Cochlear implant electrode array misplaced in Hyrtl's fissure

Mouzali, A.; Ouennoughi, Kheiredidine; Haraoubia, Mohamed-Salah; Zemirli, Omar; Triglia, J.-M.

doi:10.1016/j.ijporl.2011.08.007

Cited by 19 publications

(11 citation statements)

References 7 publications

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“…In addition, incomplete ossification of the tympano meningeal fissure (Hyrtl's fissure) that usually occurs by the 24th week in utero causes permanent patency that can be another potential space for extracochlear misplacement of the electrode array. There are two reported cases in the literature involving pediatric patients 8, 9. In the case presented by Mouzali et al,8 the authors acknowledged that knowing about the abnormality prior to surgery would have suggested the possibility of misdirection of the electrode array, and cautious consideration of the axis of insertion.…”

Section: Discussionmentioning

confidence: 99%

Cochlear implant electrode misplacement: Incidence, evaluation, and management

et al. 2013

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Objectives/Hypothesis To review the presentation and management of improper electrode array placement, and to help guide clinical decision-making. Study Design Retrospective case series. Methods Pediatric and adult cochlear implant patients managed from January 2001 to present whose electrode arrays were not placed properly within the cochlea or extended beyond the cochlea into the internal auditory canal or adjacent structures. Results Four patients, three pediatric and one adult, were identified from over 824 cases (< 1%) managed over the study duration. All cases had normal cochlear anatomy. These cases were initially identified due to poor auditory skill development or absent behavioral responses following implantation, which prompted imaging. Two patients presented several years after surgery. Sites of improper placement included the eustachian tube, vestibule, internal carotid artery canal, and internal auditory canal (IAC). Intraoperative findings and management are reviewed. Conclusions Electrode array malpositioning is a rare, but serious and correctable complication in cochlear implant surgery. A multidisciplinary approach, including prompt audiologic evaluation and imaging, is important, particularly when benefit from the implant is limited or absent. Management of electrode arrays in the IAC may be more challenging.

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Section: Discussionmentioning

confidence: 99%

Cochlear implant electrode misplacement: Incidence, evaluation, and management

et al. 2013

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“…9 As this necessitated further repositioning, the authors suggested that pre-surgical imaging could be of paramount importance for patients undergoing cochlear implantation, to help identify congenital deformities. 9 As this necessitated further repositioning, the authors suggested that pre-surgical imaging could be of paramount importance for patients undergoing cochlear implantation, to help identify congenital deformities.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Mouzali et al . reported a case of a failed cochlear implantation in an eight-year-old where the electrode array was misplaced in a Hyrtl's fissure 9 . As this necessitated further repositioning, the authors suggested that pre-surgical imaging could be of paramount importance for patients undergoing cochlear implantation, to help identify congenital deformities.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous resolution of cerebrospinal fluid otorrhoea in a patient with a Hyrtl's fissure

et al. 2015

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“…An endoscopic CI involves entering the ME by means of endoscopic transcanal tympanotomy and insertion of the electrode array into the scala tympani via the RW under direct endoscopic control [71,72]. Limited access to the ME structures can result in electrode misplacement, damage to the FN and injury to the CTN when a CI is carried out with an FR approach [73][74][75][76][77][78]. Indeed, bilateral sacrificing of the CTN due to a narrow FR in bilaterally implanted children can lead to morbidity that has not yet been investigated in depth.…”

Section: Endoscopic Cochlear Implantationmentioning

confidence: 99%

Minimally Invasive Transcanal Endoscopic Ear Surgery

Migirov¹,

Wolf²

2015

Endoscopy - Innovative Uses and Emerging Technologies

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Endoscopes have rapidly become widely accepted in the performance of ear surgery. Current chapter describes surgical technique and benefits and limitations for endoscopic eradication of cholesteatoma, endoscopic tympanoplasty, endoscopic stapedotomy and endoscopic cochlear implantation.Minimally invasive endoscopic and endoscope-assisted surgical techniques are increasingly being employed in the surgical management of cholesteatoma. Endoscopic surgeries distinctly reduced residual cholesteatomas and the indications of later tympanotomy thanks to the good visualization of residual cholesteatoma sites, such as the anterior and posterior epitympanic spaces, sinus tympani, facial recess, and hypotympanum. Minimally invasive transcanal endoscopic approach can be applied as for primary cholesteatomas as well as for revision of CWU cases, when residual/recurrent cholesteatoma is confined to the middle ear, and in CWD or radical cavities, when residual/recurrent disease is hidden in the supratubal recess, sinus tympani or under pseudo-membrane in the large mastoid cavities.The use of endoscopes in myringoplasty is especially helpful in patients with narrow external canals, anterior defects and bone overhang, when perforation's margins are barely, if at all, visible under a microscope.The transcanal endoscopic stapedotomy can be beneficial in improving the visibility and accessibility of the stapes and the oval window niche, avoiding manipulation of the chorda tympani nerve and blind fracture of the stapedial crurae.An endoscopic cochlear implantation involves entering the middle ear by means of endoscopic transcanal tympanotomy and insertion of the electrode array into the scala tympani via the round window under direct endoscopic control. The main benefits of the endoscopic transcanal approach to cochlear implant are improving the visibility and accessibility of the round window membrane, obviating the need to divide the chorda tympani nerve in order to obtain adequate exposure of the middle ear structures, and eliminating the risk of the facial nerve injury since it is not in the direction of drilling.

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Cochlear implant electrode array misplaced in Hyrtl's fissure

Cited by 19 publications

References 7 publications

Cochlear implant electrode misplacement: Incidence, evaluation, and management

Cochlear implant electrode misplacement: Incidence, evaluation, and management

Spontaneous resolution of cerebrospinal fluid otorrhoea in a patient with a Hyrtl's fissure

Minimally Invasive Transcanal Endoscopic Ear Surgery

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