Cochlear implantation outcomes with round window electrode insertion versus cochleostomy insertion

Elafandi, Haytham; Khalifa, Mohamed; El-Guindy, Ahmed

doi:10.1016/j.ijporl.2020.110272

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…19 Study conducted by Hytham et al also showed that round window insertion is associated with superior cochlear implantation outcomes regarding speech perception, language acquisition and speech production rather than the standard cochleostomy insertion. 20 RW approach in terms of hearing preservation was also demonstrated by Nasiff et al, Causon et al, and Adunka et al [21][22][23] As a support to above studies, Briggs et al and Lenarz et al proposed that when using a custom short array, RW approach produces little intracochlear damage, as it's less traumatic and more direct approach to the scala tympani than the traditional cochleostomy.…”

Section: Discussionmentioning

confidence: 72%

Comparison of residual hearing preservation and auditory based performance after paediatric cochlear implantation by round window insertion versus cochleostomy technique: an ambispective cohort study

Antony

Chacko

Arodiyil

2021

Int J Otorhinolaryngol Head Neck Surg

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Background: Cochlear implantation (CI) has revolutionized the treatment of sensorineural deafness. The aim of the study was to compare auditory based performance in cochlear implants who underwent round window insertion and cochleostomy.Methods: Ambispective cohort study was done among the children who underwent perilingual cochlear implant in a tertiary care hospital for period of 1 year. Children who satisfied the inclusion criteria were selected and randomly subdivided into 2 groups: group A- round window insertion and group B-cochleostomy. Pre- and post-operative pure tone average (PTA) and residual hearing preserved were evaluated among the cochleostomy and round window insertion groups separately. Post-operatively, children were evaluated, from three months to 1 year from the activation of cochlear implant, with the use of scores such as Category of Auditory Performance (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility rating (SIR) and Meaningful use of speech scale (MUSS score) to measure speech production skills by auditory verbal therapist. Results: A total of 80 patients were included in the study. Complete hearing preservation (within 10 dB) was significantly high in round window insertion group compared to cochleostomy technique (p<0.001). None the subjects had complete loss of residual hearing. On evaluating the post CI performance, MAIS score in the round window insertion group (9.34, 18.21, 27.79) were significantly better compared to cochleostomy group during the 3 months, 6 months and 12 months follow-up.Conclusions: Round window insertion technique is significantly more successful in complete hearing preservation at low frequencies compared to cochleostomy technique. Among the auditory scores, only MAIS in the round window insertion group was found to be significantly better compared to cochleostomy group.

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Section: Discussionmentioning

confidence: 72%

Comparison of residual hearing preservation and auditory based performance after paediatric cochlear implantation by round window insertion versus cochleostomy technique: an ambispective cohort study

Antony

Chacko

Arodiyil

2021

Int J Otorhinolaryngol Head Neck Surg

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“…Five of the included studies evaluated speech perception [ 21 , 27 - 30 ]. Two studies [ 28 , 30 ] showed that the RW approach resulted in improved speech perception when compared to the C approach while three studies [ 21 , 27 , 29 ] indicated that there was no difference (Table 3 , Figure 4 ).…”

Section: Reviewmentioning

confidence: 99%

“…Our analysis did not reveal the superiority of either the RW or C approach in maximizing speech perception with 60% of the studies we reviewed regarding speech perception revealing no difference between the approaches [ 21 , 27 , 29 ]. The remaining 40% of studies revealed that the RW approach was superior, suggesting that the RW approach may maximize speech perception when compared to the C approach [ 28 , 30 ]. Further systematic reviews/meta-analyses of this topic are necessary to better understand this relationship.…”

Section: Reviewmentioning

confidence: 99%

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Avasarala¹,

Jinka²,

Jeyakumar³

2022

Cureus

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We conducted a systematic review and meta-analysis to compare round window (RW) and cochleostomy (C) surgical approaches for the placement of cochlear implants (CIs). After obtaining the Institutional Review Board (IRB) approval, 213 peer-reviewed articles published between January 1, 2000, and August 1, 2021, comparing RW and C approaches were identified via a search on Google Scholar, Cochrane, and PubMed. The inclusion criteria were articles having an English version and involving only human subjects (cadaveric or alive). Statistical analysis of compiled electrode-to-modiolus distances was performed with two-sample independent t-tests. Live patients were categorized as having complete hearing preservation (<10 dB threshold shift), partial hearing preservation (10-20 dB shift), or minimal hearing preservation (>20 dB shift). Chi-squared testing was used to compare the distribution of hearing preservation categories between surgical approaches. Due to the heterogeneous nature of the data, only summative information was provided on the effects of approaches on trauma, electrical impedance, speech perception, vestibular dysfunction, ease of scala tympani insertion, and scalar shift. A total of 3,797 CI patients were evaluated. The RW approach resulted in a smaller (0.15 mm smaller on average, p<0.05) electrode-to-modiolus distance when compared to the C approach. The RW approach (93.0%) led to statistically better hearing preservation than the C approach (84.3%) (p<0.05). The RW approach was also associated with better outcomes in terms of speech perception, ease of scala tympani insertion, and reduced scalar shift. No difference between approaches was found with regard to trauma, electrical impedance, and vestibular dysfunction. Based on our findings, the RW approach appears to have several benefits compared to the C approach.

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“…4 However, promontorial cochleostomy or round window enlargement are routinely used in those cases with poor visualisation of the round window membrane. 5,6 The feasibility of the round window approach through posterior tympanotomy could be influenced by the anatomical configuration of the retrotympanum in relationship to the round window niche. Indeed, some bony structures, such as the pyramidal eminence and the pyramidal ridge, could hide the round window niche.…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of posterior tympanotomy: influence of the retrotympanum on round window exposure

et al. 2023

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Objectives To describe how the retrotympanic structures could influence the visibility of the round window niche and the round window membrane during cochlear implant surgery, and to investigate if a round window approach is possible even in cases with unfavourable anatomy. Methods Video recordings from 37 patients who underwent cochlear implantation were reviewed. The visibility of the round window niche and round window membrane at different timepoints was assessed according to a modified version of the Saint Thomas Hospital classification. The structures that concealed the round window niche and round window membrane were evaluated. Results After posterior tympanotomy, 54 per cent of cases had limited exposure (classes IIa, IIb and III) of the round window niche. After remodelling the retrotympanum, round window niche visibility significantly increased, with 100 per cent class I and IIa cases. Following remodelling of the round window niche, visibility of more than 50 per cent of the round window membrane surface was achieved in 100 per cent of cases. Conclusion Remodelling the retrotympanum and the round window niche significantly increased exposure of the round window niche and round window membrane respectively, allowing round window insertion in all cases.

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Cochlear implantation outcomes with round window electrode insertion versus cochleostomy insertion

Cited by 8 publications

References 14 publications

Comparison of residual hearing preservation and auditory based performance after paediatric cochlear implantation by round window insertion versus cochleostomy technique: an ambispective cohort study

Comparison of residual hearing preservation and auditory based performance after paediatric cochlear implantation by round window insertion versus cochleostomy technique: an ambispective cohort study

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

Surgical anatomy of posterior tympanotomy: influence of the retrotympanum on round window exposure

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