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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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Das S, Raja K, Ramkumar G, MS V, Ganesan S, Alexander A, Penubarthi LK. Radiological Parameters Predicting the Round Window Niche Visibility through Facial Recess Approach in Cochlear Implantation. Indian J Otolaryngol Head Neck Surg 2024; 76:944-952. [PMID: 38440460 PMCID: PMC10909018 DOI: 10.1007/s12070-023-04333-9] [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: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 03/06/2024] Open
Abstract
Aim The aim was to study the radiological parameters using High Resolution Computed Tomography (HRCT) temporal bone to predict the Round Window Niche (RWN) visibility through the facial recess approach and to study radiological types of the round window niche. Materials and Methods Prospective study was done in the patients underwent CI surgery from 2019 to 2021. HRCT radiological parameters of the patients and their intraoperative visualisation from video recordings were compared to predict the most feasible parameters to predict good visualisation of RWN. Results Among 51 patients (34 males, 17 females) in 48 children round window membrane insertion was done and in three children cochleostomy was done and in two children partial canal wall drilling was done due to poor visualisation of RWN area. Multiple parameters to assess the visibility of the RWN were used. Facial recess width (4.2 mm), location of the mastoid segment of facial nerve (2 mm), external auditory canal to basal turn of cochlea angle (< 13.50) and the radiological types (tunnel shape and semi-circular shape) of the RWN by HRCT were found to be significant parameters in predicting a good visualisation of the RWN. Conclusion HRCT parameters prepare the surgeon to face the possibility of a difficult surgery and plan to deal with difficult situations. This would eventually lead to better preparedness of surgeons for management of complications.
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Affiliation(s)
- Sauradeep Das
- Department of Otorhinolaryngology, NEIGRIHMS, Meghalaya, India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
| | - G Ramkumar
- Department of Radiodiagnosis, JIPMER, Puducherry, India
| | - Vishak MS
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
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Malhotra V, Kumar S, Menon GS, Hejjaji Krishnamurthy A, Medikeri S, Dutt SN. Morphometric Analysis of Temporal Bone Radiology for Cochlear Implant Candidacy. Indian J Otolaryngol Head Neck Surg 2024; 76:702-711. [PMID: 38440533 PMCID: PMC10908920 DOI: 10.1007/s12070-023-04257-4] [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: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 03/06/2024] Open
Abstract
Cochlear Implantation (CI) is a well-accepted treatment for severe-to-profound sensorineural hearing loss, refractory to conventional hearing amplification. Pre-operative Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play pivotal roles in patient selection to rule out findings that preclude surgery or identify conditions that may impact the surgical procedure. A prospective study was carried out in a tertiary care center over three years, from January 2020 to January 2023. One hundred and ninety (380 ears) patients' High-Resolution Computed Tomography (HRCT) studies of the temporal bone and MRI scans of the auditory pathways were analyzed. A reporting format was followed which was devised by a team of senior implant surgeons and senior neuro-radiologists. Our study aims to provide a comprehensive radiologic protocol for CI candidacy including normative data for the essential morphometrics in the Indian setting.
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Agarwal P, Gupta Y, Mundra RK. Role of Imaging in Evaluating Patients for Cochlear Implantation. Indian J Otolaryngol Head Neck Surg 2023; 75:2760-2768. [PMID: 37974843 PMCID: PMC10646041 DOI: 10.1007/s12070-023-03845-8] [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: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 11/19/2023] Open
Abstract
Role of Imaging in evaluating patients for Cochlear Implantation. To assess the role of imaging using High resolution computed tomography (HRCT) and Magnetic resonance imaging (MRI) temporal bone for evaluating candidates for cochlear implantation (CI). It was a prospective study conducted in the department of Otorhinolaryngology at a tertiary care centre, 30 children up to 5 years of age with severe to profound sensorineural hearing loss(SNHL) were included in the study, radiological evaluation was done in all children. 20(66.67%) children were in 2-4 years age group with female preponderance. Radiological abnormalities were reported in 13(43.33%) children. Abnormalities of inner ear were seen in 8(26.67%) cases, which included bilateral cochlear nerve aplasia, unilateral cochlear aplasia with bilateral cochlear nerve aplasia, bilateral severe cochlear hypoplasia, mondini's dysplasia. Cochlear nerve deficiency was found in 3(10%) children and narrow Internal auditory canal in 4(13.33%) children. 2(6.67%) patients out of 30 were not the candidates for CI, they had bilateral absent cochlear nerve which is an absolute contraindication for CI. 28(93.33%) patients were evaluated as candidates for CI. Imaging is a fundamental part of the preoperative workup for cochlear implantation, HRCT and MRI temporal bone are complementary to each other in evaluating children for cochlear implantation as HRCT is excellent for demonstrating bony details but, lack in providing details of inner ear neural structures and MRI is better than CT in demonstrating vestibulocochlear nerves.
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Affiliation(s)
- Priyanshi Agarwal
- Department of Otorhinolaryngology, Head and Neck Surgery, MGM Medical College, Indore, M.P. India
- Present Address: Government Medical College Datia, Datia, M.P. India
| | - Yamini Gupta
- Department of Otorhinolaryngology, Head and Neck Surgery, MGM Medical College, Indore, M.P. India
| | - R. K. Mundra
- Department of Otorhinolaryngology, Head and Neck Surgery, MGM Medical College, Indore, M.P. India
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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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Jain S, Deshmukh PT, Lakhotia P, Kalambe S, Chandravanshi D, Khatri M. Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature. Int Arch Otorhinolaryngol 2019; 23:e281-e291. [PMID: 31360247 PMCID: PMC6660289 DOI: 10.1055/s-0038-1676100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/06/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction
Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR.
Objective
The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery.
Methods
Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters.
Results
The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24–3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm.
Conclusion
The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.
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Affiliation(s)
- Shraddha Jain
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - P T Deshmukh
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Pooja Lakhotia
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Sanika Kalambe
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Deepshikha Chandravanshi
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Mohnish Khatri
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
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