Total Endoscopic Ear Surgery in management of cochleocele: A case series

Mok, Florence; Leonard, Colin G; Adams, Mark; Trimble, Keith; Papsin, Blake C.; James, Adrian L.; Isaacson, Brandon

doi:10.1016/j.ijporl.2020.110109

Cited by 5 publications

(7 citation statements)

References 10 publications

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“…Current strategies advocated for repair of congenital perilymphatic footplate fistula include subtotal petrosectomy (12). Less invasive surgery through an endaural approach has been recommended for cochleocele repair and for access to the round window (10), but in our experience, the minimally invasive endoscopic transcanal approach has proved successful for repair of lesions arising though the footplate as well as this case through the round window (1). At the time of publication, none of these seven children are known to have developed CSF leak or meningitis (personal communications).…”

Section: Discussionmentioning

confidence: 99%

“…Typically, these complications arise from a defect of the stapes footplate. A fistula in the footplate may allow a fluid-filled pouch of endosteum to bulge into the middle ear space, referred to as a cochleocele, or, if open, allow leakage of CSF into the ear (1). Most commonly, these lesions are described with IP1 or common cavity anomalies (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…At the age of 16 months, under hypotensive general anesthesia, the ear was debrided then prepared with Betadine (Purdue Frederick Co., Norwalk, CT). Intravenous tobramycin was given, and these precautions were taken to guard against the risk of early postoperative pseudomonas meningitis (1). Pneumococcal vaccination had been completed in accordance with standard practice.…”

Section: Interventionmentioning

confidence: 99%

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Endoscopic Repair of Round Window Cochleocele

James

Papsin²

2022

Otol Neurotol

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Objective: To describe the novel presentation, implications, and endoscopic management of a congenital round window cochleocele. Patient: A 16-month old girl with profound hearing loss from bilateral incomplete partition type 1 (IP1) anomaly of the cochlea plus left-sided cochlear nerve aplasia and cochleocele. Intervention: Anomalies were identified with computed tomographic scanning and magnetic resonance imaging during cochlear implant candidacy assessment. While under general anesthesia for right-sided cochlear implantation, the cochleocele was removed and packed with temporalis fascia using transcanal endoscopic ear surgery. The endoscope was held by an assistant while the surgeon packed the round window using a two-handed technique to counter the gush of cerebrospinal fluid. Results: The child made an uneventful recovery with no cerebrospinal fluid leak or meningitis.Conclusions: Cochleocele can protrude through the round window of a cochlea with incomplete partition type 1 anomaly. An increased risk of meningitis secondary to acute otitis media is expected given the known risk from cochleocele arising through a stapes footplate fistula. Care should be taken to check for the presence of a cochleocele in hearing loss from congenital malformations involving the basal turn of the cochlea on imaging and also at the time of cochlear implant surgery. Repair should be considered at the first opportunity to prevent meningitis. If early cochlear implant surgery is not feasible or appropriate (as, for example, with cochlear nerve aplasia), transcanal endoscopic ear surgery provides good access for a low-morbidity approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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Endoscopic Repair of Round Window Cochleocele

James

Papsin²

2022

Otol Neurotol

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“…However, a real cyst does not have any opening into any other surface, and therefore this pathology is different from a true cyst. Likewise, the term “cochleocelle” used by Mok et al ( 3 ) may not be appropriate because the pathology does not originate from cochlea, and it can be observed even in the absence of a cochlea. One suggestion is to use the term “endosteocele;” this may be appropriate if we think of the origin of the cystic structure as the inner ear endosteum.…”

Section: Discussionmentioning

confidence: 99%

“…Although the history may reveal recurrent meningitis and the radiologic examination demonstrates IEM, radiological signs of stapes footplate fistula are not very obvious and not well defined. Recently Mok et al ( 3 ) published a case series showing the opacity of the cyst on computerized tomography (CT); however, a study investigating all IEMs from this perspective has not yet been done. As meningitis is a serious, life-threatening condition, it is important to know which anomalies can cause meningitis, and to define its non-obvious signs.…”

Section: Introductionmentioning

confidence: 99%

Radiological Features and Pathognomonic Sign of Stapes Footplate Fistula in Inner Ear Malformations

Sennaroḡlu¹

2021

TAO

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Objective: Some inner ear malformations may cause recurrent meningitis, which may be fatal. The etiology is usually a stapes footplate fistula which enables microorganisms to pass into the inner ear containing cerebrospinal fluid (CSF), causing repeated attacks of meningitis. Radiological signs of the fistula are not obvious and are not reported in detail in the literature. The aim of the study is to investigate the radiological features of stapes footplate fistula in inner ear malformations. Methods: Radiological findings were analyzed for seventeen patients with inner ear malformations (IEMs) operated on because of recurrent meningitis. Using this information, images of 1,010 patients with IEMs were retrospectively reviewed to investigate the radiological findings of stapes footplate fistula and their relationship to IEMs. They were classified according to the Sennaroglu classification system, and according to different stages of stapes footplate fistula. Results: In the case of a stapes footplate cyst, computerized tomography shows an opacity at the oval window. On magnetic resonance imaging, a fluid filled cystic structure continuous with and having similar signal characteristics to the CSF in the inner ear is a pathognomonic finding of a stapes footplate cyst. It is most commonly found in common cavity anomaly (18.2%); the second most frequent finding is incomplete partition type I (15%). And it can even be seen in cases of cochlear aplasia where only the vestibule is present. Conclusion: If the history reveals recurrent meningitis, particular attention should be given to the oval window area, where an opacity, cyst or a leaking lesion should be looked for on the imaging. It is the responsibility of the otolaryngologist to notice these findings, and to operate on the patient to prevent further attacks of meningitis.

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Totally endoscopic tympanic membrane repair

James

2021

HNO

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Total Endoscopic Ear Surgery in management of cochleocele: A case series

Cited by 5 publications

References 10 publications

Endoscopic Repair of Round Window Cochleocele

Endoscopic Repair of Round Window Cochleocele

Radiological Features and Pathognomonic Sign of Stapes Footplate Fistula in Inner Ear Malformations

Totally endoscopic tympanic membrane repair

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