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Cottrell J, Winchester A, Friedmann D, Jethanamest D, Spitzer E, Svirsky M, Waltzman SB, Shapiro WH, McMenomey S, Roland JT. Characterizing Cochlear Implant Trans-Impedance Matrix Heatmaps in Patients With Abnormal Anatomy. Otol Neurotol 2024; 45:e630-e638. [PMID: 39190800 DOI: 10.1097/mao.0000000000004304] [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: 08/29/2024]
Abstract
OBJECTIVE To characterize transimpedance matrix (TIM) heatmap patterns in patients at risk of labyrinthine abnormality to better understand accuracy and possible TIM limitations. STUDY DESIGN Retrospective review of TIM patterns, preoperative, and postoperative imaging. SETTING Tertiary referral center. PATIENTS Patients undergoing cochlear implantation with risk of labyrinthine abnormality. INTERVENTION None. RESULTS Seventy-seven patients were evaluated. Twenty-five percent (n = 19) of patients had a TIM pattern variant identified. These variants were separated into 10 novel categories. Overall, 9% (n = 6) of electrodes were malpositioned on intraoperative x-ray, of which 50% (n = 3) were underinserted, 17% (n = 1) were overinserted, 17% (n = 1) had a tip foldover, and 17% (n = 1) had a coiled electrode. The number of patients with a variant TIM pattern and normal x-ray was 18% (n = 14), and the number of patients with normal TIM pattern and malposition noted on x-ray was 3% (n = 2; both were electrode underinsertions that were recognized due to open circuits and surgical visualization).A newly defined skip heat pattern was identified in patients with IP2/Mondini malformation and interscalar septum width <0.5 mm at the cochlear pars ascendens of the basal turn. CONCLUSIONS This study defines novel patterns for TIM heatmap characterization to facilitate collaborative and comparative research moving forward. In doing so, it highlights a new pattern termed skip heat, which corresponds with a deficient interscalar septum of the cochlea pars ascendens of the basal turn in patients with IP2 malformation. Overall, the data assist the surgeon in better understanding the implications and limitations of TIM patterns within groups of patients with risk of labyrinthine abnormalities.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, New York
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Shin BJ, Kim HC, Kim DH, Cho HH. Intraoperative Handheld Digital X-ray for Assessment of Intracochlear Positioning of Electrode Arrays in Recipients of Cochlear Implants. EAR, NOSE & THROAT JOURNAL 2024:1455613231223954. [PMID: 38321704 DOI: 10.1177/01455613231223954] [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: 02/08/2024] Open
Abstract
Objectives: This study aims to evaluate the practicality of handheld digital X-ray in determining the position of the electrode array following Cochlear implantation (CI). Methods: A retrospective study was conducted involving 11 patients (12 ears) who underwent intraoperative imaging via handheld X-ray (MINE ALNU®, OTOM, Gwangju, South Korea) post-CI between December 2021 and January 2023. Immediate confirmation of the correct electrode array placement in the cochlea was achieved, with subsequent comparisons made to C-arm image and postoperative transorbital view X-ray. Results: Rapid intraoperative imaging was achieved in all instances. The electrode types used included 9 Nucleus slim modiolar electrodes, 1 Nucleus contour electrode, and 2 Medel flex26 electrodes. A malpositioned electrode array was detected in one patient. The handheld digital X-ray also adeptly visualized the electrodes implanted in pediatric patients. Conclusions: The use of intraoperative handheld digital X-ray using MINE ALNU® proves to be a safe, efficient, straightforward, and reliable method for immediate identification of an inserted electrode array. It has potential to replace the traditional C-arm X-ray for verifying electrode positioning in the operating room.
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Affiliation(s)
- Bong-Jin Shin
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Do Hyung Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyong-Ho Cho
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Predictive Value of Transimpedance Matrix Measurements to Detect Electrode Tip Foldover. Otol Neurotol 2022; 43:1027-1032. [PMID: 36040040 DOI: 10.1097/mao.0000000000003667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the ability of the transimpedance matrix (TIM) measurement to detect cochlear implant electrode tip foldover by comparing results to a "gold standard," the intraoperative plain film radiograph. STUDY DESIGN Retrospective case series. SETTING Tertiary referral hospital. PATIENTS One hundred three patients who underwent cochlear implantation between June 2020 and August 2021. INTERVENTIONS Intraoperative electrophysiologic monitoring (electrode impedances, neural response telemetry, and TIM measurement) and modified Stenver's view plain film radiographs. MAIN OUTCOME MEASURES Identification of tip foldover on both TIM and plain films. RESULTS In total, 103 patients (117 ears) had both a TIM measurement and intraoperative X-ray available for review, including 68 adults and 35 children. One hundred patients (85%) received the Cochlear Slim Modiolar electrode. Tip foldovers were noted in three of 117 implants (2.5%). In all cases, TIM was able to detect the foldover, and the electrode arrays were reinserted with the patients still under anesthesia, with repeat X-ray demonstrating a normal configuration. Two other abnormal TIM patterns were identified. One was in a patient with an obstructed cochlea in whom only 10 electrodes could be inserted, the other was in a patient with a common cavity abnormality. One additional patient underwent electrode repositioning intraoperatively because of overinsertion. In this patient, the TIM appeared to be within normal limits, but the over-insertion was apparent on X-ray. Overall, the sensitivity and specificity of TIM measurements in detecting electrode tip foldover were both 100%. CONCLUSION TIM measurements were able to accurately identify tip foldovers. More research is needed to define the adjunctive role of TIM as an intraoperative measure.
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Wei X, Zhang H, Lu S, Yang M, Chen B, Chen J, Zhang L, Liu S, Xian J, Li Y, Kong Y. Application of Multiplanar Volume Reconstruction Technique for the Assessment of Electrode Location and Analysis of the Correlation to Cochlear Programming and Performance in Common Cavity Deformity. Front Neurol 2022; 12:783225. [PMID: 35087468 PMCID: PMC8787298 DOI: 10.3389/fneur.2021.783225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose: Owing to the characteristic anatomy, cochlear implantation (CI) for common cavity deformity (CCD) has resulted in varied outcomes and frequent facial and vestibular nerve stimulation. The current study analyzed the correlation among the distance between each electrode and cavity wall (abbreviation, D), programming parameters, and performances outcomes. Materials and Methods: The current, retrospective study included 25 patients (27 ears) with CCD underwent CI. The multiplanar volume reconstruction (MPVR) techniques were employed to reconstruct and evaluate the postoperative temporal bone CT. The D and maximum comfortable level (MCL) 6 months after CI, facial and vestibular nerve stimulation, and outcomes 1, 2, and 3 years after CI pertaining to the questionnaires were documented and analyzed. Results: The patients were divided into symptomatic (10, 37%) and asymptomatic (17, 63%) groups according to with or without facial and vestibular nerve stimulation. The MCL pertaining to the symptomatic group was significantly lower than asymptomatic group, but Categories of Auditory Performance (CAP) scores 1 year after surgery was better (p < 0.05). The subjects were divided into flat (12, 44.4%) and curved (15, 55.6%) groups based on the contour of MCL map. The MCL and D were lower and shorter in the curved group than the flat group, and CAP score 1 year after surgery and Speech Intelligibility Rating (SIR) 3 years after surgery were better (p < 0.05). Conclusion: Although abnormal reactions such as facial and vestibular nerve stimulation were observed to be more frequent, lower MCL and better outcomes were observed in relation to the shorter D.
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Affiliation(s)
- Xingmei Wei
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Huaiyu Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Simeng Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Mengge Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Biao Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Jingyuan Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Lifang Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Sha Liu
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China.,Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxin Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China
| | - Ying Kong
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China.,Beijing Institute of Otolaryngology, Capital Medical University, Ministry of Education, Beijing, China
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Bae SH, Choi J, Choi JY. Cochlear Implants for Patients With Common Cavity Deformities and the Impact of Electrode Positioning. Clin Exp Otorhinolaryngol 2022; 15:77-83. [PMID: 35052024 PMCID: PMC8901950 DOI: 10.21053/ceo.2021.00745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Common cavity deformity is a rare congenital bony labyrinth malformation associated with profound hearing loss. Cochlear implants are widely used for hearing rehabilitation for common cavity deformities; however, the reported prognosis is poor. Due to the deformed anatomical structure, it is important to consider the position of the electrodes to maximize the performance of the cochlear implant. The present study discusses the impact of electrode placement on hearing outcomes. Methods A retrospective medical chart review of eight common cavity deformity patients (10 cochlear implants) who received cochlear implants was performed at a single university hospital. In all eight patients, implant surgery was performed using single-slit labyrinthotomy. Electrodes wer e manually bent before insertion to prevent misplacement and to reduce physical damage to the neuroepithelium. Results Four of the 10 electrodes were misplaced, with their tips placed in the anterior semicircular canal or internal auditory canal. However, after implant surgery, all patients—including those with misplaced electrodes—gained auditory perception and improved hearing function. One patient who had electrodes that did not contact the inner wall of the cavity showed limited activity of the electrodes (27%) compared to others (64%–100%). Conclusion Proper contact of the electrode with the inner wall was more likely to be important for cochlear implant success in cases of common cavity deformity than appropriate placement of the electrode tip.
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Affiliation(s)
- Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jihoon Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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6
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Cochlear implantation in common cavity deformity: a systematic review. Eur Arch Otorhinolaryngol 2021; 279:37-48. [PMID: 34052873 DOI: 10.1007/s00405-021-06884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Cochlear implantation became a valid hearing rehabilitation option in common cavity deformity. This study aimed to assess the audiological and speech outcomes of cochlear implantation in common cavity deformity patients and to address the surgical aspect used in this population. METHODS A comprehensive systematic literature review based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline from database inception through April 2020. Eighteen published articles including 138 patients with common cavity deformity met the inclusion criteria. These articles studied the surgical techniques and the audiological outcomes of cochlear implantation in patients with common cavity deformity in English language. RESULTS Trans-mastoid labyrinthotomy was the common surgical approach in these patients. The average speech intelligibility rating and categories of auditory performance scores in common cavity deformity were lower than in normal cochlea subjects (p < 0.05), and non-significant (p > 0.05) compared with other types of inner ear malformations. CONCLUSION Patients with common cavity deformity who underwent cochlear implantation showed a beneficial audiological and speech outcome. However, their performance is highly variable. Therefore, pre-operative counseling of the parents is necessary. The surgical approaches should be individualized according to clinical, radiological, and surgical findings.
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7
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Cooper T, Hildrew D, McAfee JS, Piatt BK, Branstetter B, McCall AA, Hirsch BE. Optimization of Intraoperative Imaging Protocol to Confirm Placement of Cochlear Implant Electrodes. Otol Neurotol 2020; 40:625-629. [PMID: 31083084 DOI: 10.1097/mao.0000000000002200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The need to intraoperatively confirm correct placement of the active electrode of a cochlear implant may occur in various clinical settings. These include a malformed cochlea, difficulty with insertion, or suboptimal or abnormal electrical responses (impedance or evoked action potentials) obtained during intraoperative testing. Frustration with inconsistent images using portable x-ray machines prompted this study to determine the technique needed to reliably image the electrode within the cochlea. Our objective was to establish a radiology protocol that would be reproducible and reliable across institutions. METHODS Prospective cadaveric imaging study. Access to the round window via the facial recess was established using cadaver heads. Electrodes provided by three cochlear implant manufacturers were inserted into the cochlea. The position of the head, angle of the x-ray tube, and beam settings were varied. A compendium of electrode images was obtained and analyzed by neurotologists and a head and neck radiologist to reach a consensus on an optimal imaging protocol. RESULTS The optimal position for intraoperative x-ray confirmation of cochlear implant electrode placement is obtained by turning the head 45 degrees toward the contralateral ear. The portable digital x-ray machine and central ray was angled 15 degrees (aiming cephalic) from vertical with exposure settings of 32 mAs at 70 kVp and the digital radiography image receptor was positioned under the mattress of the operating table. CONCLUSION A protocol for patient and beam source positioning and exposure using a portable digital x-ray unit can provide reliable imaging for intraoperative confirmation of cochlear implant electrode positioning.
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Affiliation(s)
- Timothy Cooper
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Hildrew
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut
| | | | - Brian K Piatt
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barton Branstetter
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barry E Hirsch
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Ishiyama A, Risi F, Boyd P. Potential insertion complications with cochlear implant electrodes. Cochlear Implants Int 2020; 21:206-219. [PMID: 32079506 DOI: 10.1080/14670100.2020.1730066] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The aim of this discussion paper and literature review was to estimate the incidence of a variety of complications associated with the surgical placement of cochlear implant (CI) electrode arrays and to discuss the implications and management of sub-optimal electrode placement. Results: A review of the peer-reviewed literature suggests that the incidence of incomplete electrode insertion and kinking is more prevalent in straight arrays and not more than about 2% in CI recipients with normal cochlear anatomy/patency. Incidence of tip fold-over is greater with perimodiolar arrays but also occurs with straight arrays and is typically less than 5%. Conversely, electrode migration is more common with straight arrays, and high rates (up to 46%) have been reported in some studies. Scalar translocations have also been reported for both perimodiolar and straight arrays. Higher rates have been reported for stylet-based perimodiolar electrodes inserted via cochleostomy (up to 56%), but with much lower rates (<10%) with both sheath-based perimodiolar arrays and lateral wall arrays. Electrode positioning complications represent a significant proportion of perioperative CI complications and compromise the level of benefit from the device. Careful surgical planning and appropriate pre- and intraoperative imaging can reduce the likelihood and impact of electrode positioning complications. There is also evidence that newer array designs are less prone to certain complications, particularly scalar translocation. Conclusions: It is important that implanting surgeons are aware of the impact of sub-optimal electrode placement and the steps that can be taken to avoid, identify and manage such complications.
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Affiliation(s)
- Akira Ishiyama
- Rehabilitation Center, 1000 Veteran Ave., Los Angeles, CA, USA
| | - Frank Risi
- Clinical Affairs, Cochlear Ltd, Macquarie University, Sydney, Australia
| | - Paul Boyd
- Clinical Affairs, Cochlear Ltd, Macquarie University, Sydney, Australia
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Stultiens JJA, Postma AA, Guinand N, Pérez Fornos A, Kingma H, van de Berg R. Vestibular Implantation and the Feasibility of Fluoroscopy-Guided Electrode Insertion. Otolaryngol Clin North Am 2019; 53:115-126. [PMID: 31677739 DOI: 10.1016/j.otc.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.
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Affiliation(s)
- Joost Johannes Antonius Stultiens
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida Annechien Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nils Guinand
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Hermanus Kingma
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands.
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Brotto D, Avato I, Lovo E, Muraro E, Bovo R, Trevisi P, Martini A, Manara R. Epidemiologic, Imaging, Audiologic, Clinical, Surgical, and Prognostic Issues in Common Cavity Deformity. JAMA Otolaryngol Head Neck Surg 2019; 145:72-78. [DOI: 10.1001/jamaoto.2018.2839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Davide Brotto
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Irene Avato
- Department of Otorhinolaryngology, PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Elisa Lovo
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Eva Muraro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Patrizia Trevisi
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Alessandro Martini
- ENT Unit, Neurosciences Department, Università degli Studi di Padova, Padova, Italy
| | - Renzo Manara
- Department of Neuroradiology, University of Salerno, Salerno, Italy
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Kim CS, Maxfield AZ, Foyt D, Rapoport RJ. Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy. Cochlear Implants Int 2017; 19:170-179. [PMID: 29188758 DOI: 10.1080/14670100.2017.1403146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE AND IMPORTANCE To describe cases that illustrate the utility of intraoperative computed tomography (CT) in cochlear implantation of patients with difficult temporal bone anatomy. CLINICAL PRESENTATION A 2-year-old male with congenital X-linked stapes gusher syndrome and a 2-year-old female with enlarged vestibular aqueduct underwent successful cochlear implantation with the help of intraoperative CT. In the latter case, the initial intraoperative C-arm fluoroscopy suggested malposition of the electrode, however, was not able to provide details for adjustments. In both cases, intraoperative CT changed the insertion technique of the operating surgeon and allowed for improved electrode positioning. A 47-year-old female with polyostotic fibrous dysplasia and a 55-year-old male with post-meningitis near-total cochlear obliteration underwent successful cochlear implantation with confirmation of electrode position with intraoperative CT. In the former case, the image-guided navigation system was also implemented. Finally, a 72-year-old female underwent cochlear implantation during which intraoperative C-arm fluoroscopy suggested intra-cochlear insertion. However, postoperative CT showed the electrode extending into the internal auditory canal (IAC), illustrating the limitations of C-arm fluoroscopy. INTERVENTION Intraoperative CT imaging and image-guided navigation system. CONCLUSION When faced with challenging temporal bone anatomy, intraoperative CT can provide critical details of the patient's microanatomy that allows for improved localization of the electrode and adjustments in operative techniques for successful cochlear implantation.
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Affiliation(s)
- Christine S Kim
- a Division of Otolaryngology (CSK, DF) , Albany Medical Center , 50 New Scotland Avenue, MC41, Albany , NY , USA
| | - Alice Z Maxfield
- b Division of Otolaryngology-Head and Neck Surgery (AZM) , Brigham and Women's Hospital , 45 Francis Street, Boston , MA , USA
| | - David Foyt
- a Division of Otolaryngology (CSK, DF) , Albany Medical Center , 50 New Scotland Avenue, MC41, Albany , NY , USA
| | - Robert J Rapoport
- c Department of Medical Imaging (RJR) , St. Peter's Hospital , 315 South Manning Blvd, Albany , NY , USA
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12
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Appachi S, Schwartz S, Ishman S, Anne S. Utility of intraoperative imaging in cochlear implantation: A systematic review. Laryngoscope 2017; 128:1914-1921. [DOI: 10.1002/lary.26973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/22/2017] [Accepted: 09/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Swathi Appachi
- Department of Otolaryngology–Head and Neck SurgeryThe Cleveland ClinicCleveland
| | - Seth Schwartz
- Department of Otolaryngology–Head and Neck SurgeryVirginia MasonSeattle Washington U.S.A
| | - Stacey Ishman
- Divisions of Pediatric Otolaryngology–Head and Neck Surgery and Pulmonary MedicineCincinnati Children's Hospital Medical Center
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnati Ohio
| | - Samantha Anne
- Department of Otolaryngology–Head and Neck SurgeryThe Cleveland ClinicCleveland
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Wei X, Li Y, Fu QJ, Gong Y, Chen B, Chen J, Shi Y, Su Q, Cui D, Liu T. Slotted labyrinthotomy approach with customized electrode for patients with common cavity deformity. Laryngoscope 2017; 128:468-472. [PMID: 28498488 DOI: 10.1002/lary.26627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. STUDY DESIGN Retrospective review of 13 cochlear implant (CI) patients with CCD. METHODS Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. RESULTS The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P < .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P > .05). CONCLUSIONS For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. LEVEL OF EVIDENCE 4. Laryngoscope, 128:468-472, 2018.
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Affiliation(s)
- Xingmei Wei
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxin Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A.
| | - Yue Gong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Biao Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Shi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiaotong Su
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Danmo Cui
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Farhood Z, Nguyen SA, Miller SC, Holcomb MA, Meyer TA, Rizk AHG. Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings. Otolaryngol Head Neck Surg 2017; 156:783-793. [DOI: 10.1177/0194599817696502] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories—closed-set words, open-set words, and open-set sentences—and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.
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Affiliation(s)
- Zachary Farhood
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University, St Louis, Missouri, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen C. Miller
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Meredith A. Holcomb
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - and Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Saeed H, Powell HRF, Saeed SR. Cochlear implantation in X-linked deafness - How to manage the surgical challenges. Cochlear Implants Int 2016; 17:178-183. [PMID: 27142359 DOI: 10.1080/14670100.2016.1180018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE AND IMPORTANCE In children with X-linked deafness, cochlear malformations challenge the implant surgeon to avoid electrode insertion into the internal auditory meatus and prevent a continuous cerebrospinal fluid (CSF) leak. We describe our experience of cochlear implantation (CI) in two children with profound hearing loss secondary to X-linked deafness, highlighting safer operative techniques to avoid potential complications. CLINICAL PRESENTATION Descriptive cases of two children with X-linked deafness (patient 1 and patient 2) undergoing CI. Peri-operative imaging and work-up to surgery are discussed. Specific operative considerations, post-operative complications and subsequent audiological performance are highlighted. TECHNIQUE In each case, intra-operative fluoroscopic imaging ensured intra-cochlear insertion of electrodes. Expected CSF gusher was seen in each case which was initially controlled by packing around the cochleostomy and array with temporalis muscle and fascia. Patient 1 developed post-operative meningitis secondary to continuous CSF leak. We avoided further significant CSF leak by planning staged procedures for patient 2, with obliteration of the middle ear cleft and external ear canal (EAC) at the time of implantation. In both patients, bilateral implantation successfully provided hearing thresholds of less than 35 dB in both ears at routine follow up. CONCLUSIONS When planning for CI in children with radiological features of X-linked deafness, intra-operative imaging should be utilized to ensure correct electrode positioning. Traditional methods of stopping a CSF gusher may not suffice. We therefore encourage additional surgical obliteration of the middle ear space and EAC to avoid persistent CSF leak and its associated complications.
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Affiliation(s)
- Haroon Saeed
- a Department of Ear Nose and Throat Surgery , Tameside General Hospital , Fountain Street, Ashton-under-Lyne OL6 9RW , UK
| | - Harry R F Powell
- b Royal National Throat, Nose and Ear Hospital, University College London Hospitals , UK
| | - Shakeel R Saeed
- b Royal National Throat, Nose and Ear Hospital, University College London Hospitals , UK
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Intra-operative skull X-ray for misdirection of the cochlear implant array into the vestibular labyrinth. The Journal of Laryngology & Otology 2016; 129:923-7. [PMID: 26314324 DOI: 10.1017/s0022215115001966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This paper reports five cases of aberrant cochlear implant electrode array insertion into the vestibular labyrinth. A review of the literature was conducted in order to clarify reasonable preventive and detection strategies and endorse the routine use of intra-operative plain skull X-ray. METHODS The study entailed a clinical case series and literature review. The setting was a tertiary academic referral centre. The following data were evaluated: pre-operative temporal bone computed tomography, operative reports, intra-operative imaging, neural response telemetry/imaging and post-operative imaging. RESULTS There were no consistent pre-operative risk factors found on computed tomography scans and no reliable intra-operative signs of electrode array misdirection. All misdirections in our case series, and those in the literature, were easily detectable on intra-operative plain film X-ray. CONCLUSION These reported cases demonstrate implant misdirection without the surgeon's awareness. Aberrant insertion cannot be anticipated, and neural response telemetry/imaging is not a reliable indicator of misdirection. Routine intra-operative anteroposterior plain X-ray of the head is a reliable indicator of misdirection, and is fast and relatively inexpensive.
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Cosetti MK, Friedmann DR, Heman-Ackah SE, Perez R, Waltzman SB, Roland JT. Surgical techniques and outcomes of cochlear implantation in patients with radiographic findings consistent with X-linked deafness. Int J Pediatr Otorhinolaryngol 2015; 79:1689-93. [PMID: 26250436 DOI: 10.1016/j.ijporl.2015.07.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES X-linked deafness is a potential etiology of sensorineural hearing loss characterized by bulbous dilatation of the fundus of the internal auditory canal (IAC) and the absence of the bony plates separating the basal turn of the cochlea and IAC. These malformations predispose patients to IAC insertion during cochlear implantation (CI). Our objective is to describe the surgical technique, audiometric and speech performance outcomes in a group of patients with this unique cochlear malformation. METHODS A retrospective chart review was performed of all patients at a tertiary care facility who underwent CI between January 2006 and July 2011. RESULTS A total of five patients were identified with radiographic findings characteristic of X-linked deafness, specifically a deficient modiolous, absent lamina cribrosa and bulbous IAC. A modified cochleostomy was utilized to ensure electrode insertion within the scala tympani avoiding the IAC. In each case, fluoroscopy was utilized to visual electrode progression during insertion and complete insertion was accomplished. All patients demonstrated improved speech performance following implantation. CONCLUSIONS Utilizing the techniques described, patients with these unique radiographic findings consistent with X-linked deafness may successfully undergo CI with excellent potential for auditory rehabilitation.
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Affiliation(s)
- Maura K Cosetti
- Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Louisiana State University, Shreveport, LA, USA.
| | - David R Friedmann
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - Selena E Heman-Ackah
- Division of Otolaryngology, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ronen Perez
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Susan B Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
| | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA
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The use of cone-beam computed tomography to determine cochlear implant electrode position in human temporal bones. Otol Neurotol 2015; 35:1338-44. [PMID: 24809280 DOI: 10.1097/mao.0000000000000295] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the utility of cone-beam computed tomography (CBCT) imaging in the estimation of cochlear implant (CI) electrode position in implanted temporal bones. STUDY DESIGN Eight fresh frozen temporal bones were mounted and oriented as for standard surgery and were implanted with Cochlear Slim-Straight (SS) or Contour Advance electrode arrays by 2 CI surgeons. The bones were then imaged using an Accuitomo F170 CBCT scanner (isometric 250 μm voxel size) and were then processed for histologic sectioning (500 μm sections). MAIN OUTCOME MEASURES The CBCT images and the histologic micrographs (providing the "gold standard") were examined independently by several observers who assessed the scalar position (tympani or vestibuli) of each electrode in each temporal bone specimen. RESULTS Examination of the histologic micrographs confirmed that all electrodes were positioned within the scala tympani in all 8 bones. Similar judgments were made by the observers rating the CBCT images, except that one of the 2 observers estimated some of the apical electrodes to be located in the scala vestibuli in two of the bones implanted with the SS electrode. CONCLUSION Cone-beam CT imaging is able to provide a good indication of the scalar position of implanted electrodes, although estimation may be slightly less reliable for apical electrodes and for straight electrode designs. Additional advantages of using CBCT for this purpose are shorter acquisition time and reduction of radiation dose as compared with conventional CT.
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Pradhananga RB, Thomas JK, Natarajan K, Kameswaran M. Long term outcome of cochlear implantation in five children with common cavity deformity. Int J Pediatr Otorhinolaryngol 2015; 79:685-9. [PMID: 25758199 DOI: 10.1016/j.ijporl.2015.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A common cavity (CC) deformity is a deformed inner ear in which the cochlea and vestibule are confluent forming a common rudimentary cystic cavity. The outcome of cochlear implantation (CI) in this deformity is not expected as good as in other cochlear deformity. Categories of Auditory Performance (CAP) score, Speech Intelligibility Rating (SIR) scale, Meaningful Auditory-Integration Scale (MAIS) and Meaningful Use of Speech Scale (MUSS) are scales designed to assess benefit of functional device (hearing aid, Cochlear implant, ABI) in young children. The aim of the study was to observe and report the long-term audiological progress and speech development of children with CC deformity after CI by means of CAP, SIR, MAIS, MUSS scores and CI aided threshold. METHODS AND MATERIALS The retrospective and prospective study was carried out in five Indian children with CC deformity who underwent CI from 2004 to 2010. Demographic data of onset and/or duration of deafness, age at implantation, time with hearing aids before implantation, duration with CI and co-morbidity were retrieved from a local data base. Their outcome score in audition and speech development on the basis of their CAP and SIR score at the end of 1 year of habilitation were collected. All the patients were called to follow up to obtain latest CI aided audiogram, CAP, SIR, MAIS and MUSS scores. RESULTS One male and four female children were detected with common cavity deformity among 258 deaf children of age below 6 years operated during study period. The CAP and SIR Scores increased from average of 0.4 and 1 to 3.4 and 2.4, respectively, over one year of habilitation. The CAP score improved in subsequent follow up to average of 5.0 after more than 3 years of follow up but the SIR score hardly improved. We assessed the MAIS and MUSS at last visit after 3 years. The mean of MAIS and MUSS was 32.4 and 26.4, respectively. CONCLUSION Though the habilitation outcome was not up to the mark in children with CC deformity, CI provides excellent awareness of environment sound and development of few words.
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Affiliation(s)
- Rabindra Bhakta Pradhananga
- Department of Implantation Otology, Madras ENT Research Foundation (MERF), 1, I Cross Street, Off. II Main Road, R.A. Puram, Chennai 600 028, Tamil Nadu, India.
| | - John K Thomas
- Department of Implantation Otology, Madras ENT Research Foundation (MERF), 1, I Cross Street, Off. II Main Road, R.A. Puram, Chennai 600 028, Tamil Nadu, India
| | - Kiran Natarajan
- Department of Implantation Otology, Madras ENT Research Foundation (MERF), 1, I Cross Street, Off. II Main Road, R.A. Puram, Chennai 600 028, Tamil Nadu, India
| | - Mohan Kameswaran
- Department of Implantation Otology, Madras ENT Research Foundation (MERF), 1, I Cross Street, Off. II Main Road, R.A. Puram, Chennai 600 028, Tamil Nadu, India
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Abstract
CONCLUSION The facial recess approach is preferred in common cavity (CC) malformation with an incomplete basal turn, and the transmastoid single-slit labyrinthotomy approach in classic CC malformation. Patients with CC benefit from cochlear implantation (CI) over time, but the audiological and speech development is poorer than in cases with normal cochleas. OBJECTIVES To discuss the surgical aspects and performance of CI in 21 patients with CC malformation. METHODS Twenty-one CC malformations were classified into 2 types: classic CC malformation and CC malformation with an incomplete basal turn. Twenty-one patients without inner ear malformation were set as the control group. Thus, data for 42 patients were analyzed. RESULTS The facial recess approach was used in 3 patients with CC malformation with an incomplete basal turn, and the transmastoid single-slit labyrinthotomy approach in 18 patients with classic CC malformation. After follow-up for 36 months, the average free-field hearing threshold was higher, and the scores for the CAP, SIR, IT-MAIS, and closed-set/open-set auditory speech perception tests were lower than in the control group (p < 0.05).
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Affiliation(s)
- Jiao Xia
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing , China
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Heman-Ackah SE, Friedmann DR, Cosetti MK, Waltzman SB, Roland JT. Revision cochlear implantation following internal auditory canal insertion. Laryngoscope 2013; 123:3141-7. [PMID: 24114888 DOI: 10.1002/lary.23340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS In pediatric patients with congenital malformations of the inner ear, anomalies within the anatomy may facilitate unintentional insertion of the cochlear implant electrode into the internal auditory canal. Revision procedures for removal and replacement of cochlear implant electrodes following internal auditory canal insertion are fraught with potential danger, including the theoretical risk of injury to vasculature within the internal auditory canal, repeat insertion within the internal auditory canal, and cerebrospinal fluid leak. The objective of this presentation is to describe a technique for revision cochlear implantation following internal auditory canal insertion to minimize the potential associated risks. STUDY DESIGN Case series. METHODS A retrospective chart review was performed on all patients at a tertiary care facility who underwent revision cochlear implantation for internal auditory canal insertion between January 1999 and July 2011. RESULTS A total of four patients referred from outside institutions have undergone revision cochlear implantation for internal auditory canal insertion. The records from these patients were reviewed. Electrodes were safely removed in all cases without injury to the anterior inferior cerebellar artery or its branches (i.e., labyrinthine artery). Complete insertion was accomplished on reimplantation. Neural response telemetry was performed in all cases, and responses were noted. Fluoroscopy was utilized to visualize electrode progression during insertion. A detailed description of the operative technique is provided. CONCLUSIONS This case series describes a technique for revision cochlear implantation that appears to be safe and effective in preventing potential associated complications.
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Affiliation(s)
- Selena E Heman-Ackah
- Department of Otolaryngology, New York University School of Medicine, New York, New York, U.S.A
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Beltrame MA, Birman CS, Cervera Escario J, Kassouma J, Manolidis S, Pringle MB, Robinson P, Sainz Quevedo M, Shanks M, Suckfüll M, Tomás Barberán M. Common cavity and custom-made electrodes: speech perception and audiological performance of children with common cavity implanted with a custom-made MED-EL electrode. Int J Pediatr Otorhinolaryngol 2013; 77:1237-43. [PMID: 23759335 DOI: 10.1016/j.ijporl.2013.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Few studies exist on children with common cavity, fewer still on their long-term audiological development after having received a cochlear implant. Our goal was to observe and report the long-term audiological progress of children with common cavity who were implanted with a custom-made electrode. METHODS In this longitudinal, multi-center study, 19 children were implanted with a MED-EL custom-made electrode via either single slit cochleostomy or double posterior labyrinthotomy. We observed their audiological development with a test battery consisting of Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and Ling 6-Sounds tests. We tested the children 1 month prior to the surgery; at first fitting; at 1, 3, 6, 12, and 18 months post first-fitting; at 2 years after first-fitting; and, whenever possible, at 3, 4, and 5 years after first-fitting. RESULTS Children with common cavity tend to steadily and significantly improve their audiological skills over time. This development may, however, be highly individual; probably in part due to relatively high levels of additional needs. Parents should be counseled to establish realistic post-implantation expectations. Surgically, contrary to our expectations, we cannot confirm that double posterior labyrinthotomy reduces intracochlear electrode movement or that the MED-EL custom electrode leads to fewer incidences of intra- or post-implantation complications. CONCLUSIONS Cochlear implantation is a safe and effective treatment option in children with common cavity. The majority of children with CC derive significant audiological benefit from implantation. Intra- and post-surgical complications, while serious, and be dealt with effectively in most cases.
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Senn P, Rostetter C, Arnold A, Kompis M, Vischer M, Häusler R, Ozdoba C, Mantokoudis G, Caversaccio M. Retrograde cochlear implantation in postmeningitic basal turn ossification. Laryngoscope 2012; 122:2043-50. [PMID: 22648482 DOI: 10.1002/lary.23397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 03/06/2012] [Accepted: 04/09/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Postmeningitic basal turn ossification is a challenge for successful cochlear implantation despite the availability of sophisticated implants and advanced drill-out procedures. A less complex concept consisting of a cochleostomy near the apex with retrograde array insertion is evaluated clinically and experimentally with emphasis on imaging of intracochlear array morphology. STUDY DESIGN Retrospective case-control study. METHODS Outcome, hearing performance, and radiological findings including three-dimensional (3D) reconstructions were assessed in the long term in eight retrograde implanted ears of seven postmeningitic deaf patients and compared to an etiology- and device-matched control group of 17 basal turn implanted ears of 14 patients. Experimental insertions into three autopsy-derived human temporal bones were evaluated using high-resolution microtomography, 3D reconstruction, and histology. RESULTS No complications occurred. At the long-term follow-up, the average monosyllabic word test scores were 41% for the study group and 67% for the control group (P = .03). Radiological follow-up revealed insertion sites into either the apical or middle turn and frequent intracochlear array direction changes (n = 5). Experimental implantations in temporal bones resulted in folding-free, retrograde, middle turn insertions (n = 3). CONCLUSIONS The retrograde cochlear implantation is a safe and efficient alternative approach in basal turn ossification. Despite a high occurrence of intracochlear array direction changes, open set speech discrimination was achieved in all patients. Postoperative computed tomography is recommended for fitting the speech processor according to intracochlear array positions. The experimental insertion in temporal bones helped to optimize the approach.
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Affiliation(s)
- Pascal Senn
- University Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern, Switzerland.
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Abstract
OBJECTIVE To generate an evidence-based algorithm for the use of intraoperative testing during cochlear implantation (CI). STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS A total of 277 children (aged 6 mo to 17 yr) and adults 18 years and older with normal cochlear anatomy who underwent primary and revision cochlear implantation at a single center between 2005 and 2010 were included. INTERVENTION Intraoperative electrophysiologic monitoring and intraoperative Stenver's view plain film radiography. MAIN OUTCOME MEASURE Intraoperative testing included the following: 1) individual electrode impedance measurements; 2) neural response telemetry (tNRT) levels for electrodes E20, E15, E10, and E5; and 3) plain film radiograph assessment of electrode position. RESULTS No patient demonstrated abnormalities on all 3 modalities. Open or short electrodes on impedance testing were found in 6% of patients; half of these normalized when remeasured. Absent tNRT responses on 1 or more electrodes occurred in 14% of patients, although complete lack of response was rare (1.4%) and did not correlate with a dysfunctional device. Spread of excitation was performed in 1 patient and was consistent with a tip rollover. Intraoperative radiography identified tip-rollover and extracochlear electrode placement in all cases (n = 5, 1.8%) and prompted the use of the backup device. CONCLUSION Immediate intraoperative determination of device functionality and optimal electrode placement is advantageous. Of the modalities tested, including electrode impedance, tNRT, and plain radiograph, only the radiographic results impacted intraoperative surgical decision making and led to the use of the backup device.
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Heman-Ackah SE, Roland JT, Haynes DS, Waltzman SB. Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria. Otolaryngol Clin North Am 2012; 45:41-67. [PMID: 22115681 DOI: 10.1016/j.otc.2011.08.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.
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Affiliation(s)
- Selena E Heman-Ackah
- Department of Otolaryngology, New York University Cochlear Implant Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA
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Cosetti MK, Waltzman SB. Outcomes in cochlear implantation: variables affecting performance in adults and children. Otolaryngol Clin North Am 2012; 45:155-71. [PMID: 22115688 DOI: 10.1016/j.otc.2011.08.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article highlights variables that affect cochlear implant performance, emerging factors warranting consideration, and variables shown not to affect performance. Research on the outcomes following cochlear implantation has identified a wide spectrum of variables known to affect pos0timplantation performance. These variables relate to the device itself as well as individual patient characteristics. Factors believed to affect spiral ganglion cell survival and function have been shown to influence postoperative performance. Binaural hearing affects performance. Social and educational factors also affect postoperative performance. Novel variables capable of affecting performance continue to emerge with increased understanding of auditory pathway development and neural plasticity.
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Affiliation(s)
- Maura K Cosetti
- Department of Otolaryngology, New York University School of Medicine, 550 First Avenue, Suite 7Q, New York, NY 10016, USA
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Roman BR, Coelho DH, Roland JT. Implantation of the common cavity malformation may prevent meningitis. Cochlear Implants Int 2012; 14:56-60. [PMID: 22333042 DOI: 10.1179/1754762811y.0000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED OBJECTIVES AND IMPORTANCE: Children with certain congenital malformations of the inner ear, including those with a common cavity defect, have a higher incidence of spontaneous cerebrospinal fluid (CSF) leak and resulting meningitis. However, they may also benefit from cochlear implantation. We suggest that surgical management may be possible that both prevents meningitis and provides hearing rehabilitation during the same procedure. CLINICAL PRESENTATION A 2-year-old girl with bilateral common cavity defects who had previously undergone cochlear implantation developed contralateral CSF leak resulting in meningitis. INTERVENTION After resolution of the infection, cochlear implantation was performed at the same time as definitive CSF leak repair. Simultaneous cochlear implantation and repair of the CSF leak successfully decreased the chance of recurrent meningitis in this case. She has been deriving hearing benefit from the bilateral implants. CONCLUSION This case suggests a role for cochlear implantation to be combined with simultaneous CSF leak repair in children with a cochlear malformation. Furthermore, bilateral cochlear implantation at an early age may be warranted in these patients before CSF leaks and meningitis have occurred.
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Affiliation(s)
- Benjamin R Roman
- Department of Otolaryngology, New York University School of Medicine, New York, NY, USA
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Pakdaman MN, Herrmann BS, Curtin HD, Van Beek-King J, Lee DJ. Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy. Otolaryngol Head Neck Surg 2011; 146:180-90. [DOI: 10.1177/0194599811429244] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery. Data Sources. MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary. Review Methods. A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data. Results. The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures. Conclusion. Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.
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Affiliation(s)
- Michael N. Pakdaman
- Department of Otorhinolaryngology, University of Texas Medical School, Houston, Texas, USA
| | - Barbara S. Herrmann
- Department of Audiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugh D. Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Van Beek-King
- Department of Otolaryngology–Head and Neck Surgery, Georgia Health Sciences University, Augusta, Georgia, USA
| | - Daniel J. Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Ahn JH, Lim HW, Lee KS. Hearing improvement after cochlear implantation in common cavity malformed cochleae: long-term follow-up results. Acta Otolaryngol 2011; 131:908-13. [PMID: 21534716 DOI: 10.3109/00016489.2011.570786] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION We suggest that cochlear implantation (CI) should be a good therapeutic modality for hearing restoration in patients with common cavity malformed ears. OBJECTIVE To analyze hearing improvement from CI performed in common cavity malformed cochleae. METHODS A total of 11 patients (5 male and 6 female, mean age 4.5 ± 2.8 years) and 12 ears were enrolled in this study. During the insertion of electrodes, we used C-arm fluoroscopy to avoid intrameatal placement. We evaluated hearing improvement every 6 months and the mean follow-up period was 80.5 ± 24.1 months (53-125 months). RESULTS During the operation, there were only four cases with fully inserted electrodes. Cerebrospinal fluid gushed out in two cases during the cochleostomy and postoperative meningitis occurred in two patients. One patient had to undergo reimplantation 4 years later due to device failure and recurrent meningitis. During the 48 months follow-up hearing evaluation, the ability of hearing increased along with the age. The final average MAIS, CAP, SIR, and open set one- and two-syllable word scores were 90.3 ± 18.1%, 4.9 ± 1.6, 3.1 ± 0.9, 24.1 ± 25.9%, and 48.6 ± 38.7%, respectively.
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Affiliation(s)
- Joong Ho Ahn
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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