Endoscopic cochlear implantation: Call for caution

Tarabichi, Muaaz; Nazhat, Omar; Kassouma, Jamal; Najmi, Murtaza

doi:10.1002/lary.25462

Cited by 19 publications

(22 citation statements)

References 16 publications

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“…It is easier to identify the RW with a transcanal approach, but transcanal insertion vector may carry the risk of leading to a more lateral position of the array in the ST and may increase the battery energy needed to stimulate the spiral ganglion neurons. Also, elevating the tympanic annulus carries a significant risk of injury to the annulus or tympanic membrane [ 20 , 31 , 32 ]. We think that transfacial recess endoscopic identification of the RW obviates the need to switch to a transcanal approach.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic ear surgery (EES) has gained considerable popularity during the last decade [ 26 , 29 , 31 , 33 , 34 ], and this enthusiasm encouraged the otologists to use endoscopes during conventional and alternative CI surgeries. The first advantage of EES is the endoscopic magnification, which is the growth of the visual field as the endoscope approaches near the object of interest.…”

Section: Discussionmentioning

confidence: 99%

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Endoscope-Assisted Cochlear Implantation

Günerı

Olgun

2018

Clin Exp Otorhinolaryngol

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Objectives Our aim was to present our endoscope-assisted cochlear implantation (CI) technique, in which the middle ear landmarks were identified through the facial recess exposure by using an endoscopic view without elevating the tympanic annulus. The secondary goal was to assess whether the situation of difficult surgical exposure could be predicted by evaluating preoperative axial computed tomography (CT) examinations.Methods CT examinations and surgical outcomes of endoscope-assisted CI surgeries were analyzed.Results A total of 179 CI operations performed in 27 adults (15.1%) and 152 children (84.9%) were retrospectively evaluated. It was found that in 14 cases (7.8%), endoscopic examination contributed substantially in identifying the round window (RW) membrane correctly. Endoscopic identification of the RW through the posterior tympanotomy enabled us to perform a straightforward surgery in all these cases, without the need for switching to a bony cochleostomy or alternative surgical techniques. The difficulty in the surgical exposure was predicted preoperatively by examining the axial CT scans in six of the 14 cases (42.8%) for which endoscopic assistance was necessary in order to identify the RW correctly.Conclusion The main benefit of endoscope-assisted CI is the improved visibility leading to a panoramic view of the RW region. The implementation of transfacial recess endoscopic examination into the conventional CI technique is helpful to avoid problems during surgical orientation. However, the difficulty in the surgical exposure of the RW cannot be reliably predicted by the subjective evaluation of preoperative CT scans and more studies are needed to obtain reliable criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Cochlear Implantation

Günerı

Olgun

2018

Clin Exp Otorhinolaryngol

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“…Reported advantages of the transcanal endoscopic approach include avoidance of drilling the mastoid cavity, better visualisation of the round window area and safety of the facial nerve. However, in a recent study that analysed the orientation of the cochlear basal turn in relation to the ear canal, it was demonstrated that the trajectory provided by the conventional posterior tympanotomy aligned more favourably with the cochlear basal turn than the transcanal approach, thus may result in less damage caused by deflection of the electrode array in the scala tympani . In addition, it has also been reported that transcanal endoscopic cochlear implantation may lead to late‐onset complications, including electrode extrusion and acquired cholesteatoma in the ear canal …”

Section: Discussionmentioning

confidence: 99%

Using endoscopy to locate the round window membrane during cochlear implantation: Our experience with 25 patients

Chen

Liu

Yang

et al. 2017

Clinical Otolaryngology

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“…Electrode handling is minimal in case of posterior tympanotomy approach, while in the transcanal approach, the electrode array passes through three bends from transcanal well into the tunnel at its entry, exit from the tunnel, and then through the cochleostomy; complete alignment to the basal turn of cochlea is not possible in all cases. 12,13 Cholesteatoma or severe retraction of pars tensa is a complication which occurs due to injury to the canal wall or tympanic annulus and thin external meatal wall. Bone resorption can lead to migration of keratinocytes.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Surgical Approach: A Comparative Study between Transcanal and Posterior Tympanotomy Approach for Cochlear Implantation

Suri

Sandilya

Sayani

et al. 2020

Annals of Otology and Neurotology

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Introduction The aim of our study is to compare the surgical complications of the transcanal and posterior tympanotomy approach and to evaluate the advantages and disadvantages of both techniques. Materials and Methods It is a prospective study involving 252 pediatric cochlear implant patients operated in the Department of ENT, GMERS Medical College and General Hospital, Gandhinagar, Gujarat, India. Out of these, 126 patients were operated by transcanal approach (group A) and 126 patients were operated by posterior tympanotomy approach (group B). Results No significant difference in the mean duration of surgery (p > 0.064) was observed in both the groups. Major complications occurred in 60.2% of group A and 3.1% of group B and minor complications occurred in 65% of group A and 3.1% in group B, which is highly significant (p < 0.0134). The categories of auditory perception, speech intelligibility rating scales, meaningful auditory integration scale, and meaningful use of speech scale were assessed in both groups. Conclusion Complication rate in the transcanal approach is higher as compared with posterior tympanotomy approach. A complete alignment and introduction of electrode array into the basal turn of cochlea is more favorable in the posterior tympanotomy approach. Transcanal technique even as an alternative may not be useful. Outcomes may be affected depending upon the technique chosen.

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Endoscopic cochlear implantation: Call for caution

Abstract: 4. Laryngoscope, 126:689-692, 2016.

Cited by 19 publications

References 16 publications

Endoscope-Assisted Cochlear Implantation

Endoscope-Assisted Cochlear Implantation

Using endoscopy to locate the round window membrane during cochlear implantation: Our experience with 25 patients

Impact of the Surgical Approach: A Comparative Study between Transcanal and Posterior Tympanotomy Approach for Cochlear Implantation

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