Cochlear implantation in children without preoperative computed tomography diagnostics. Analysis of procedure and rate of complications

Ehrmann-Müller, Désirée; Shehata‐Dieler, Wafaa; Kaulitz, Stefan; Back, Daniela; Kurz, Anja; Kühn, Heike; Hagen, Rudolf; Rak, Kristen

doi:10.1016/j.ijporl.2020.110266

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…Based on the present results, it is possible to waive ionized radiation–based imaging prior to cochlear implantation 36 . However, not performing a preoperative CT scan can lead to different problems in surgical planning.…”

Section: Discussionmentioning

confidence: 91%

“…Based on the present results, it is possible to waive ionized radiation–based imaging prior to cochlear implantation. 36 However, not performing a preoperative CT scan can lead to different problems in surgical planning. The CT scan is mainly used to identify structures of the temporal bone, especially the course of the facial nerve and the size of the mastoid.…”

Section: Discussionmentioning

confidence: 99%

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Cochlear Duct Length Measurements in Computed Tomography and Magnetic Resonance Imaging Using Newly Developed Techniques

Taeger¹,

Müller-Graff²,

Ilgen³

et al. 2021

OTO Open

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Objective Growing interest in measuring the cochlear duct length (CDL) has emerged, since it can influence the selection of cochlear implant electrodes. Currently the measurements are performed with ionized radiation imaging. Only a few studies have explored CDL measurements in magnetic resonance imaging (MRI). Therefore, the presented study aims to fill this gap by estimating CDL in MRI and comparing it with multislice computed tomography (CT). Study Design Retrospective data analyses of 42 cochleae. Setting Tertiary care medical center. Methods Diameter (A value) and width (B value) of the cochlea were measured in HOROS software. The CDL and the 2-turn length were determined by the elliptic circular approximation (ECA). In addition, the CDL, the 2-turn length, and the angular length were determined via HOROS software by the multiplanar reconstruction (MPR) method. Results CDL values were significantly shorter in MRI by MPR ( d = 1.38 mm, P < .001) but not by ECA. Similar 2-turn length measurements were significantly lower in MRI by MPR ( d = 1.67 mm) and ECA ( d = 1.19 mm, both P < .001). In contrast, angular length was significantly higher in MRI ( d = 26.79°, P < .001). When the values were set in relation to the frequencies of the cochlea, no clinically relevant differences were estimated (58 Hz at 28-mm CDL). Conclusion In the presented study, CDL was investigated in CT and MRI by using different approaches. Since no clinically relevant differences were found, diagnostics with radiation may be omitted prior to cochlear implantation; thus, a concept of radiation-free cochlear implantation could be established.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Cochlear Duct Length Measurements in Computed Tomography and Magnetic Resonance Imaging Using Newly Developed Techniques

Taeger¹,

Müller-Graff²,

Ilgen³

et al. 2021

OTO Open

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“…Ehrmann-Müller et al. haben dazu bei Kindern unter 36 Monaten untersucht, dass der Verzicht auf eine präoperative Felsenbein-CT ein sicheres Vorgehen ohne zusätzliches perioperatives Risiko darstellt [ 10 ]. Um bei Patienten unter 18 Jahren die CDL-Messung einzig an der MRT durchzuführen und somit auch diesen Patienten eine angepasste Cochleaimplantatversorgung anbieten zu können, ist ein direkter Vergleich zwischen Messungen an MRT und CT unerlässlich.…”

Section: Hintergrundunclassified

Vermessung der Cochlea mittels eines Tablet-basierten Softwarepakets: Einfluss der Bildgebungsmodalität und des Untersucherhintergrunds

Weber

Kwok

Picou

et al. 2022

HNO

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Zusammenfassung Hintergrund Die Größe der Cochlea ist individuell unterschiedlich, was sich in der variablen Länge des Ductus cochlearis (CDL) ausdrücken lässt. In der Cochleaimplantatversorgung ist ein in der Länge angepasster Elektrodenträger durch eine optimale Abdeckung der Cochlea erfolgversprechend. Dazu kann die CDL auf Höhe des Corti-Organs (CDLOC) mittels eines Tablet-basierten Softwarepakets ausgemessen werden, um abgestimmt auf die Anatomie einen passenden Elektrodenträger auszuwählen. Fragestellung Haben die Modalität der Bildgebung und der Untersucherhintergrund einen Einfluss auf die Vermessung der CDL? Methoden Die Datensätze der Magnetresonanztomographie (MRT) und Flachdetektor-Volumen-Computertomographie (fpVCT) von 10 Patienten (20 Cochleae) wurden in der Software OTOPLAN (MED-EL, Innsbruck, Österreich) analysiert. Als Untersucher wurden eine Oberärztin der Hals-Nasen-Ohren-Heilkunde, eine Assistenzärztin der HNO-Heilkunde und ein Audiologe ausgewählt. Zur Analyse der Effekte der Bildgebung und des Untersucherhintergrunds auf die CDL-Messungen wurden linear gemischte Modelle konstruiert. Ergebnisse Die Messungen ergaben einen Mittelwert CDLOC(fpVCT) = 36,69 ± 1,78 mm und CDLOC(MRT) = 36,81 ± 1,87 mm. Die Analysen zeigten keinen signifikanten Effekt des Untersucherhintergrunds auf die Messergebnisse (F (2, 105) = 0,84; p = 0,437). Die Bildgebungsmodalität zeigte einen signifikanten Einfluss (F (1, 105) = 20,70; p < 0,001), wobei die Messungen an MRT im Mittel um 0,89 mm größer waren. Schlussfolgerung Da der Untersucherhintergrund keinen Einfluss auf die Messungen hatte, lässt sich schließen, dass die Messungen nicht ausschließlich von ärztlichem Personal, insbesondere nicht nur von erfahrenen Neurootologen, durchgeführt werden müssen. Die Methode der Bildgebung (fpVCT vs. MRT) kann die CDL-Werte statistisch signifikant beeinflussen, wobei eine klinische Relevanz fraglich ist.

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“…On the long term, the system might be used in a radiation free cochlear implantation. Omitting radiation is of high bene t, especially for children 42 , since there is growing evidence from epidemiological studies that radiation exposure of the brain poses further substantial risks [43][44][45] . In this concept preoperative planning of the implantation, like measuring the CDL 46,47 , the examination of the course of facial nerve 48 and the size of the temporal bone 49 , will be performed in MRI imaging.…”

Section: Discussionmentioning

confidence: 99%

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Herrmann

Müller-Graff

Kaulitz

et al. 2021

Preprint

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Purpose: This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI).Methods: Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCTSECO).Results: During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. Conclusion: It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion.

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Cochlear implantation in children without preoperative computed tomography diagnostics. Analysis of procedure and rate of complications

Cited by 8 publications

References 23 publications

Cochlear Duct Length Measurements in Computed Tomography and Magnetic Resonance Imaging Using Newly Developed Techniques

Cochlear Duct Length Measurements in Computed Tomography and Magnetic Resonance Imaging Using Newly Developed Techniques

Vermessung der Cochlea mittels eines Tablet-basierten Softwarepakets: Einfluss der Bildgebungsmodalität und des Untersucherhintergrunds

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

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