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Elzayat S, Elfarargy HH, Lotfy R, Soltan I, Lasheen HN, Margani V, Covelli E, Barbara M, Mandour M. Validation of the radiological detection of the chorda-facial angle: impact on the round window accessibility during pediatric cochlear implantation. Eur Radiol 2022; 33:144-151. [PMID: 35732930 DOI: 10.1007/s00330-022-08953-7] [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: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The facial recess, an essential landmark for the posterior tympanotomy approach, is limited by the facial nerve and the chorda tympani, with a complicated relationship. This study tried to find the most appropriate radiological method to evaluate the chorda-facial angle (CFA). We also checked the effect of this angle on the round window accessibility during cochlear implantation. METHODS It was a retrospective study that included cochlear implant surgeries of 237 pediatric patients, from September 2016 to April 2021. Two physicians evaluated the CFA in the para-sagittal cut of the preoperative HRCT. The round window accessibility was assessed in the unedited surgery videos. RESULTS The CFA ranged from 21° to 35° with a mean of 27.14 ± 3.5°. It was detected in all cases with a high agreement between the two CT reviewers' measurements. The CFA differed significantly between the accessible group and the group with difficult accessibility (p value < 0.001). Spearman's correlation coefficient revealed a strong correlation between the CFA and the intraoperative round accessibility. 25.5° was the best cutoff point; below this angle, difficult accessibility into the RW was expected, with high sensitivity, specificity, and accuracy CONCLUSIONS: Our study on a relatively large number of cases provided a precise, valid, reliable, and applicable method to evaluate the CFA in the HRCT scan. We found a significant-close relation between the CFA and the round window accessibility; the difficulty increased with a need for posterior tympanotomy modification when the angle decreased. KEY POINTS • Radiological detection of the chorda-facial angle was always problematic, without a previous straightforward method in the literature. • We used the para-sagittal cut of the high-resolution CT scans to evaluate the CFA. This cut was beneficial to seeing the chorda tympani nerve in every examined case. There was a high agreement between the two CT reviewers' measurements. • Preoperative evaluation of the CFA in the HRCT accurately predicted the round window accessibility. Patients with CFA less than 25.5° were expected to have difficult accessibility into the round window during cochlear implantation.
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Affiliation(s)
- Saad Elzayat
- Otolaryngology Department, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | | | - Rasha Lotfy
- Radiology Department, Tanta University, Tanta, Egypt
| | - Islam Soltan
- Otolaryngology Department, Kafrelsheikh University, Kafr el-Sheikh, Egypt
| | | | - Valerio Margani
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Edoardo Covelli
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Maurizio Barbara
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
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Elzayat S, Mandour M, Elfarargy HH, Lotfy R, Soltan I, Lotfy A, Margani V, Covelli E, Monini S, Barbara M. Radiological Analysis of the Facial Recess: Impact on Posterior Tympanotomy Difficulty During Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg 2022; 167:769-776. [PMID: 35133920 DOI: 10.1177/01945998221076998] [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: 11/17/2022]
Abstract
OBJECTIVES We analyzed several radiological features of the facial recess to correlate them with the intraoperative findings to highlight the most reliable predictors of posterior tympanotomy difficulty. STUDY DESIGN Retrospective observational cohort study. SETTING Multicenter study at tertiary referral institutions. METHODS We included 184 pediatric patients who underwent cochlear implantation through the posterior tympanotomy approach. The correlation was attempted between 8 radiological features in the preoperative high-resolution computed tomography scan and intraoperative surgical difficulty. RESULTS Posterior tympanotomy was straightforward in 136 (73.9%) patients. In contrast, it was challenging in 48 (26.1%) patients. The facial recess was aerated in 74.5% of patients. The mean (SD) posterior tympanotomy depth was 3.98 (0.867) mm. The mean (SD) chorda-facial angle was 27.67° (3.406°). The mean (SD) chorda-facial to stylomastoid length was 3.898 (0.6304) mm. The mean (SD) facial nerve second genu angle was 94.54° (6.631)°. Deep-unaerated facial recess wall was associated with the most difficulty. There was a statistically significant difference in the unchallenging and challenging posterior tympanotomy groups regarding the surgical duration (P < .0001). CONCLUSIONS According to this analytic study, the chorda-facial angle, the facial recess aeration, and the chorda-facial to stylomastoid length were respectively the strongest preoperative radiological predictors of the surgical difficulty of posterior tympanotomy during cochlear implantation. Chorda-facial angle <25.5° was associated with difficult posterior tympanotomy. The oblique parasagittal cut was essential for the radiological analysis of the facial recess.
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Affiliation(s)
- Saad Elzayat
- Otolaryngology Department, Tanta University, Egypt
| | | | | | - Rasha Lotfy
- Radiology Department, Tanta University, Tanta, Egypt
| | - Islam Soltan
- Otolaryngology Department, Tanta University, Egypt
| | - Ashraf Lotfy
- Otolaryngology Department, El-Glaa Military Hospital, Cairo, Egypt
| | - Valerio Margani
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Edoardo Covelli
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Simonetta Monini
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Maurizio Barbara
- Otolaryngology Department, Sapienza University of Rome, Rome, Italy
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Burck I, Helal RA, Naguib NNN, Nour-Eldin NEA, Scholtz JE, Martin S, Leinung M, Helbig S, Stöver T, Lehn A, Vogl TJ. Postoperative radiological assessment of the mastoid facial canal in cochlear implant patients in correlation with facial nerve stimulation. Eur Radiol 2021; 32:234-242. [PMID: 34226991 PMCID: PMC8660739 DOI: 10.1007/s00330-021-08128-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/22/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
Objectives To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence. Methods Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression. Results Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients’ age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression. Conclusion The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors. Key Points • Post-operative radiological assessment of the mastoid facial canal and the positional relationship with the CI electrode provide no predictor of post-cochlear implant facial nerve stimulation. • Radiological detection of extracochlear electrode contacts and the previous clinical history of meningitis/encephalitis are two important risk factors for postoperative facial nerve stimulation in cochlear implant patients. • The presence of scala vestibuli electrode insertion as well as the lateral wall electrode type, the younger patient’s age, and early onset of SNHL can play important role in the prediction of post-cochlear implant facial nerve stimulation.
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Affiliation(s)
- Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Rania A Helal
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Nagy N N Naguib
- Department of Radiology, AMEOS Clinic Halberstadt, Halberstadt, Sachsen-Anhalt, Germany
- Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria University, Alexandria, Egypt
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo University, Cairo, Egypt
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Simon Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Martin Leinung
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Silke Helbig
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Germany
| | - Annette Lehn
- Department of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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黄 健, 夏 巍, 唐 翔, 谭 颂, 唐 安. [Progress of research on cone beam CT in cochlear implantation]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:567-572. [PMID: 34304522 PMCID: PMC10128610 DOI: 10.13201/j.issn.2096-7993.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/22/2021] [Indexed: 11/12/2022]
Abstract
Cochlear implant, as the most successful artificial auditory implant, brings tens of thousands of patients with severe or profound sensorineural hearing loss back to the world of sound every year. With the expansion of surgical indications, a large number of difficult cases bring new challenges for cochlear implantation. As a new technology, cone beam CT has the double advantages of high spatial resolution and low radiation. It is considered as the second revolution of CT technology, which shows unique value in the application of cochlear implantation. This article reviews the basic principles of cone beam CT and its application and research progress in cochlear implantation.
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Affiliation(s)
- 健健 黄
- 广西医科大学第一附属医院耳鼻咽喉头颈外科(南宁,530021)
| | - 巍 夏
- 广西医科大学第一附属医院耳鼻咽喉头颈外科(南宁,530021)
| | - 翔龙 唐
- 广西医科大学第一附属医院耳鼻咽喉头颈外科(南宁,530021)
| | - 颂华 谭
- 广西医科大学第一附属医院耳鼻咽喉头颈外科(南宁,530021)
| | - 安洲 唐
- 广西医科大学第一附属医院耳鼻咽喉头颈外科(南宁,530021)
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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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Jain S, Deshmukh PT, Lakhotia P, Kalambe S, Chandravanshi D, Khatri M. Anatomical Study of the Facial Recess with Implications in Round Window Visibility for Cochlear Implantation: Personal Observations and Review of the Literature. Int Arch Otorhinolaryngol 2019; 23:e281-e291. [PMID: 31360247 PMCID: PMC6660289 DOI: 10.1055/s-0038-1676100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/06/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction
Posterior tympanotomy through facial recess (FR) is the conventional and most preferred approach to facilitate cochlear implantation, especially when the electrode is inserted through the round window. The complications of the FR approach can be minimized by proper understanding of the anatomy of the FR.
Objective
The present study was undertaken to assess the various parameters of FR and round window visibility, which may be of relevance for cochlear implant surgery.
Methods
Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of FR and posterior tympanum. Photographs were taken with an 18 megapixels digital camera, which were then imported to a computer to determine various parameters.
Results
The mean distance from the take-off point/crotch of the chorda tympani nerve (CTN) to the stylomastoid foramen was 4.08 ± 0.8 mm (range of 2.06 - 5.5 mm). The variations in the course of the CTN included origin at the level of the lateral semicircular canal. The mean chorda-facial angle in our study was 26.91° ± 1.19°, with a range of 25° to 28.69°. The mean FR length ranged between 9.4 mm and 18.56 mm (mean of 12.41 ± 2.91mm) and varied with the origin of the CTN and pneumatization of temporal bone. The average maximum width of the FR was 2.93 ± 0.4 mm (range 2.24–3.45 mm) and the mean width of the FR at the level of the round window was 2.65 ± 0.41 mm.
Conclusion
The FR approach provides good access to the round window membrane in all cases. In some cases, table adjustment is required.
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Affiliation(s)
- Shraddha Jain
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - P T Deshmukh
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Pooja Lakhotia
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Sanika Kalambe
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Deepshikha Chandravanshi
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
| | - Mohnish Khatri
- Department of Otorhinolaryngology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Jawaharlal Nehru Medical College, Maharashtra, India
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SKARZYNSKI H, MATUSIAK M, FURMANEK M, PILKA A, WLODARCZYK E, OLDAK M, SKARZYNSKI P. Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:468-475. [PMID: 30498276 PMCID: PMC6265667 DOI: 10.14639/0392-100x-1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.
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Affiliation(s)
- H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. MATUSIAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. FURMANEK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - A. PILKA
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - E. WLODARCZYK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. OLDAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - P.H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Kondratowicza, Warszawa, Poland
- Institute of Sensory Organs, Mokra, Kajetany, Poland
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