Utility of vestibular testing and new technologies in a complex cholesteatoma

Abstract

This paper reports a patient with a large recidivist cholesteatoma who underwent audio-vestibular tests and used customized 3D technologies (3D printing, augmented reality, virtual reality) to understand risks of the surgery. The patient was extremely concerned with her clinical findings and it found difficult to understand them. Customized 3D models helped the patient to understand the spatial relations and possible complications of surgery. The benefits of using new technologies in preoperative surgical planning for the surgeon and patient are also explained in a setting when radiological findings indicate high risks for surgery. Computed tomography scan showed a posterior semicircular canal fistula, which would add a significant challenge to the surgery. The fistula was not found in the result of the physiological test (cervical vestibular evoked myogenic potentials) and not found intra-operatively. Application of modern audio-vestibular investigations and use of customized 3D technologies may prove useful aids.

Three-dimensional study of vestibular anatomy as it relates to the stapes footplate and its clinical implications: an augmented reality development

“…The value of generating 3D tools to understand such anatomy is vital in pushing the frontiers of understanding the inner ear. The role of augmented and virtual reality has been discussed in relation to the teaching of technical skills in otological and rhinological surgery, 11 , 12 , 18 – 21 but the role of augmented reality as an educational tool for understanding inner-ear anatomy is still evolving. This is the first such study of inner-ear anatomy, with the resolution of structures demonstrated in micrometres.…”

“…It also allowed further visualisation of the nerve supply and the anatomy of the vestibule from inside and out. These methods of creating 3D files have been described previously 11 , 12 . The augmented reality digital content can be visualised with a smart device such as an iPhone or iPad, using a free software application called Hyperspaces (Inglobe Technologies, Ceccano, Italy).…”