s)
- Sanjay Vaid
- />Head Neck & ENT Imaging Division, Star Imaging and Research Center, Pune, 411001 India
- />2, National Hsg Society, Baner Road, Aundh, Pune, Maharashtra 411007 India
| | - Neelam Vaid
- />Department of Otorhinolaryngology, K.E.M. Hospital, Rastapeth, Pune, 411011 India
| | - Manoj Manikoth
- />Dr. Manoj’s Multispeciality ENT Hospital, Calicut, Kerala India
| | - Amit Zope
- />Department of Diagnostic Imaging and Radiology, Grant Medical Foundation, Pune, 411001 India
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Abstract
CONCLUSION The facial recess approach is preferred in common cavity (CC) malformation with an incomplete basal turn, and the transmastoid single-slit labyrinthotomy approach in classic CC malformation. Patients with CC benefit from cochlear implantation (CI) over time, but the audiological and speech development is poorer than in cases with normal cochleas. OBJECTIVES To discuss the surgical aspects and performance of CI in 21 patients with CC malformation. METHODS Twenty-one CC malformations were classified into 2 types: classic CC malformation and CC malformation with an incomplete basal turn. Twenty-one patients without inner ear malformation were set as the control group. Thus, data for 42 patients were analyzed. RESULTS The facial recess approach was used in 3 patients with CC malformation with an incomplete basal turn, and the transmastoid single-slit labyrinthotomy approach in 18 patients with classic CC malformation. After follow-up for 36 months, the average free-field hearing threshold was higher, and the scores for the CAP, SIR, IT-MAIS, and closed-set/open-set auditory speech perception tests were lower than in the control group (p < 0.05).
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Affiliation(s)
- Jiao Xia
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing , China
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Jeong SW, Kim LS. A New Classification of Cochleovestibular Malformations and Implications for Predicting Speech Perception Ability after Cochlear Implantation. Audiol Neurootol 2015; 20:90-101. [DOI: 10.1159/000365584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/30/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives: The aims of this study were to introduce a new classification of cochleovestibular malformation (CVM) and to investigate how well this classification can predict speech perception ability after cochlear implantation in children with CVM. Methods: Fifty-nine children with CVM who had used a cochlear implant for more than 3 years were included. CVM was classified into 4 subtypes based on the morphology of the cochlea and the modiolus on temporal bone computed tomography (TBCT): normal cochlea and normal modiolus (type A, n = 16), malformed cochlea and partial modiolus (type B, n = 31), malformed cochlea and no modiolus (type C, n = 6), and no cochlea and no modiolus (type D, n = 6). Speech perception test scores were compared between the subtypes of CVM using analysis of covariance with post hoc Bonferroni test. Univariate and multivariate regression analyses were used to identify the significant predictors of the speech perception test scores. Results: The speech perception test scores after implantation were significantly better in children with CVM type A or type B than in children with CVM type C or type D. The test scores did not differ significantly between the implanted children with CVM type A or type B and those without CVM. In univariate regression analysis, the type of CVM was a significant predictor of the speech perception test scores in implanted children with CVM. Multivariate regression analysis revealed that the age at cochlear implantation, cochlear nerve size and preimplantation speech perception test scores were significant predictors of the postimplantation speech perception test scores. The chance of cochlear nerve deficiency increased progressively from CVM type A to type D. Conclusion: The new classification of CVM based on the morphology of the cochlea and the modiolus is simple and easy to use, and correlated well with postimplantation speech perception ability and cochlear nerve status. This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of children with CVM.
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Surgical Outcomes After Cochlear Implantation in Children With Incomplete Partition Type I. Otol Neurotol 2015; 36:e11-7. [DOI: 10.1097/mao.0000000000000606] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cabbarzade C, Sennaroglu L, Süslü N. CSF gusher in cochlear implantation: The risk of missing CT evidence of a cochlear base defect in the presence of otherwise normal cochlear anatomy. Cochlear Implants Int 2014; 16:233-6. [DOI: 10.1179/1754762813y.0000000048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bille J, Fink-Jensen V, Ovesen T. Outcome of cochlear implantation in children with cochlear malformations. Eur Arch Otorhinolaryngol 2014; 272:583-9. [DOI: 10.1007/s00405-014-2883-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
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Kim CS, Kwon BJ, Chang SO, Oh SH, Lee HJ, Choi BY, Park YH. CSF gusher in cochlear implantation. Cochlear Implants Int 2013; 5 Suppl 1:67-9. [DOI: 10.1179/cim.2004.5.supplement-1.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nikolopoulos TP, Kiprouli K. Cochlear implant surgery in challenging cases. Cochlear Implants Int 2013; 5 Suppl 1:56-63. [DOI: 10.1179/cim.2004.5.supplement-1.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Todt I, Rademacher G, Ernst A. Identification and revision of a displaced cochlear implant electrode in the internal auditory canal. Cochlear Implants Int 2013; 14:236-9. [DOI: 10.1179/1754762812y.0000000015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Heman-Ackah SE, Friedmann DR, Cosetti MK, Waltzman SB, Roland JT. Revision cochlear implantation following internal auditory canal insertion. Laryngoscope 2013; 123:3141-7. [PMID: 24114888 DOI: 10.1002/lary.23340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS In pediatric patients with congenital malformations of the inner ear, anomalies within the anatomy may facilitate unintentional insertion of the cochlear implant electrode into the internal auditory canal. Revision procedures for removal and replacement of cochlear implant electrodes following internal auditory canal insertion are fraught with potential danger, including the theoretical risk of injury to vasculature within the internal auditory canal, repeat insertion within the internal auditory canal, and cerebrospinal fluid leak. The objective of this presentation is to describe a technique for revision cochlear implantation following internal auditory canal insertion to minimize the potential associated risks. STUDY DESIGN Case series. METHODS A retrospective chart review was performed on all patients at a tertiary care facility who underwent revision cochlear implantation for internal auditory canal insertion between January 1999 and July 2011. RESULTS A total of four patients referred from outside institutions have undergone revision cochlear implantation for internal auditory canal insertion. The records from these patients were reviewed. Electrodes were safely removed in all cases without injury to the anterior inferior cerebellar artery or its branches (i.e., labyrinthine artery). Complete insertion was accomplished on reimplantation. Neural response telemetry was performed in all cases, and responses were noted. Fluoroscopy was utilized to visualize electrode progression during insertion. A detailed description of the operative technique is provided. CONCLUSIONS This case series describes a technique for revision cochlear implantation that appears to be safe and effective in preventing potential associated complications.
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Affiliation(s)
- Selena E Heman-Ackah
- Department of Otolaryngology, New York University School of Medicine, New York, New York, U.S.A
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Selvadurai DK, Gibbin KP. Case Report: Cochlear implantation in Mondini dysplasia with congenital footplate defect – implications for meningitis risks during implantation. Cochlear Implants Int 2013; 4:196-200. [DOI: 10.1179/cim.2003.4.4.196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hongjian L, Guangke W, Song M, Xiaoli D, Daoxing Z. The prediction of CSF gusher in cochlear implants with inner ear abnormality. Acta Otolaryngol 2012; 132:1271-4. [PMID: 22831706 DOI: 10.3109/00016489.2012.701328] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONCLUSION The incidence rate of the cerebrospinal fluid (CSF) gusher in cochlear implant with inner ear abnormality is 30%. Bony defect in the fundus of the internal acoustic meatus is most often responsible for the occurrence of CSF gusher. This feature of the CT scan can be used to predict the occurrence of a CSF gusher. OBJECTIVE To predict the occurrence of CSF gusher in cochlear implants with inner ear abnormality. METHODS This was a retrospective analysis of 442 patients with inner ear abnormality who underwent cochlear implantation from February 1998 to July 2011. The patients were reviewed for the findings on temporal high resolution computed tomography (HRCT) scans and the complication of CSF gusher in cochlear implantation. RESULTS Among the 422 cases, 134 (30%) suffered from the complication of CSF gusher during the operation. They were all found to have a bony defect in the fundus of the internal acoustic meatus on the CT scans.
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Affiliation(s)
- Liu Hongjian
- Department of Otolaryngology, Henan Province People's Hospital, Zhengzhou University, Zhengzhou, Henan, China
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Yuan YY, Song YS, Chai CM, Shen WD, Han WJ, Liu J, Wang GJ, Dong TX, Han DY, Dai P. Intraoperative CT-guided cochlear implantation in congenital ear deformity. Acta Otolaryngol 2012; 132:951-8. [PMID: 22668345 DOI: 10.3109/00016489.2012.674214] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Intraoperative computed tomography (iCT)-guided cochlear implantation is practical and effective for correct electrode placement in the cochlea of patients with congenital inner ear and/or complex middle ear malformation. OBJECTIVES The operation in patients with inner ear and/or complex middle ear malformation including abnormal facial nerve course is difficult. This study evaluated the efficacy of cochlear implantation under the guidance of iCT to insure correct electrode placement. METHODS This was a prospective interventional case series. Ten patients with severe to profound sensorineural hearing loss due to ear malformations were enrolled, and iCT was used to confirm the right placement of electrodes. RESULTS Intraoperative CT was performed three times in one patient, twice in two, and once in the others. Interruption of the surgical process for each iCT until resumption of surgery was 9.64 ± 0.63 min. iCT revealed incorrectly positioned cochlear implants in two patients, which were immediately corrected. There were no reoperations due to misplacement of electrodes. iCT helped locate the cochlea in the middle ear of one patient with an abnormal facial nerve course. The overall intervention rate based on iCT findings was 30%. LEVEL OF EVIDENCE level 4.
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MESH Headings
- Adult
- Child
- Child, Preschool
- China
- Cochlear Implantation/methods
- Deafness/congenital
- Deafness/diagnostic imaging
- Deafness/physiopathology
- Deafness/surgery
- Ear, Inner/abnormalities
- Ear, Inner/diagnostic imaging
- Ear, Inner/physiopathology
- Ear, Inner/surgery
- Ear, Middle/abnormalities
- Ear, Middle/diagnostic imaging
- Ear, Middle/physiopathology
- Ear, Middle/surgery
- Electrodes, Implanted
- Facial Nerve/abnormalities
- Facial Nerve/physiopathology
- Facial Nerve/surgery
- Female
- Hearing Loss, Sensorineural/congenital
- Hearing Loss, Sensorineural/diagnostic imaging
- Hearing Loss, Sensorineural/physiopathology
- Hearing Loss, Sensorineural/surgery
- Humans
- Infant
- Male
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/physiopathology
- Surgery, Computer-Assisted/methods
- Telemetry
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Yong-Yi Yuan
- Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
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Stelter K, Ledderose G, Hempel JM, Morhard DF, Flatz W, krause E, Mueller J. Image guided navigation by intraoperative CT scan for cochlear implantation. ACTA ACUST UNITED AC 2012; 17:153-60. [DOI: 10.3109/10929088.2012.668937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy. Otolaryngol Head Neck Surg 2011; 146:180-90. [DOI: 10.1177/0194599811429244] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery. Data Sources. MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary. Review Methods. A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data. Results. The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures. Conclusion. Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.
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Affiliation(s)
- Michael N. Pakdaman
- Department of Otorhinolaryngology, University of Texas Medical School, Houston, Texas, USA
| | - Barbara S. Herrmann
- Department of Audiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Van Beek-King
- Department of Otolaryngology–Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia, USA
| | - Daniel J. Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Kontorinis G, Goetz F, Giourgas A, Lenarz T, Lanfermann H, Giesemann AM. Radiological diagnosis of incomplete partition type I versus type II: significance for cochlear implantation. Eur Radiol 2011; 22:525-32. [DOI: 10.1007/s00330-011-2301-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
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Kim LS, Jeong SW, Lee YM, Kim JS. Cochlear implantation in children. Auris Nasus Larynx 2010; 37:6-17. [DOI: 10.1016/j.anl.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/10/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
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Real-Time Intraoperative Computed Tomography to Assist Cochlear Implant Placement in the Malformed Inner Ear. Otol Neurotol 2009; 30:23-6. [DOI: 10.1097/mao.0b013e31818d1cd2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Intact meatal skin, canal wall down approach for difficult cochlear implantation. The Journal of Laryngology & Otology 2008; 123:903-6. [PMID: 18976512 DOI: 10.1017/s0022215108004039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The intact posterior meatal skin, canal wall down technique for difficult cochlear implantation provides expanded access to the middle ear for cochleostomy in cases of obscured middle-ear landmarks, limited facial recess access and limited mastoid cavity dimensions. Careful preservation of the posterior canal wall skin in this procedure obviates the need for obliteration of the middle-ear mucosa and closure of the external auditory canal. OBJECTIVES To present a canal wall down technique for cochlear implantation, which preserves the intact posterior external auditory canal wall skin. This approach is employed when a standard facial recess cochleostomy is not possible. METHODS Three cases of intact posterior meatal skin, canal wall down cochlear implantation are presented together with long-term follow-up results. In all three cases, implantation via a facial recess approach was not possible. One patient suffered from severe cochlear otosclerosis with obliteration of the round window niche. The second patient had severe middle-ear fibrosis with encasement of all middle-ear structures and obliteration of routine landmarks. The third patient had an anterior sigmoid sinus obscuring access to the facial recess. Cochlear implantation via the canal wall down, intact posterior canal wall skin technique was successfully performed in each of these patients. RESULTS All three patients were successfully implanted, with full electrode insertion achieved. All patients subsequently became active implant users. One patient did suffer from a minor wound complication post-operatively, unrelated to the approach. Patient follow up ranged from four to six years.
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