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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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The feasibility of cochlear implantation in early infancy. Int J Pediatr Otorhinolaryngol 2023; 165:111433. [PMID: 36634570 DOI: 10.1016/j.ijporl.2022.111433] [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: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the key image anatomical parameters that are relevant to cochlear implantation (CI) using temporal bone high-resolution computed tomography (HRCT) scans and to identify age group differences in order to provide image anatomical support for early CI. METHODS The data of 346 temporal bone HRCTs of 173 children from 5 months to 18 years of age were retrospectively selected and reviewed. Parameters of the human temporal bone that are relevant to CI key surgical steps include mastoid thickness (MT), the facial recess width (FRW), and an angle representing the round window visibility. All measurements are performed on axial images. RESULTS There was no significant difference in the above morphological values by gender (p > 0,05). Two-sided FRW was not significantly different (p > 0,05), but MT and angle A were significantly different (p < 0,001). FRW and angle were independent of age (p > 0,05). However, MT had been found to exhibit postnatal development. The linear function of MT were calculated as y = 2463 × group(s) + 20,574 (p < 0,001). CONCLUSIONS Based on preoperative imaging analysis at different ages, middle ear development was stable at 5 months of age, allowing early CI in infancy with severe to severe hearing loss at this age. These data must be considered exploratory and more extensive clinical studies are needed.
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Transtympanic Visualization of Cochlear Implant Placement With Optical Coherence Tomography: A Pilot Study. Otol Neurotol 2022; 43:e824-e828. [PMID: 35970156 DOI: 10.1097/mao.0000000000003635] [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
OBJECTIVE This study aimed to evaluate the ability of transtympanic middle ear optical coherence tomography (ME-OCT) to assess placement of cochlear implants (CIs) in situ. PATIENT A 72-year-old man with bilateral progressive heredodegenerative sensorineural hearing loss due to work-related noise exposure received a CI with a slim modiolar electrode for his right ear 3 months before his scheduled checkup. INTERVENTION A custom-built swept source ME-OCT system (λo = 1550 nm, ∆λ = 40 nm) designed for transtympanic middle ear imaging was used to capture a series of two- and three-dimensional images of the patient's CI in situ. Separately, transtympanic OCT two-dimensional video imaging and three-dimensional imaging were used to visualize insertion and removal of a CI with a slim modiolar electrode in a human cadaveric temporal bone through a posterior tympanotomy. MAIN OUTCOME MEASURE Images and video were analyzed qualitatively to determine the visibility of implant features under ME-OCT imaging and quantitatively to determine insertion depth of the CI. RESULTS After implantation, the CI electrode could be readily visualized in the round window niche under transtympanic ME-OCT in both the patient and the temporal bone. In both cases, characteristic design features of the slim modiolar electrode allowed us to quantify the insertion depth from our images. CONCLUSIONS ME-OCT could potentially be used in a clinic as a noninvasive, nonionizing means to confirm implant placement. This study shows that features of the CI electrode visible under ME-OCT can be used to quantify insertion depth in the postoperative ear.
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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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Utility and value of pre-operative CT and MRI for cochlear implantation in the elderly. Am J Otolaryngol 2021; 42:102853. [PMID: 33460977 DOI: 10.1016/j.amjoto.2020.102853] [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: 09/01/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the utility and value of pre-operative imaging among the elderly population ≥70 y.o. with bilateral progressive sensorineural hearing loss undergoing cochlear implantation. MATERIALS AND METHODS A retrospective, cross-sectional review was performed at a tertiary referral center between 2010 and 2018 including patients ≥70 y.o. with bilateral presbycusis who underwent preoperative imaging and cochlear implantation. Primary outcome was whether pre-operative imaging changed the surgeon's surgical plan such as side of implant or abort procedure entirely. Patient characteristics including age, sex, side of implant, imaging modality, whether imaging changed surgical plan, and surgical complications were reviewed. One-way analysis of variance with post-hoc tests using the Bonferroni and Fisher's exact test were used to examine differences between groups. Secondary outcome was cost of preoperative imaging. RESULTS One hundred thirty-three patients (mean age 79.38 [5.51 SD]) who underwent a total of 142 surgical cases and 147 total scans. There were 92, 27, and 14 patients who underwent CT, MRI, or both, respectfully (n=133). Of the 142 implants that were placed, preoperative imaging did not reveal a contraindication to placing implant on one side over another. Total cost of imaging was $29,694. Estimated cost if 20% of cochlear implant eligible patients ≥70 y.o. underwent imaging is $7,763,490. CONCLUSION Decreasing unnecessary preoperative imaging can potentially decrease cost in cochlear implantation. In this sample, preoperative imaging did not affect the surgeon's choice of which side to operate on. However, imaging may provide an anatomic roadmap and contribute to either surgical confidence or caution. With the increasing amount of cochlear implant eligible elderly adults, preoperative imaging needs to be more clearly defined in this unique population.
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Radiological and surgical aspects of round window visibility during cochlear implantation: a retrospective analysis. Eur Arch Otorhinolaryngol 2021; 279:67-74. [PMID: 33471167 PMCID: PMC8739281 DOI: 10.1007/s00405-021-06611-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022]
Abstract
Purpose The round window approach has become the most preferred option for cochlear implant (CI) insertion, however, sometimes it may not be possible due to the (in)visibility of the round window membrane (RWM). We addressed the prevalence, consequences and indicators of difficult detection of the RWM in cochlear implant surgery. Methods This study retrospectively analysed the operative reports and preoperative high resolution axial-computed tomography (CT) scans of a consecutive cohort of patients who underwent a CI insertion. The main outcomes were surgical outcomes of the RW approach, and assessment of radiological
markers. Results The operative reports showed that RWM insertion was feasible in 151 out of 153 patients. In 18% of the patients the RWM was difficult to visualize. All these patients had at least one intraoperative event. The chorda tympani nerve (CTN) or posterior canal wall was affected in 8% of the 153 patients and the fallopian canal in 6%. These patients had a facial-chorda tympani nerve distance on the CT scan that was considerably smaller than normal patients (1.5 mm vs 2.3 mm). In addition, a prediction line towards the anterolateral side of the RWM was found to be more prevalent in these patients’ CT scans (sensitivity 81%, specificity 63%). Conclusion The RW approach is feasible in almost all patients undergoing CI surgery. Difficult visualisation of the RWM seems to lead to at least one intraoperative event. Radiological measures showed that these patients had a smaller facial recess and a more anteriorly placed facial nerve, which can be used to better plan a safe insertion approach.
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Helal RA, Jacob R, Elshinnawy MA, Othman AI, Al-Dhamari IM, Paulus DW, Abdelaziz TT. Cone-beam CT versus Multidetector CT in Postoperative Cochlear Implant Imaging: Evaluation of Image Quality and Radiation Dose. AJNR Am J Neuroradiol 2021; 42:362-367. [PMID: 33414229 DOI: 10.3174/ajnr.a6894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/15/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Cone-beam CT is being increasingly used in head and neck imaging. We compared cone-beam CT with multidetector CT to assess postoperative implant placement and delineate finer anatomic structures, image quality, and radiation dose used. MATERIALS AND METHODS This retrospective multicenter study included 51 patients with cochlear implants and postoperative imaging via temporal bone cone-beam CT (n = 32 ears) or multidetector CT (n = 19 ears) between 2012 and 2017. We evaluated the visualization quality of single electrode contacts, the scalar position of the electrodes, cochlear walls, mastoid facial canal, metallic artifacts (using a 4-level visual score), and the ability to measure the insertion angle of the electrodes. The signal-to-noise ratio and radiation dose were also evaluated. RESULTS Cone-beam CT was more sensitive for visualizing the scalar position of the electrodes (P = .046), cochlear outer wall (P = .001), single electrode contacts (P < .001), and osseous spiral lamina (P = .004) and had fewer metallic artifacts (P < .001). However, there were no significant differences between both methods in visualization of the modiolus (P = .37), cochlear inner wall (P > .99), and mastoid facial canal wall (P = .07) and the ability to measure the insertion angle of the electrodes (P > .99). The conebeam CT group had significantly lower dose-length product (P < .001), but multidetector CT showed a higher signal-to-noise ratio in both bone and air (P = .22 and P = .001). CONCLUSIONS Cone-beam CT in patients with cochlear implants provides images with higher spatial resolution and fewer metallic artifacts than multidetector CT at a relatively lower radiation dose.
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Affiliation(s)
- R A Helal
- From the Radiodiagnosis Department (R.A.H., M.A.E., A.I.O., T.T.A.), Ain Shams University, Cairo, Egypt
| | - R Jacob
- HNOplus (R.J.), Höhr-Grenzhausen, Germany
| | - M A Elshinnawy
- From the Radiodiagnosis Department (R.A.H., M.A.E., A.I.O., T.T.A.), Ain Shams University, Cairo, Egypt
| | - A I Othman
- From the Radiodiagnosis Department (R.A.H., M.A.E., A.I.O., T.T.A.), Ain Shams University, Cairo, Egypt
| | - I M Al-Dhamari
- Institute for computational visualistics (I.M.A.-D., D.W.P.), Koblenz University, Koblenz, Germany
| | - D W Paulus
- Institute for computational visualistics (I.M.A.-D., D.W.P.), Koblenz University, Koblenz, Germany
| | - T T Abdelaziz
- From the Radiodiagnosis Department (R.A.H., M.A.E., A.I.O., T.T.A.), Ain Shams University, Cairo, Egypt
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The Feasibility of Magnetic Resonance Imaging Without General Anesthesia Using the "Bundle and Scan" Technique for Infants With Sensorineural Hearing Loss. Otol Neurotol 2020; 42:92-98. [PMID: 32810007 DOI: 10.1097/mao.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the feasibility of magnetic resonance imaging (MRI) without general anesthesia (GA) for infants being evaluated for sensorineural hearing loss (SNHL) using the bundle and scan technique. STUDY DESIGN Retrospective study. SETTING Pediatric tertiary care hospital. PATIENTS All infants who underwent MRI using the bundle and scan technique as part of the diagnostic workup for unilateral or bilateral SNHL between June 2016 to April 2019 were included. MAIN OUTCOME MEASURE The primary outcome was the proportion of clinically useful images produced. RESULTS We reviewed 21 bundle and scan MRI examinations in infants being evaluated for SNHL. Patients had a median age of 10 (range: 6-25) weeks at the time of MRI. Motion artifact was noted in 38% (8/21) of cases. Eighty-six percent (18/21) of the magnetic resonance images produced using the bundle and scan technique were of diagnostic quality and/or sufficient for surgical planning for cochlear implantation. Repeat imaging with GA was required for three cases (14%) as the initial images were not clinically useful. All patients requiring GA had unilateral SNHL. All patients with bilateral SNHL successfully underwent MRI without GA using the bundle and scan technique. CONCLUSION The results of our study demonstrate that it is feasible to perform MRI using the bundle and scan technique in the majority of young infants being evaluated for SNHL. This has the potential to help determine cochlear implant candidacy earlier, reduce exposure to GA, and reduce healthcare costs.
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Burzyńska-Makuch M, Mierzwiński J, Haber K. The role of preoperative imaging for auditory implants in children. Otolaryngol Pol 2020; 75:23-35. [PMID: 33724221 DOI: 10.5604/01.3001.0014.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Preoperative imaging, besides audiological evaluation, plays a major role in evaluation of candidacy for auditory implants, and in particular cochlear implants. It is essential to assess whether the basic criteria necessary for implantation are met. Diagnostic imaging is crucial not only in determining candidacy, but also determining the feasibility of cochlear implantation as it allow to anticipate surgical difficulties which could preclude or complicate the implantation of the device. The aim of the study is to present the protocol for the evaluation of preoperative imaging studies with particular focus on the factors potentially affecting clinical decisions in children qualified for cochlear implantation. <br><b>Material and method:</b> Preoperative imaging studies of 111 children performed prior to cochlear implantation were analyzed: high-resolution computed tomography (HRCT) of temporal bones and MRI. The assessment was made according to the presented protocol. <br><b>Results:</b> Pathologies and anomalies identified during the assessment of preoperative imaging studies significantly altered clinical decisions in 30% of patients. In the study group, in 17% of patients inner ear malformations were identified. 2.7% of children were disqualified from a cochlear implantation due to severe congenital inner ear malformations. 9% of the patients have had bacterial meningitis. In 50% of them difficulties related to complete or progressive cochlear ossification occurred. In 4.5% of patients less common surgical approaches other than mastoidectomy with a posterior tympanotomy were applied. <br><b>Discussion:</b> Preoperative imaging allow for the identification of significant pathologies and anomalies affecting qualification decisions and further treatment. HRCT and MRI are complementary to each other for preoperative imaging. The two modalities in combination allow accurate and optimal evaluation of the anatomical structures prior to implantation. Inner ear malformations and cochlear ossification following meningitis are relatively frequently encountered in children qualified for a cochlear implant.
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Affiliation(s)
- Małgorzata Burzyńska-Makuch
- Oddział Otolaryngologii, Audiologii i Foniatrii Dziecięcej, Dziecięcy Program Implantów Słuchowych, Wojewódzki Szpital Dziecięcy w Bydgoszczy, Zakład Diagnostyki Obrazowej, Wojewódzki Szpital Dziecięcy w Bydgoszczy
| | - Józef Mierzwiński
- Oddział Otolaryngologii, Audiologii i Foniatrii Dziecięcej, Wojewódzki Szpital Dziecięcy, Bydgoszcz
| | - Karolina Haber
- Department of Otolaryngology, Audiology and Pediatric Phoniatrics, Children's Hearing Implant Program, Provincial Children's Hospital in Bydgoszcz
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Chen J, Wu Y, Shi J, Jia H, Wang Z, Zhang Z, Wu H. Predictors of round window membrane visibility in pediatric cochlear implant surgery using temporal bone HRCT: A retrospective study. Int J Pediatr Otorhinolaryngol 2019; 121:150-153. [PMID: 30913502 DOI: 10.1016/j.ijporl.2019.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To predict round window membrane (RWM) visibility and electrode insertion sites using high-resolution computed tomography (HRCT) in pediatric cochlear implant surgery. MATERIALS AND METHODS Sixty-two ears of 36 infants less than 1 year old were included in our study. Intraoperative RWM visibility was classified into three types corresponding to three different surgical approaches. Radiologic parameters were measured on preoperative axial temporal HRCT images and correlated with RWM visibility and surgical approaches. RESULTS A significant correlation was found between the degree of RWM visibility and the following two parameters: 1) a line (lw) was drawn from the posterior margin of the RWM to the intersection point of the posterior wall of the external auditory canal (EAC) and mastoid cortex. Another line (lf) was drawn between the posterior margin of the RWM and the lateral margin of the FN. The angle between lw and lf was measured as angle A, P < 0.01, R2 = -0.809; 2) a line (lm) was drawn from the anterior to posterior margin of the RWM, and the angle between lm and lf was measured as angle B, P < 0.01, R2 = -0.850. A nonsignificant correlation was found between the degree of RWM visibility and the facial recess width, p > 0.05, R2 = -0.00015. CONCLUSION RWM visibility showed a high correlation with the two angular measurements (angle A and angle B) and was associated with electrode insertion sites. In children less than one year old, surgeons can depend on those two parameters in predicting the RWM visibility.
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Affiliation(s)
- Jianqing Chen
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Yingwei Wu
- Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Shi
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Huan Jia
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China
| | - Zhihua Zhang
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China.
| | - Hao Wu
- Department of Otolaryngology, Head & Neck Surgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai, China.
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Vu TH, Perazzini C, Puechmaille M, Bachy A, Mulliez A, Boyer L, Mom T, Gabrillargues J. CT-scan contouring technique allows for direct and reliable measurements of the cochlear duct length: implication in cochlear implantation with straight electrode-arrays. Eur Arch Otorhinolaryngol 2019; 276:2135-2140. [PMID: 31011800 DOI: 10.1007/s00405-019-05432-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The advent of hybrid electro-acoustic implants requires precise positioning of the electrode-array (EA) within the cochlea. The cochlea size, that is, the length of the cochlear scala tympani, is often indirectly estimated from distance A by Escudé's method. This technique has been confirmed by anatomical studies, in a bunch of cadaveric specimens, but it is not yet widely established in the field of computed tomography (CT). We compared cochlear duct length obtained by Escudé's method to those directly acquired on CT images. MATERIALS AND METHODS The lengths of cochlear scala tympani were directly measured on CT scans by contouring the external cochlear wall (contouring technique-CoT). In fifteen patients implanted with a straight EA, the length of the EA and the measured length of the cochlea by the CoT were compared, to check the reliability of the CoT. Then, in 200 CT-scans, the length of the cochlear duct was measured by the CoT then compared to Escudé's method. RESULTS In the 200 CT-scans which served for cochlear length measurements, a significant variability between the cochleae were observed, as expected. At 360°, the correlation between the measurements of the length of the cochlear scala tympani between the two techniques differed, with a difference of 0.2 ± 0.7 mm at 360° (extreme: 2 mm; p < 0.001) and 2.2 ± 1.2 mm at 540° (extreme: 5.6 mm; p < 0.001). CONCLUSION The CoT can predict with accuracy the length of EA-insertion depth, more precisely than estimation methods such as Escudé's.
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Affiliation(s)
- Thi Hau Vu
- Department of Radiology, Hôpital Bach Mai, Université de Médecine de Ha Noi, 78 Giai Phong, Dong Da, Ha Noi, Viet Nam.,Department of Radiology, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Chiara Perazzini
- Department of Radiology, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Mathilde Puechmaille
- Department of Otolaryngology Head and Neck Surgery, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.,Unité Mixte de Recherche de l'Institut National des Sciences et de la Recherche en Médecine (UMR-INSERM, 1107), Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Aurélie Bachy
- Department of Otolaryngology Head and Neck Surgery, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Louis Boyer
- Department of Radiology, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.,Cardiovascular Interventional Therapy and Imaging (CaVITI Team), Therapy Guided By Imaging Institute (TGI-Institut Pascal), Unité Mixte de Recherche 6602 du Centre National de la Recherche Scientifique (UMR-CNRS), Université Clermont Auvergne, UCA/CNRS/SIGMA, Campus Universitaire des Cézeaux, 4 Avenue Blaise Pascal, Clermont-Ferrand, France
| | - Thierry Mom
- Department of Otolaryngology Head and Neck Surgery, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France. .,Unité Mixte de Recherche de l'Institut National des Sciences et de la Recherche en Médecine (UMR-INSERM, 1107), Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
| | - Jean Gabrillargues
- Department of Radiology, CHU Gabriel Montpied, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
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Siu JM, Blaser SI, Gordon KA, Papsin BC, Cushing SL. Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation. Laryngoscope 2019; 129:2627-2633. [PMID: 30613974 DOI: 10.1002/lary.27666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual-imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI-predominant with selective HRCT imaging protocol. STUDY DESIGN Retrospective review. METHODS The protocol was implemented over a 4-year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained. RESULTS Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced. CONCLUSIONS MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2627-2633, 2019.
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Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Diagnostic Imaging-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Mandour M, Tomoum M, El Zayat S, Hamad H, Amer M. Surgeon Oriented Preoperative Radiologic Evaluation in Cochlear Implantation - Our experience with a Proposed Checklist. Int Arch Otorhinolaryngol 2018; 23:137-141. [PMID: 30956695 PMCID: PMC6449130 DOI: 10.1055/s-0038-1648247] [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: 08/02/2017] [Accepted: 03/09/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Preoperative temporal bone imaging studies have been routinely performed prior to cochlear implantation. Radiologists need to report these examinations with special focus on the surgeon's expectations. Objectives To provide a basic structured format, in the form of a checklist, for reporting preoperative computed tomography (CT) and to its clinical impact on operative findings. Methods The preoperative temporal bone CT scans of 47 patients were analyzed and reported according to the proposed checklist. Intraoperative assessment of mastoidectomy, posterior tympanotomy and round window access was done by the surgeon in a blinded fashion and were correlated with the radiological findings to assess its significance. Results The proposed radiological checklist was reliable in assessing operative difficulty during cochlear implantation. Contracted mastoid and lower tegmen position were associated with a greater difficulty of the cortical mastoidectomy. Presence of an air cell around the facial nerve (FN) was predictive of easier facial recess access exposure. Facial nerve location and posterior external auditory canal (EAC) wall inclination were predictive of difficult round window (RW) accessibility. Conclusion Certain parameters on the preoperative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.
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Affiliation(s)
- Mahmoud Mandour
- Department of ORL-HNS, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Mohammed Tomoum
- Department of ORL-HNS, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Saad El Zayat
- Department of ORL-HNS, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | - Hisham Hamad
- Department of ORL-HNS, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Mohamed Amer
- Department of ORL-HNS, Tanta University Faculty of Medicine, Tanta, Egypt
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Bony cochlear nerve canal and internal auditory canal measures predict cochlear nerve status. The Journal of Laryngology & Otology 2017; 131:676-683. [DOI: 10.1017/s0022215117001141] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:The bony cochlear nerve canal is the space between the fundus of the internal auditory canal and the base of the cochlear modiolus that carries cochlear nerve fibres. This study aimed to determine the distribution of bony labyrinth anomalies and cochlear nerve anomalies in patients with bony cochlear nerve canal and internal auditory canal atresia and stenosis, and then to compare the diameter of the bony cochlear nerve canal and internal auditory canal with cochlear nerve status.Methods:The study included 38 sensorineural hearing loss patients (59 ears) in whom the bony cochlear nerve canal diameter at the mid-modiolus was 1.5 mm or less. Atretic and stenotic bony cochlear nerve canals were examined separately, and internal auditory canals with a mid-point diameter of less than 2 mm were considered stenotic. Temporal bone computed tomography and magnetic resonance imaging scans were reviewed to determine cochlear nerve status.Results:Cochlear hypoplasia was noted in 44 out of 59 ears (75 per cent) with a bony cochlear nerve canal diameter at the mid-modiolus of 1.5 mm or less. Approximately 33 per cent of ears with bony cochlear nerve canal stenosis also had a stenotic internal auditory canal and 84 per cent had a hypoplastic or aplastic cochlear nerve. All patients with bony cochlear nerve canal atresia had cochlear nerve deficiency. The cochlear nerve was hypoplastic or aplastic when the diameter of the bony cochlear nerve canal was less than 1.5 mm and the diameter of the internal auditory canal was less than 2 mm.Conclusion:The cochlear nerve may be aplastic or hypoplastic even if temporal bone computed tomography findings indicate a normal cochlea. If possible, patients scheduled to receive a cochlear implant should undergo both computed tomography and magnetic resonance imaging of the temporal bone. The bony cochlear nerve canal and internal auditory canal are complementary structures, and both should be assessed to determine cochlear nerve status.
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Abstract
OBJECTIVE To characterize stimulation of taste fibers in the facial nerve following cochlear implantation. PATIENT A 34-year old presented with reversible dysgeusia following activation of a cochlear implant. INTERVENTION Reprogramming targeted to specific offending electrodes reduced symptom intensity. Computed tomography demonstrated dehiscence of the bone separating the labyrinthine segment of the facial nerve and the basal turn of the cochlea in proximity to the electrode array. RESULTS Dysgeusia was attributed to stimulation of taste fibers in the facial nerve by electrodes 13 to 16 of the cochlear implant array located in the superior-most portion of the basal turn. CONCLUSIONS Dysgeusia following cochlear implant activation has not previously been reported. This likely results from stimulation of taste fibers through dehiscence of the bone separating the labyrinthine segment of the Fallopian canal and the basal turn of the cochlea. While in some cases of apparent dehiscence there may be thin bone present, recognition of this potential anatomic feature may influence the choice of which ear and which electrode design to implant.
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Emal T. Cochlear implantation in a subject with a narrow facial recess: Importance of preoperative radiological findings. Cochlear Implants Int 2016; 17:158-61. [PMID: 27160011 DOI: 10.1080/14670100.2016.1177261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This case report aims to emphasize the importance of preoperative computed tomography to evaluate the anatomy of the facial recess (FR) in order to prevent complications during cochlear implantation (CI) and to discuss alternative surgical approaches for the management of a narrow FR. Failure to notice this anomaly may result in facial nerve (FN) injury or inability to complete CI. CASE PRESENTATION A 50-year-old female with bilateral sensorineural hearing loss presented for CI. High-resolution CT (HRCT) demonstrated a narrow FR; specifically the space between the vertical segment of the FN and external auditory canal (EAC) was narrow. A section of the EAC was removed to obtain adequate exposure and was repaired with a cartilage graft following CI. CONCLUSION CI surgery may be difficult in patients with a narrow FR. Such surgical difficulty could be avoided if cochlear implant surgeons have adequate preoperative radiological imaging to evaluate the anatomy of the temporal bone. HRCT is the only modality that can detect this abnormality preoperatively. If the surgeon identifies this abnormality on preoperative HRCT, an alternative surgical technique could be used.
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Van Rompaey V, De Belder F, Parizel P, Van de Heyning P. Semicircular Canal Fibrosis as a Biomarker for Lateral Semicircular Canal Function Loss. Front Neurol 2016; 7:43. [PMID: 27047448 PMCID: PMC4803745 DOI: 10.3389/fneur.2016.00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Radiological abnormalities at the level of the semicircular canals are frequently observed without known correlation to a pathologic condition or function. They include narrowing or sclerosis on computed tomography (CT) and narrowing or signal loss on T2-weighted magnetic resonance imaging (MRI). Our hypothesis was that these radiological abnormalities at the level of the semicircular canals reflect an aspecific but advanced stage of vestibular decay. Materials and methods Retrospective study in 35 consecutive patients with bilateral profound deafness eligible for cochlear implantation. Electronystagmography, CT, and MRI were performed as part of evaluation for cochlear implant candidacy. Results In our population, 31.4% had a bilateral lateral semicircular canal function loss, while 11.4% had a unilateral lateral semicircular canal function loss. CT-scan abnormalities did not correlate to lateral semicircular canal function loss at a statistically significant level. However, abnormalities observed on MRI correlated significantly with ipsilateral lateral semicircular canal function loss. This statistically significant difference was present not only if abnormalities were observed in at least one of the semicircular canals but also if we studied the posterior, superior, and lateral semicircular canals separately. Conclusion Semicircular canal abnormalities on T2-weighted MRI (including narrowing and/or signal loss in one or more semicircular canals) are correlated to lateral semicircular canal function loss.
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Affiliation(s)
- Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Frank De Belder
- Department of Radiology, Antwerp University Hospital , Edegem , Belgium
| | - Paul Parizel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Hanekom T, Hanekom JJ. Three-dimensional models of cochlear implants: A review of their development and how they could support management and maintenance of cochlear implant performance. NETWORK (BRISTOL, ENGLAND) 2016; 27:67-106. [PMID: 27136100 DOI: 10.3109/0954898x.2016.1171411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Three-dimensional (3D) computational modeling of the auditory periphery forms an integral part of modern-day research in cochlear implants (CIs). These models consist of a volume conduction description of implanted stimulation electrodes and the current distribution around these, coupled with auditory nerve fiber models. Cochlear neural activation patterns can then be predicted for a given input stimulus. The objective of this article is to present the context of 3D modeling within the field of CIs, the different models, and approaches to models that have been developed over the years, as well as the applications and potential applications of these models. The process of development of 3D models is discussed, and the article places specific emphasis on the complementary roles of generic models and user-specific models, as the latter is important for translation of these models into clinical application.
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Affiliation(s)
- Tania Hanekom
- a Bioengineering, Department of Electrical, Electronic and Computer Engineering , University of Pretoria , Pretoria , South Africa
| | - Johan J Hanekom
- a Bioengineering, Department of Electrical, Electronic and Computer Engineering , University of Pretoria , Pretoria , South Africa
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Tamplen M, Schwalje A, Lustig L, Alemi AS, Miller ME. Utility of preoperative computed tomography and magnetic resonance imaging in adult and pediatric cochlear implant candidates. Laryngoscope 2015; 126:1440-5. [PMID: 26360798 DOI: 10.1002/lary.25659] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the utility of preoperative imaging in adult and pediatric cochlear implant candidates. STUDY DESIGN Retrospective chart review. METHODS Medical records of 101 consecutive adult and 20 consecutive pediatric patients who underwent 137 cochlear implantation (CI) procedures at a single institution were reviewed. RESULTS Computed tomography (CT) was obtained preoperatively in 110 (90.9%) patients, preoperative magnetic resonance imaging (MRI) was obtained in 102 (84.3%) patients, and both were obtained in 94 (77.7%) patients. MRI revealed one acoustic neuroma and two meningiomas, which affected surgical planning for three (2.2%) procedures. MRI identified enlarged vestibular aqueduct (EVA) in 2.0% of adult patients. CT demonstrated middle ear disease in four (3.3%) patients. CT was useful in indicating round window and cochlear patency in three (2.2%) patients with cochlear otosclerosis. Twenty pediatric patients underwent 27 CI procedures. Preoperative CT in the pediatric cohort demonstrated five (25%) dysplastic cochleae, three (15%) dysplastic vestibules and/or semicircular canals, and three (15%) EVAs. In one patient, CT demonstrated a duplicated right internal auditory canal (IAC) and hypoplastic left IAC; MRI confirmed hypoplastic cochlear nerves. CONCLUSIONS Preoperative MRI can demonstrate retrocochlear pathology, cochlear patency, and EVA in adults being evaluated for cochlear implantation. CT may provide additional information in patients with chronic otitis media or otosclerosis. However, in postlingually deafened adults without conductive or asymmetrical hearing loss, imaging is unlikely to affect surgical decision making. Both CT and MRI can identify anomalies in pediatric patients. MRI does not offer substantial benefit over CT for routine evaluation of pediatric inner ear and temporal bone anatomy. LEVEL OF EVIDENCE 4 Laryngoscope, 126:1440-1445, 2016.
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Affiliation(s)
- Matthew Tamplen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
| | - Adam Schwalje
- University of California San Francisco School of Medicine, San Francisco, California
| | - Lawrence Lustig
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, College of Physicians & Surgeons, New York, New York
| | - Aurash S Alemi
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
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