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Predictive Value of Transimpedance Matrix Measurements to Detect Electrode Tip Foldover. Otol Neurotol 2022; 43:1027-1032. [PMID: 36040040 DOI: 10.1097/mao.0000000000003667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the ability of the transimpedance matrix (TIM) measurement to detect cochlear implant electrode tip foldover by comparing results to a "gold standard," the intraoperative plain film radiograph. STUDY DESIGN Retrospective case series. SETTING Tertiary referral hospital. PATIENTS One hundred three patients who underwent cochlear implantation between June 2020 and August 2021. INTERVENTIONS Intraoperative electrophysiologic monitoring (electrode impedances, neural response telemetry, and TIM measurement) and modified Stenver's view plain film radiographs. MAIN OUTCOME MEASURES Identification of tip foldover on both TIM and plain films. RESULTS In total, 103 patients (117 ears) had both a TIM measurement and intraoperative X-ray available for review, including 68 adults and 35 children. One hundred patients (85%) received the Cochlear Slim Modiolar electrode. Tip foldovers were noted in three of 117 implants (2.5%). In all cases, TIM was able to detect the foldover, and the electrode arrays were reinserted with the patients still under anesthesia, with repeat X-ray demonstrating a normal configuration. Two other abnormal TIM patterns were identified. One was in a patient with an obstructed cochlea in whom only 10 electrodes could be inserted, the other was in a patient with a common cavity abnormality. One additional patient underwent electrode repositioning intraoperatively because of overinsertion. In this patient, the TIM appeared to be within normal limits, but the over-insertion was apparent on X-ray. Overall, the sensitivity and specificity of TIM measurements in detecting electrode tip foldover were both 100%. CONCLUSION TIM measurements were able to accurately identify tip foldovers. More research is needed to define the adjunctive role of TIM as an intraoperative measure.
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Abstract
OBJECTIVE To determine root causes leading to misplaced cochlear implant (CI) electrode arrays and discuss their management using a case series and contemporary literature review. STUDY DESIGN Retrospective case review and contemporary literature review. SETTING Single tertiary-referral center. PATIENTS Adult and pediatric patients who were diagnosed with a misplaced CI electrode array, excluding tip-foldover. Literature review was performed via a MEDLINE database PubMed query. All articles that described at least one case of extracochlear electrode array misplacement were included; partial insertions and extrusions were excluded. MAIN OUTCOME MEASURE Extracochlear misplacement. RESULTS A total of 61 cases were reviewed, including 4 new cases and 57 cases from 29 previously published articles. We discuss management of CI arrays in the carotid canal, the vestibule, and the modiolus. The rate of CI misplacement is estimated to be 0.49%. The most frequent location of misplacement CI was the vestibular system (50.8%) followed by the internal carotid canal (11.5%). Normal cochlear anatomy was noted on preoperative computer tomography (CT) in 59.0% of patients; abnormalities were noted in 27.9%. The most common technical issue was misidentification or poor visualization of the round window. CONCLUSION CI electrode misplacement is rare but can cause postoperative complications and may result in permanently diminished CI performance and hearing outcomes, even after revision surgery. Failure to identify the round window is the most common reason for CI misplacement, despite most patients having normal cochlear anatomy. Surgical strategies to localize the round window and basal turn are imperative for proper electrode placement. LEVEL OF EVIDENCE 4.
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Misplaced Cochlear Implant Electrodes Outside the Cochlea: A Literature Review and Presentation of Radiological and Electrophysiological Findings. Otol Neurotol 2022; 43:567-579. [PMID: 35261380 DOI: 10.1097/mao.0000000000003523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS It is possible to detect when misplacement and malposition of the cochlear implant (CI) electrode array has occurred intraoperatively through different investigations. We aim to explore the literature surrounding cochlear implant misplacements and share our personal experience with such cases to formulate a quick-reference guide that may be able to help cochlear implant teams detect misplacements early. BACKGROUND Misplacement and malposition of a cochlear implant array can lead to poor hearing outcomes. Where misplacements go undetected during the primary surgery, patients may undergo further surgery to replace the implant array into the correct intracochlear position. METHODS Systematic literature review on cochlear implant misplacements and malpositions and a retrospective review of our program's cases in over 6,000 CI procedures. RESULTS Twenty-nine cases of CI misplacements are reported in the English literature. Sixteen cases of cochlear implant misplacements are reported from our institution with a rate of 0.28%. A further 12 cases of intracochlear malpositions are presented. The electrophysiological (CI electrically evoked auditory brainstem response, transimpedance matrix) and radiological (X-ray and computed tomography scan) findings from our experience are displayed in a tabulated quick-reference guide to show the possible characteristics of misplaced and malpositioned cochlear implant electrode arrays. CONCLUSION Both intraoperative electrophysiological and radiological tests can show when the array has been misplaced or if there is an intracochlear malposition, to prompt timely intra-operative reinsertion to yield better outcomes for patients.
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Subcochlear canaliculus patterns in the pediatric and adult population: radiological findings and surgical implications. Surg Radiol Anat 2021; 43:1285-1290. [PMID: 33609169 DOI: 10.1007/s00276-021-02709-6] [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: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The pneumatization of the different regions of the temporal bone is strictly related to the age and the degree of development of the mastoid and the middle ear. Petrous apex pneumatization is the last step of the development of the petrous bone system. The subcochlear canaliculus is an anatomical cavity, originating in the space between the fustis and the finiculus, and connecting the round window area to the petrous apex. The aim of the present article is analyzing the trend of development of the subcochlear canaliculus pneumatization, classified through CT scan examination, in different age subgroups. MATERIALS AND METHODS We conducted a retrospective review of patients who underwent temporal bone CT scans between 2014 and 2019. Pediatric and adult patients were included and divided into different age subgroups. The subcochlear canaliculus was examined through coronal view scans at the level of the round window niche and classified into 3 different groups (A, B and C) according to the degree of pneumatization. RESULTS A total of 270 Petrous bone CT scans was analyzed. The percentage of type A subcochlear canaliculus was significantly higher in the pediatric population if compared to the adult population (p = 0.001326). As far as type B subcochlear canaliculus is concerned, the difference between children and adults was not statistically significant (p = 0.2378). On the other hand, type C subcochlear canaliculus was predominant in the adult population (p = 0.000256). CONCLUSIONS There is a constant increase in pneumatization of the subcochlear canaliculus from 0 to 19 years and then a progressive decrease. This discovery has relevant surgical implications and has to be borne in mind in particular for cholesteatoma surgery and cochlear implantation surgery in the age groups in which the subcochlear canaliculus is highly pneumatized.
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Lyutenski S, El‐Saied S, Schwab B. Impact of occlusive material and cochlea-carotid artery relation on eustachian tube occlusion in subtotal petrosectomy. Laryngoscope Investig Otolaryngol 2020; 5:1140-1146. [PMID: 33364405 PMCID: PMC7752035 DOI: 10.1002/lio2.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the success rate of eustachian tube (ET) occlusion in subtotal petrosectomy relative to the occlusive material used and to the varying protympanum anatomy, by means of standardized alignment of the cochlea-carotid artery relation on computed tomography images. PATIENTS AND METHODS All cases of subtotal petrosectomy carried out by the same surgeon at a tertiary care referral center were retrospectively evaluated. Only cases with available computed tomography prior to second stage cochlear or middle ear implantation were included. The occlusive material was either muscle tissue or oxidized regenerated cellulose in combination with bone wax. On 3D multiplanar image reconstruction, the varying topographic interrelation of the cochlea and the petrous carotid artery was measured and categorized into two groups: detachment or overlapping. RESULTS In 9 (31%) of the 29 included cases there was insufficient occlusion of the ET. In none of these cases was an infection of the fat filling in the obliterated cavity observed during the implantation procedure on second stage (average 10 months interval). The failure rate of both occlusion materials was almost the same (using muscle tissue, in 4 (33.3%) of 12 or oxidized regenerated cellulose, in 5 (29.4%) of 17 cases). It was also similar for both materials in each of the anatomic variation groups. CONCLUSIONS An incomplete occlusion of the ET alone does not appear to lead to an infection of the obliterated cavity. Autologous muscle tissue and oxidized regenerated cellulose had similar rates of ET occlusion failure. The topographical variance of the protympanum appears to have no direct influence on the success of the ET occlusion.
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Affiliation(s)
- Stefan Lyutenski
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of OtorhinolaryngologyHelios Hospital Berlin‐BuchBerlinGermany
| | - Sabri El‐Saied
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of Otolaryngology ‐ Head and Neck SurgerySoroka University Medical CenterBe'er ShevaIsrael
| | - Burkard Schwab
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of OtorhinolaryngologyHelios Hospital HildesheimHildesheimGermany
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Yilmazer R, Karatay E, Akbulut S, Alkan Z, Sarikaya B. Anatomical landmarks for cochlear implantatıon in ossifıed cochleas. Eur Arch Otorhinolaryngol 2020; 277:3301-3306. [PMID: 32440899 DOI: 10.1007/s00405-020-06044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE In this study, we aimed to introduce the facial nerve as a new anatomical landmark which can be used in ossified cochleas during cochlear implantation. We also set out to define a safe line to preserve the internal auditory canal (IAC) while drilling the basal turn of the cochlea. METHODS Thirty patients who had temporal computed tomography (CT) were studied. The distances from the facial nerve and the round window to the IAC, carotid artery, and jugular bulb were measured in the reformatted CT images. We have created a line in the direction of the stapedial tendon from the round window to the IAC and called it ROWIAC (Round window-IAC) line. We have investigated whether this line intersects the IAC and measured the distances from this line to the IAC. RESULTS Fifty-four temporal CT scans were included to the study. The mean distances from the facial nerve to the IAC, carotid artery, and jugular bulb were 8.8 ± 0.9, 15.0 ± 2.0, and 12.2 ± 2.9 mm, respectively. The mean distances from the round window to these structures were 3.8 ± 0.7, 9.4 ± 2.2, and 8.3 ± 2.9 mm, respectively. ROWIAC line did not intersect the IAC in any of the patients. The mean distance between this line and the IAC was 0.8 ± 0.4 mm. CONCLUSION We propose that facial nerve and ROWIAC line can be used as potential landmarks during cochlear implantation in ossified cochleas to protect the adjacent neurovascular structures.
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Affiliation(s)
- Rasim Yilmazer
- Department of Otolaryngology, Demiroglu Bilim University Hospital, Istanbul, Turkey.
- Florence Nightingale Atasehir Hastanesi, Kulak Burun Bogaz Anabilim Dali, Kuçukbakkalkoy Mahallesi, Isiklar Cd. 35/A, 34750, Atasehir/Istanbul, Turkey.
| | - Emrah Karatay
- Department of Radiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Sevtap Akbulut
- Department of Otolaryngology, Yeditepe University Hospital, Istanbul, Turkey
| | - Zeynep Alkan
- Department of Otolaryngology, Yeditepe University Hospital, Istanbul, Turkey
| | - Basar Sarikaya
- Department of Radiology, University of Washington, Seattle, WA, USA
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Mehanna AM, Gamaleldin OA, Fathalla MF. The misplaced cochlear implant electrode array. Int J Pediatr Otorhinolaryngol 2019; 117:96-104. [PMID: 30579097 DOI: 10.1016/j.ijporl.2018.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluation of the clinical, electrophysiologic findings, the management plans of the misplaced cochlear implant electrode array and the possible causes of misplacement. Also to provide recommendations to prevent a repeat of cochlear implant electrode misplacement into abnormal sites. STUDY DESIGN Retrospective study. METHODS Pediatric cochlear implant recipients implanted from January 2012 till January 2018 whose electrode arrays were misplaced outside the cochlea into the surrounding structures. RESULTS Eight pediatric cochlear implant recipients, were identified to have a misplaced cochlear implant electrode array. Different sites of improper placement included one case in the eustachian tube, another one in the vestibule, one electrode array was found to be in the petrous apex lateral to the internal carotid canal, and another one in the internal auditory canal (IAC), and in three cases the electrode arrays were packed in the hypotympanum, and lastly an electrode array recoiled after perfect insertion and was found to be in the facial recess. Six cases were initially identified immediate because of their poor intraoperative implant testing which prompted imaging while in two cases, the one found in the petrous apex and the other one in the internal auditory canal (IAC) were diagnosed several months after surgery due to unsatisfactory auditory skills development or absent behavioral responses following implantation. CONCLUSIONS Electrode array misplacement may be due to either failure to identify the anatomical landmarks during surgery specially the infracochlear air cell track or unidentified inner ear malformation. The routine use of intraoperative electrophysiologic testing and postoperative imaging should help to avoid such complications. Misplacement is a rare but still correctable complication after cochlear implant surgery. The diagnosis of misplacement can be delayed for years and in this occasion, it is suspected when benefit from the implant is limited or absent. Once misplacement is diagnosed revision surgery has to be done.
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Affiliation(s)
- Ahmed Mohamed Mehanna
- Otorhinolaryngology Department, Alexandria Faculty of Medicine, Alexandria Main University Hospital, Egypt.
| | - Omneya A Gamaleldin
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Alexandria Main University Hospital, Egypt
| | - Mohamed Fawzy Fathalla
- Otorhinolaryngology Department, Alexandria Faculty of Medicine, Alexandria Main University Hospital, Egypt
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Jain S, Gaurkar S, Deshmukh PT, Khatri M, Kalambe S, Lakhotia P, Chandravanshi D, Disawal A. Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation. Braz J Otorhinolaryngol 2018; 85:435-446. [PMID: 29759935 PMCID: PMC9443052 DOI: 10.1016/j.bjorl.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/27/2018] [Accepted: 03/19/2018] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. OBJECTIVE The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. METHODS Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. RESULTS When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27mm (mean of 0.69±0.25mm). Maximum width of round window ranged from 0.51 to 2.04mm (mean of 1.16±0.47mm). Average minimum distance between round window and carotid canal was 3.71±0.88mm (range of 2.79-5.34mm) and that between round window and jugular fossa was 2.47±0.9mm (range of 1.24-4.3mm). CONCLUSION The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.
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Affiliation(s)
- Shraddha Jain
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India.
| | - Sagar Gaurkar
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Prasad T Deshmukh
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Mohnish Khatri
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Sanika Kalambe
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Pooja Lakhotia
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Deepshikha Chandravanshi
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
| | - Ashish Disawal
- Jawahar Lal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DU), Department of Otorhinolaryngology and Heand and Neck Surgery, Sawangi(M), Wardha, India
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Rzaev RM, Rzaev RR, Rzaev RR. [The modern state and prospects of development of endoscopic otosurgery]. Vestn Otorinolaringol 2018; 83:74-78. [PMID: 30412182 DOI: 10.17116/otorino20188305174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this review presents data on efficiency endoscopic operations at some ear diseases. Now endoscopic operations are widely applied at primary and residual (or recuring) middle ear cholesteatomas, tympanic membrane perforation, otosclerosis and cochlear implantation. Proceeding from resolving power of endoscopic technology, endoscopic operation can be applied as an independent method, or as an endoscopic assisted, to be combined with otomicrosurgery operation. Efficiency of endoscopic operation in many respects is defined by a possibility of panoramic visualization of anatomical structures of middle and inner ear, and also carrying out high-quality elimination of focus lesion from areas, being remote when performing otomicrosurgery operation.
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Affiliation(s)
- R M Rzaev
- Department of Otorhinolaryngology - Head and Neck Surgery, Central Azerbaijan Railway Hospital, Baku, Azerbaijan
| | - R R Rzaev
- State Scientific Clinical of Otorhinolaryngology, Federal Medico-Biological Agency, Moscow, Russia
| | - Rd R Rzaev
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia
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Di Lella F, Falcioni M, Piccinini S, Iaccarino I, Bacciu A, Pasanisi E, Cerasti D, Vincenti V. Prevention and management of vascular complications in middle ear and cochlear implant surgery. Eur Arch Otorhinolaryngol 2017; 274:3883-3892. [DOI: 10.1007/s00405-017-4747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022]
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Singla A, Gupta T, Sahni D, Gupta AK, Aggarwal A. Topography of neurovascular structures in relation to round window and how it relates to cochlear implantation. Surg Radiol Anat 2017; 39:1309-1316. [PMID: 28597033 DOI: 10.1007/s00276-017-1884-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/01/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this investigation was to evaluate the distances and angles on basal turn of cochlea in relation to round window at which the jugular bulb, internal carotid artery and facial nerve are at maximal risk and their implications in cochlear implantation (CI). METHODS Fifty-four cadaveric temporal bones were microdissected to expose the basal turn of cochlea, the carotid canal, the facial canal and the jugular fossa. The points were marked on the basal turn of cochlea, where there was minimum distance of basal turn of cochlea from the roof of the jugular fossa (point a), carotid canal (point b) and facial canal (point c). The distances and angles of these points from the round window were measured. RESULTS The points a, b and c were at mean (range) distances of 2.8 mm (1.3-4.1 mm), 8.4 mm (6.5-10.4 mm) and 16.4 mm (12.5-20.5 mm) and at mean angles of 30° (15°-45°), 111° (71°-136°) and 284° (255°-315°), respectively, from the round window. CONCLUSIONS This study highlights that 2.8 ± 0.5 mm (30 ± 5.40), 8.4 ± 1 mm (111 ± 12.70) and 16.4 ± 1.7 mm (284 ± 13.5) from the round window are the high-risk points on the basal turn of the cochlea for the jugular bulb, internal carotid artery and facial nerve, respectively. A wide range found for each parameter indicates that it is mandatory to evaluate these distances in each CI patient on preoperative radiographs to avoid intraoperative injury to these vital structures.
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Affiliation(s)
- Anjali Singla
- Department of Anatomy, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India.
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Gupta
- Department of Otolaryngology and Head Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Relationship of cochlea with surrounding neurovascular structures and their implication in cochlear implantation. Surg Radiol Anat 2015; 37:913-9. [PMID: 25663082 DOI: 10.1007/s00276-015-1442-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
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Impingement of the carotid canal on the basal turn of the cochlea as pertaining to cochlear implantation. Otol Neurotol 2014; 35:1746-51. [PMID: 24945587 DOI: 10.1097/mao.0000000000000471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS To evaluate the relation of the basal turn of the cochlea with the carotid canal as pertaining to cochlear implantation. BACKGROUND Cochlear implantation is an established mode of treatment for patients with bilateral profound sensorineural hearing loss. An intricate knowledge of both the typical and atypical topography of the cochlea with the carotid canal is essential for safely conducting cochlear implantation. DESIGN Fifty-eight cadaveric temporal bones were microdissected to expose the medial wall of the middle ear. To open the basal turn of the cochlea, the promontory was drilled. The carotid canal was unroofed to reveal the internal carotid artery. The minimum distance between the basal turn of the cochlea and the vertical part of the carotid canal was measured. RESULTS The minimum distance between the basal turn of the cochlea and the carotid canal ranged from 0 to 3.9 mm (mean ± SD, 1.3 ± 0.8 mm). The carotid canal was abutting the basal turn of the cochlea in three cases, and impingement of the carotid canal on the anterior cochlear wall was found in five (8.6%) cases. CONCLUSION Preoperative knowledge of findings like impingement (8.6%) and abutment (5.2%) of the carotid canal on the basal turn of the cochlea is of immense importance in cochlear implantation, which may otherwise lead to disastrous consequences during surgery.
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Coombs A, Clamp PJ, Armstrong S, Robinson PJ, Hajioff D. The role of post-operative imaging in cochlear implant surgery: a review of 220 adult cases. Cochlear Implants Int 2014; 15:264-71. [PMID: 24679147 DOI: 10.1179/1754762814y.0000000071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To determine the incidence of abnormal radiological findings after cochlear implantation and their effect on clinical outcomes. METHODS Retrospective review of 220 adult cochlear implants. Clinical records and post-operative plain X-rays were reviewed and compared with pre-operative and 6-month post-operative City University of New York (CUNY) speech scores. RESULTS There were no cases of extra-cochlear array misplacement. Imaging showed 20 cases of incomplete array insertion (9.2%), 3 cases of kinking of the array (1.4%), 2 cases of tip rollover (0.9%), and 1 case of apparent array fracture (0.5%). Patient management was not altered by abnormal imaging. Patients with abnormal radiological findings had slightly minor improvements (median 39 vs. 56%) in City University of New York (CUNY) speech discrimination scores at 6 months (Mann-Whitney U test, P = 0.043). CONCLUSION All abnormalities on post-operative imaging were minor and did not alter patient management. The future role of post-operative imaging is discussed.
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Migirov L, Shapira Y, Wolf M. The feasibility of endoscopic transcanal approach for insertion of various cochlear electrodes: a pilot study. Eur Arch Otorhinolaryngol 2014; 272:1637-41. [PMID: 24619204 DOI: 10.1007/s00405-014-2995-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/01/2014] [Indexed: 11/30/2022]
Abstract
To determine the feasibility of inserting various types of electrode arrays using an endoscopic transcanal approach into the cochlea via the round window membrane (RWM). All the procedures were performed by the first author and started with a cortical mastoidectomy. A six o'clock vertical incision was made in the meatal skin, and a posterior tympano-meatal flap was elevated transmeatally to expose the middle ear cavity using a rigid 0° endoscope (diameter 3 mm, length 14 cm). The chorda tympani nerve (CTN) and body of the incus were exposed. The RWM was incised, and the electrodes were passed through the tunnel from the mastoid to the epitympanum, medial to the CTN and lateral to the incus into the round window (RW) in seven procedures. In the other six cases, an open groove had been drilled, starting superiorly and laterally to the CTN and ending in the mastoid region. After electrodes insertion, the groove was filled with bone dust and covered with a large piece of fascia prior to repositioning of the tympano-meatal flap. Complete electrode insertion (7 Nucleus Contour Advance, 5 Concerto and 1 HiRes90K) via the RW was achieved in all 13 cases. Endoscopic CI was more feasible for insertion of concerto electrode followed by HiRes90K and Nucleus. An assistance of another surgeon was required for removal of stylet in the "off-the-stylet technique" utilized for implantation of nucleus electrode. Endoscopic transcanal implantation of different cochlear electrodes through the RW is feasible in both children and adults and can be used as first surgical option or as a complementary to the traditional posterior tympanotomy approach.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Aviv University, Affiliated to Sackler School of Medicine, 5262l, Tel Hashomer, Israel,
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Benatti A, Castiglione A, Trevisi P, Bovo R, Rosignoli M, Manara R, Martini A. Endocochlear inflammation in cochlear implant users: case report and literature review. Int J Pediatr Otorhinolaryngol 2013; 77:885-93. [PMID: 23578804 DOI: 10.1016/j.ijporl.2013.03.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/07/2013] [Accepted: 03/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Cochlear implantation is a relatively safe procedure with a low complication rate. The overall rate of complications among cochlear implant patients ranges from 6% to 20%. Major complications are those that are life-threatening or require surgery, whereas minor complications are those that can be medically treated. Nonetheless, certain complications, even if highly rare, may require specific investigations and treatments. Among these rare complications are those with endocochlear involvement, such as cochleitis or labyrinthitis, with fibrosis or ossification that could lead to explantation. The aims of the present study were to report a particular case of post-operative cochleitis and to review the rate of complications after cochlear implantation, emphasising those conditions with proven endocochlear involvement. METHODS We refer to the case of an eight-year-old Italian boy affected by the sudden onset of headache, ipsilateral otalgia and facial paresis, who presented to our clinic for inexplicable worsening of the performance of his implant and his residual hearing, six years after surgery. A complete investigation including (clinical history, routine, autoimmune and serological blood tests, electrophysiological measurements from the cochlear implant and neuroimaging) was performed and is herein described. Additionally, a comprehensive review of the literature was conducted using internet search engines; 274 papers were selected, 88 of which were best suited to our purposes. RESULTS In our case, the progression of the symptoms and the performance decrement required explantation, followed by a complete recovery. Reviewing the literature revealed only three reports concerning cases of proven endocochlear phlogosis that required revision surgery. Wound swelling/infection and vertigo remain the two most common complications of cochlear implantation. Failure of the device is the third most frequent complication (10.06% of all complications and 1.53% of cochlear implantations). Other rare conditions (such as granulating labyrinthitis with cochlear fibrosis, ossification and erosion, silicone allergy and the formation of a biofilm around the internal device) are possible and unpredictable. Although rare (approximately 1%), such cases may require explantation. CONCLUSIONS Despite efforts by both surgeons and manufacturers, device-related and surgical complications still occur. These and other rare conditions demand specific management, and their frequency may be underestimated. Further studies are needed to assess more realistic rates of complications and devise more efficient strategies for early diagnosis and treatment.
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Affiliation(s)
- Alice Benatti
- Operative Unit of Otolaryngology and Otosurgery, Padua University, Via Giustiniani, 2, Padua, Italy.
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Ying YLM, Lin JW, Oghalai JS, Williamson RA. Cochlear implant electrode misplacement: incidence, evaluation, and management. Laryngoscope 2013; 123:757-66. [PMID: 23299627 DOI: 10.1002/lary.23665] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the presentation and management of improper electrode array placement, and to help guide clinical decision-making. STUDY DESIGN Retrospective case series. METHODS Pediatric and adult cochlear implant patients managed from January 2001 to present whose electrode arrays were not placed properly within the cochlea or extended beyond the cochlea into the internal auditory canal or adjacent structures. RESULTS Four patients, three pediatric and one adult, were identified from over 824 cases (< 1%) managed over the study duration. All cases had normal cochlear anatomy. These cases were initially identified due to poor auditory skill development or absent behavioral responses following implantation, which prompted imaging. Two patients presented several years after surgery. Sites of improper placement included the eustachian tube, vestibule, internal carotid artery canal, and internal auditory canal (IAC). Intraoperative findings and management are reviewed. CONCLUSIONS Electrode array malpositioning is a rare, but serious and correctable complication in cochlear implant surgery. A multidisciplinary approach, including prompt audiologic evaluation and imaging, is important, particularly when benefit from the implant is limited or absent. Management of electrode arrays in the IAC may be more challenging.
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Affiliation(s)
- Yu-Lan Mary Ying
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
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Abstract
OBJECTIVE To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI). STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included. INTERVENTION Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography. MAIN OUTCOME MEASURE Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position. RESULTS No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device. CONCLUSION Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.
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Mouzali A, Ouennoughi K, Haraoubia MS, Zemirli O, Triglia JM. Cochlear implant electrode array misplaced in Hyrtl's fissure. Int J Pediatr Otorhinolaryngol 2011; 75:1459-62. [PMID: 21906823 DOI: 10.1016/j.ijporl.2011.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/08/2011] [Accepted: 08/13/2011] [Indexed: 11/26/2022]
Abstract
Hyrtl's fissure is a cleft that is present in the developing fetal petrous temporal bone and extends from the area inferior to the round window to the meninges of the posterior fossa. Persistent Hyrtl's fissure, due to incomplete ossification, is considered a rare temporal bone malformation, and is a known cause of perilabyrinthine cerebrospinal fluid fistula. Very few cases are reported as being at risk of complication of cochlear implant surgery. Here we report the case of an 8-year-old boy with misplacement of an electrode array in Hyrtl's fissure. The diagnosis was made postoperatively, since cochlear implant failure was suspected from non-auditory responses. Computed tomography (CT) revealed the extracochlear location of the electrode array. We emphasize the role of presurgical imaging CT and magnetic resonance imaging in detecting temporal bone abnormalities, and we discuss the value of intraoperative auditory nerve response telemetry and postoperative radiological evaluation in diagnosing cochlear implant misplacement.
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Affiliation(s)
- Amina Mouzali
- Department of Otorhinolaryngology Head & Neck Surgery, Beni Messous Universitary Hospital, Alger 1600, Algeria
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Sokolov A, Hellerud BC, Pharo A, Johannessen EA, Mollnes TE. Complement activation by candidate biomaterials of an implantable microfabricated medical device. J Biomed Mater Res B Appl Biomater 2011; 98:323-9. [DOI: 10.1002/jbm.b.31855] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/05/2011] [Accepted: 02/24/2011] [Indexed: 11/06/2022]
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