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Bharadwaja S, Patnaik U, Sahoo L, Raghavan D, Mathur Y, Badal S, Srivastava K. Role of Pre-Operative High-Resolution Computed Tomography for Surgical Planning in Patients Undergoing Cochlear Implantation - An Observational Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1630-1636. [PMID: 38566635 PMCID: PMC10982146 DOI: 10.1007/s12070-023-04372-2] [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: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 04/04/2024] Open
Abstract
Background Currently preoperative magnetic resonance imaging (MRI) brain and High-Resolution Computed Tomography (HRCT) scanning of temporal bones form part of routine Cochlear implantation (CI) assessment. Pre- operative imaging demonstrates anatomic details or anomalies if any, that prove essential in pre-surgical evaluation of patients. These form a road map for the surgeon to anticipate any difficulty during surgery, to aid in decision making to implant the most appropriate ear, plan surgical technique, or select electrode arrays. Methods A descriptive observational pilot study was conducted at tertiary care hospital involving 51 paediatric patients worked-up for CI. Patients after detailed clinical evaluation and MRI Brain, a tentative surgical plan was formulated by a candidacy CI screening committee. Patients selected for surgery underwent HRCT temporal bones and surgical plan was modified after analysing the same. Percentage of cases in which surgical plan changed (in terms of laterality of surgery) after correlating with HRCT findings were determined and data analysed. Results A total of 51 patients worked up for CI were included in the study. In 37.3% cases, there were unfavourable MRI findings. HRCT scan was used to aid the surgical road map in these patients, which based on MRI findings would have had suboptimal outcome. Conclusion With this understanding, we recommend that, MRI with precise interpretation would be sufficient to furnish all necessary information in preoperative assessment of CI patients, and a HRCT temporal bones maybe indicated only in difficult cases or those with unfavourable MRI findings, may aid predict surgical events.
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Affiliation(s)
- Sanjeeva Bharadwaja
- Senior Resident, Dept of ENT, INHS Jeevanti, Goa Naval Area, Vasco da gama, Goa 401803 India
| | - Uma Patnaik
- Professor (ENT) and CO, 359 Field Hospital, Panagarh, West Bengal 700072 India
| | | | - Dilip Raghavan
- Professor (ENT) and Brig AFMS (Stdn). O/o DGAFMS, New Delhi, India
| | - Yashvir Mathur
- Professor, Dept of Radiology, Command Hospital (Southern Command), Pune, 411040 India
| | - Sachendra Badal
- Associate Professor, Dept of Pediatrics, AFMC–Command Hospital (Southern Command), Pune, 411040 India
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Barbara M, Margani V, Covelli E, Romano A, Bozzao A, Lotfy R, Mandour M, Swaid A, Soltan I, Elzayat S, Elfarargy HH. Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study. Otol Neurotol 2024; 45:e162-e169. [PMID: 38361294 DOI: 10.1097/mao.0000000000004116] [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: 02/17/2024]
Abstract
OBJECTIVES This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). STUDY DESIGN It was a prospective case-series study. SETTINGS The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. SUBJECTS We included 73 CI candidates performed via the PT approach. INTERVENTION The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. MAIN OUTCOME MEASURE We correlated this score with the intraoperative difficulty and surgical duration. RESULTS The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). CONCLUSIONS Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.
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Affiliation(s)
- Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Valerio Margani
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Andrea Romano
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alessandro Bozzao
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rasha Lotfy
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mahmoud Mandour
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ali Swaid
- Otorhinolaryngology Department, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Islam Soltan
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
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Yang HH, Patel VS, Yang I, Gopen QS. Low-Lying Tegmen and Surgical Outcomes Following the Middle Cranial Fossa Repair of Superior Canal Dehiscence. Otolaryngol Head Neck Surg 2024; 170:195-203. [PMID: 37598319 DOI: 10.1002/ohn.480] [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: 05/08/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To compare treatment response from the middle cranial fossa repair of superior canal dehiscence (SCD) between cases with and cases without low-lying tegmen (LLT). STUDY DESIGN Cohort study. SETTING Single tertiary care institution. METHODS Two investigators independently reviewed preoperative high-resolution temporal bone computed tomography images and classified the ipsilateral tegmen as either "low-lying" or "control." Patients completed a symptom questionnaire and underwent audiometric testing pre- and post-operatively. Multivariable regression models assessed for symptomatic resolution and audiometric improvement following surgery with tegmen status as the primary predictor. Models controlled for patient age, sex, bilateral SCD disease, dehiscence location, prior ear surgery status, surgery duration, and follow-up duration. RESULTS Among a total of 410 cases included, we identified 121 (29.5%) LLT cases. Accounting for all control measures, patients with LLT were significantly less likely to experience overall symptom improvement (adjusted odds ratio: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < .001) and reported a significantly lower proportion of preoperative symptoms that resolved following surgery (adjusted β: -25.6%, 95% CI: -37.0% to -14.3%, p < .001). However, audiometric outcomes following surgery did not differ significantly between patients with and patients without LLT. CONCLUSION This is the first investigation on the relationship between LLT and surgical outcomes following the middle fossa repair of SCD. Patients with LLT reported less favorable symptomatic response but exhibited a similar degree of audiometric improvement.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Vishal S Patel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Hiremath SB, Biswas A, Mndebele G, Schramm D, Ertl-Wagner BB, Blaser SI, Chakraborty S. Cochlear Implantation: Systematic Approach to Preoperative Radiologic Evaluation. Radiographics 2023; 43:e220102. [PMID: 36893052 DOI: 10.1148/rg.220102] [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: 03/10/2023]
Abstract
Sensorineural hearing loss results from abnormalities that affect the hair cells of the membranous labyrinth, inner ear malformations, and conditions affecting the auditory pathway from the cochlear nerve to the processing centers of the brain. Cochlear implantation is increasingly being performed for hearing rehabilitation owing to expanding indications and a growing number of children and adults with sensorineural hearing loss. An adequate understanding of the temporal bone anatomy and diseases that affect the inner ear is paramount for alerting the operating surgeon about variants and imaging findings that can influence the surgical technique, affect the choice of cochlear implant and electrode type, and help avoid inadvertent complications. In this article, imaging protocols for sensorineural hearing loss and the normal inner ear anatomy are reviewed, with a brief description of cochlear implant devices and surgical techniques. In addition, congenital inner ear malformations and acquired causes of sensorineural hearing loss are discussed, with a focus on imaging findings that may affect surgical planning and outcomes. The anatomic factors and variations that are associated with surgical challenges and may predispose patients to periprocedural complications also are highlighted. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Shivaprakash B Hiremath
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Asthik Biswas
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Gopolang Mndebele
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - David Schramm
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Birgit B Ertl-Wagner
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Susan I Blaser
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Santanu Chakraborty
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
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De Stefano S, Cavara M, Goldoni M, Donati G, Pasanisi E, Di Lella F. Temporal bone computed tomography checklist-TeSLANO: introduction of a standardized preoperative imaging evaluation for middle ear surgery. Eur Arch Otorhinolaryngol 2021; 279:3831-3835. [PMID: 34618226 DOI: 10.1007/s00405-021-07112-w] [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: 05/31/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aim of the study was to evaluate if the introduction of the imaging checklist TeSLANO would improve the identification of crucial anatomical findings from temporal bone computed tomography (TBCT) scans among a cohort of Otolaryngology residents. STUDY DESIGN Single-blinded prospective cohort study. SETTING Tertiary care university hospital and referral center for otology and skull base surgery. METHODS The cohort was composed by eight Otorhinolaryngology residents (four junior and four senior) that were individually asked to identify all relevant anatomic findings from preoperative TBCT scans. Supervising surgeon showed to each resident four TBCT scans before and four after the introduction of a systematic checklist evaluation system based on the TeSLANO acronym. Statistical analysis was performed using McNemar's test and results were considered significant with a P value < 0.05. RESULTS Introduction of the checklist improved global identification of critical anatomical structures from 48.75 to 89.17% (P < 0.05). The postimplementation identification percentage improved for both the senior and junior groups (P < 0.05). CONCLUSIONS The imaging checklist TeSLANO allows a systematic approach to review TBCT scans and significantly improves identification of critical anatomical structures in Otorhinolaryngology residents.
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Affiliation(s)
- Sabrina De Stefano
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, via A. Gramsci 14, 43126, Parma, Italy.
| | - Matteo Cavara
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Giulia Donati
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Enrico Pasanisi
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, via A. Gramsci 14, 43126, Parma, Italy
| | - Filippo Di Lella
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, via A. Gramsci 14, 43126, Parma, Italy
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Rashad Ghoneim MM, Ghonim MR, Mohamed Badawy AA, Abdel Razek AAK, Salam Hafez MA, Hamad MS, Salem MA. Combined preoperative HRCT parameters for prediction of round window visibility in pediatric cochlear implant patient. Int J Pediatr Otorhinolaryngol 2021; 140:110521. [PMID: 33257023 DOI: 10.1016/j.ijporl.2020.110521] [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: 10/08/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the add value of combined analysis of high resolution computed tomography (HRCT) temporal bone parameters in accurate prediction of round window (RW) visibility through posterior tympanotomy. PATIENTS AND METHODS a retrospective observational study was held in a tertiary center, conducted on 45 cochlear implant pediatric candidates between January 2017 and September 2019. Candidates were referred for CT temporal bone. They were classified into fully visible RW cases and partially or non-visible RW cases. Radiological measurements were compared between the two groups for prediction of RW visibility separate and in combination. RESULTS 45 patients were included in the study (26 males (57.8%) and 19 females (42.2%)). Their median age was 4 years (2-12 years). There were 38 (84.4%) fully visible and 7 (15.6%) partially or non-visible RW cases. Kashio posterior line (n:32/3), fascial recess width (FRW) (mean: 4.9 (3.5-7.5)/4.2 (4-4.7) mm) and round window location (RWL) (3 (1-4)/2.8 (1-3)mm) measurements significantly differentiated between the two groups; (P value 0.034, 0.012 & 0.025 respectively). Posterior kashio line and cut off values of ≥4.75 mm of FRW & 2.95 mm of RWL were showed sensitivity 84.2%, 63.2% & 65.8%, and accuracy 80%, 68.9% &68.9% in prediction of RW visibility respectively. Combination of Kashio prediction line with cut off value ≥ 7.45 mm (sum of FRW & RWL) showed P value 0.003 with further improve in the sensitivity and overall accuracy in prediction of RW visibility from 84.2% to 80% up to 91.4% and 88.6% respectively. CONCLUSION combined parameters using Kashio line with FRW and RWL increases sensitivity and overall accuracy in prediction of RW visibility rather than single parameter.
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Affiliation(s)
- Mahitab Mohamed Rashad Ghoneim
- Diagnostic and Interventional Radiology Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Egypt.
| | - Mohamed Rashad Ghonim
- Cochlear Implant Unit, Mansoura University Hospital, Otolaryngology Department, Faculty of Medicine, Mansoura University, Egypt.
| | | | - Ahmed Abdel Khalek Abdel Razek
- Diagnostic and Interventional Radiology Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Egypt.
| | | | | | - Mohammed Abdelbadie Salem
- Cochlear Implant Unit, Mansoura University Hospital, Otolaryngology Department, Faculty of Medicine, Mansoura University, Egypt.
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