The Effect of Round Window vs Cochleostomy Surgical Approaches on Cochlear Implant Electrode Position

Jiam, Nicole T.; Jiradejvong, Patpong; Pearl, Monica S.; Limb, Charles J.

doi:10.1001/jamaoto.2016.1512

Cited by 30 publications

(25 citation statements)

References 27 publications

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“…Moreover, the currently available atraumatic straight electrode is more compatible to the RW approach than cochleostomy. [1][2][3][4] Therefore, electrode insertion through RW is strongly recommended to ensure hearing preservation in procedures such as electro-acoustic stimulation (EAS). Despite these advantages, the RW approach is associated with many significant challenges and technical limitations.…”

Section: Introductionmentioning

confidence: 99%

Cochlear Implant Surgery Through Round Window Approach Is Always Possible

Bae¹,

Shin²,

Chun³

2019

Ann Otol Rhinol Laryngol

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Objectives: The benefit of round window (RW) approach for cochlear implant (CI) has been well studied. Because the RW represents a natural door to scala tympani, it facilitates precise electrode insertion. Atraumatic electrode insertion can also be performed without drilling the cochlear lateral wall. However, the RW approach has several limitations. The purpose of this study is to describe successful CI surgeries utilizing the RW approach except for severe cases of temporal bone anomaly. The authors’ successful surgical solution for cases involving difficult RW access is also described. Materials and Methods: We retrospectively analyzed 377 consecutive surgeries of cochlear implantation performed between June 2010 and December 2018 by a single experienced surgeon. Standard and alternative procedures were used according to anatomical variations. Standard procedures included modified techniques of mastoidectomy in the RW approach, opening of facial recess, exposure of RW membrane, and electrode insertion. Difficult cases involving severe rotated cochlea or hypoplastic mastoid were successfully treated with RW insertion using alternative procedures such as external auditory canal (EAC) wall mobilization and endomeatal approach. Results: We performed CI surgery through a reproducible RW technique in two cases involving endomeatal approach and three cases of EAC mobilization. Other cases were treated using the standard procedure. Conclusion: Cochlear implant surgery through RW is reliable, safe, and effective. The RW technique is reproducible via several surgical procedures in most CI cases. Identification and safe exposure of RW membrane is a prerequisite for successful electrode insertion in cochlear implant surgery.

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Section: Introductionmentioning

confidence: 99%

Cochlear Implant Surgery Through Round Window Approach Is Always Possible

Bae¹,

Shin²,

Chun³

2019

Ann Otol Rhinol Laryngol

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“…The literature clearly shows that, compared to cochleostomy, round window insertion increases the likelihood of successful peri-modiolar placement of non-modiolar hugging electrode arrays, which is associated with less current spread and greater stimulation selectivity. 6…”

Section: Discussionmentioning

confidence: 99%

“…5 The duration of deafness, the level of speech recognition before implantation, electrode insertion depth at the time of surgery, intracochlear trauma and lateral peri-modiolar placement all have an effect on post-implantation performance. 6…”

Section: Introductionmentioning

confidence: 99%

A study on modelling cochlear duct mid-scalar length based on high-resolution computed tomography, and its effect on peri-modiolar and mid-scalar implant selection

Pamuk

Akgöz

et al. 2019

J. Laryngol. Otol.

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ObjectiveTo determine cochlear duct mid-scalar length in normal cochleae and its role in selecting the correct peri-modiolar and mid-scalar implant length.MethodsThe study included 40 patients with chronic otitis media who underwent high-resolution computed tomography of the temporal bone. The length and height of the basal turn, mid-modiolar height of the cochlea, mid-scalar and lateral wall length of the cochlear duct, and the ‘X’ line (the largest distance from mid-point of the round window to the mid-scalar point of the cochlear canal) were measured.ResultsCochlear duct lateral wall length (28.88 mm) was higher than cochlear duct mid-scalar length (20.08 mm) (p < 0.001). The simple linear regression equation for estimating complete cochlear duct length was: cochlear duct length = 0.2 + 2.85 × X line.ConclusionUsing the mid-scalar point as the reference point (rather than the lateral wall) for measuring cochlear duct mid-scalar length, when deciding on the length of mid-scalar or peri-modiolar electrode, increases measurement accuracy. Mean cochlear duct mid-scalar length was compatible with peri-modiolar and mid-scalar implant lengths. The measurement method described herein may be useful for pre-operative peri-modiolar or mid-scalar implant selection.

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“… 6 , 7 The degree of quality is so significant that individual electrode contacts can be delineated, thus permitting assessment of final electrode position. 8 In this study, we used high-resolution FPCT imaging to evaluate the impact of cochleostomy approaches and round window insertion on CI electrode interscalar excursion.…”

Section: Introductionmentioning

confidence: 99%

The impact of round window vs cochleostomy surgical approaches on interscalar excursions in the cochlea: Preliminary results from a flat‐panel computed tomography study

Jiam

Limb

2016

World j. otorhinolaryngol.-head neck surg.

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ObjectiveTo evaluate incidence of interscalar excursions between round window (RW) and cochleostomy approaches for cochlear implant (CI) insertion.MethodsThis was a retrospective case-comparison. Flat-panel CT (FPCT) scans for 8 CI users with Med-El standard length electrode arrays were collected. Surgical technique was identified by a combination of operative notes and FPCT imaging. Four cochleae underwent round window insertion and 4 cochleae underwent cochleostomy approaches anterior and inferior to the round window.ResultsIn our pilot study, cochleostomy approaches were associated with a higher likelihood of interscalar excursion. Within the cochleostomy group, we found 29% of electrode contacts (14 of 48 electrodes) to be outside the scala tympani. On the other hand, 8.5% of the electrode contacts (4 of 47 electrodes) in the round window insertion group were extra-scalar to the scala tympani. These displacements occurred at a mean angle of occurrence of 364° ± 133°, near the apex of the cochlea. Round window electrode displacements tend to localize at angle of occurrences of 400° or greater. Cochleostomy electrodes occurred at an angle of occurrence of 19°–490°.ConclusionsCurrently, the optimal surgical approach for standard CI electrode insertion is highly debated, to a certain extent due to a lack of post-operative assessment of intracochlear electrode contact. Based on our preliminary findings, cochleostomy approach is associated with an increased likelihood of interscalar excursions, and these findings should be further evaluated with future prospective studies.

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The Effect of Round Window vs Cochleostomy Surgical Approaches on Cochlear Implant Electrode Position

Cited by 30 publications

References 27 publications

Cochlear Implant Surgery Through Round Window Approach Is Always Possible

Cochlear Implant Surgery Through Round Window Approach Is Always Possible

A study on modelling cochlear duct mid-scalar length based on high-resolution computed tomography, and its effect on peri-modiolar and mid-scalar implant selection

The impact of round window vs cochleostomy surgical approaches on interscalar excursions in the cochlea: Preliminary results from a flat‐panel computed tomography study

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