Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy

Kim, Christine S.; Maxfield, Alice Z.; Foyt, David; Rapoport, Robert J.

doi:10.1080/14670100.2017.1403146

Cited by 11 publications

(6 citation statements)

References 39 publications

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“…We believe that the surgical approach should be selected based on the specific type of malformation and the surgeon's experience. STP provides better control of the impairments mentioned above, but further development of specialized arrays and the use of intraoperative fluoroscopy [Perez et al, 2014] or CT [Kim et al, 2018], will perhaps mean its practice becomes more limited.…”

Section: Inner-ear Malformationsmentioning

confidence: 99%

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

Grinblat

Vlad²,

Caruso³

et al. 2020

Audiol Neurotol

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Objectives: To assess the validity of the subtotal petrosectomy (STP) technique in problematic cases of cochlear implant (CI) surgery, and review indications, outcomes, and related controversies. Study Design: This is a retrospective review of data from a private quaternary referral center of otology and skull base surgery. Patients and Methods: A review of patients who underwent CI with STP (STP-CI) as the leading approach was performed. Demographics, indications, surgical details, and main outcomes were evaluated. The surgeries performed were usually single-stage procedures encompassing a comprehensive mastoidectomy, blind sac closure of the external auditory canal (EAC), and mastoid obliteration with autologous fat. Results: A total of 107 cases were included. Mean follow-up was 7.1 years (range 1–13 years). The most frequent indication for STP-CI was chronic otitis media with/without cholesteatoma (32.7%), followed by open mastoid cavity (26.1%), and cochlear ossification (17.7%). Other difficult conditions where STP facilitates successful implantation include inner-ear malformations, temporal-bone trauma, unfavorable anatomic conditions, and revision surgery. A planned staged procedure was performed in 3 cases. The rate of major complications was 5.6% (n = 6). Three patients developed postauricular wound dehiscence which eventually resulted in device extrusion. No cases of recurrent/entrapped cholesteatoma, EAC breakdown, or meningitis were encountered. This is the largest single-center series of STP-CI reported in the literature. Conclusions: When CI is intended in technically challenging cases or associated with a high risk of complications, STP is effective and reliable. Safe implantation and excellent long-term outcomes can be achieved provided surgical steps are properly followed. Single-stage procedures can be performed in most cases, even when there is active middle-ear disease.

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Section: Inner-ear Malformationsmentioning

confidence: 99%

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

Grinblat

Vlad²,

Caruso³

et al. 2020

Audiol Neurotol

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“…Of these, 108 were excluded (Fig. 1), and ultimately 55 studies were included for analysis (Dahm et al 1995; Tucci et al 1995; Slattery & Luxford 1995; Munro et al 1996; Aschendorff et al 1997; Hoffman et al 1997; Woolley et al 1998; Au & Gibson 1999; Bent et al 1999; Harker et al 1999; Temple et al 1999; Fahy et al 2001; Miyamoto et al 2002; Daneshi et al 2003; Arnoldner et al 2004; Buchman et al 2004; Mylanus et al 2004; Loundon et al 2005; Papsin 2005; Sennaroglu et al 2006; Wootten et al 2006; Vassoler et al 2008; Lee et al 2010; Dettman et al 2011; Kontorinis et al 2011; Kuthubutheen et al 2012; Lai et al 2012; Broomfield et al 2013; Ko et al 2013; Tzifa & Hanvey 2013; Eftekharian & Amizadeh 2014; Bille et al 2015; Busi et al 2015; Jeong & Kim 2015; Pradhananga et al 2015; Pritchett et al 2015; Bianchin et al 2016; Manzoor et al 2016; Mey et al 2016; van Nierop et al 2016; Bostic et al 2017; Clarós et al 2017; Grover et al 2017; Isaiah et al 2017; Melo et al 2017; Roh et al 2017; Kim et al 2018; Hall et al 2019; Mikkelsen et al 2019; Shi et al 2019; Hura et al 2020; Ozkan et al 2020; Kumari et al 2021; Patterson et al 2021; Skrivan et al 2021). In total, 1572 children with cochlear implants were included, 698 were male and 539 female.…”

Section: Resultsmentioning

confidence: 99%

Cochlear Implantation in Children with Enlarged Vestibular Aqueduct: A Systematic Review of Surgical Implications and Outcomes

Hansen

Rasmussen²,

Cayé‐Thomasen

et al. 2022

Ear &Amp; Hearing

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Objectives: This study investigated age at implantation, improvement in hearing and speech perception outcomes, as well as surgical complications in pediatric cochlear implant recipients with Pendred Syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA). Design:A systematic review of the literature between 1984 and 2021 was performed. Two independent reviewers performed abstract and full-text screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: English language, cochlear implant, age at implantation available, age <18 years, PS, Mondini malformation, and enlarged vestibular aqueduct. Full-text analysis was completed using the National Institute of Health assessment tool for case series and case-control studies. Studies were also graded according to the Oxford Centre for Evidence-Based Medicine grading system. Results:In total, 198 studies were identified and screened, and 55 studies were included for analysis. Audiological outcomes were available in 46 studies, and the four-frequency pure-tone audiogram average improved by 60 to 78 dB HL due to cochlear implantation. Auditory performance and speech intelligibility scores increased by 44%. The overall average implantation age was 60 months. The implantation age was 21 months lower in the studies where individuals were implanted after the year 2000 compared with those implanted before the year 2000. Perilymph gusher/ oozing was the most common surgical incident reported, occurring in 187 of 1572 implantations. Conclusions:In children with PS/NSEVA, cochlear implantation improves pure-tone average by 60 to 78 dB HL and capacity of auditory performance/speech intelligibility by 44%. The implantation age for these children has decreased during the last two decades but is still somewhat higher than reported for unselected pediatric cochlear implantation. Perilymph gusher/oozing is the most common surgical complication.

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“…In addition to abnormal electrical testing, difficult insertion 2 and dysplastic anatomy also warrant intraoperative X‐rays. Some authors even argue for intraoperative CT scans to aid in electrode evaluation for patients with challenging anatomy 16,17 …”

Section: Discussionmentioning

confidence: 99%

Utility of Intraoperative Radiographs in Pediatric Cochlear Implant Surgery

Savoca

Smith

Shaffer

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo evaluate the role of intraoperative radiographs to confirm electrode position following pediatric cochlear implantation (CI).Study DesignRetrospective chart review.SettingSingle tertiary care pediatric center.MethodsA retrospective chart review was conducted, including all pediatric patients undergoing CI at UPMC Children's Hospital of Pittsburgh over a 13‐year period.ResultsWe identified 326 patients undergoing 492 procedures. Across the cohort, there were 7 cases that required intraoperative electrode reinsertion due to malposition or presumed malposition. For 6 of the 7 cases, intraoperative X‐ray identified electrode malposition. Neural response telemetry (NRT) testing was also abnormal for 4 of these cases prior to reinsertion. Implantation of Cochlear's Slim Modiolar electrode was associated with an abnormal perioperative X‐ray (odds ratio [OR]: 9.2, p = 0.03) and increased change in management (OR: 9.2, p = 0.03) compared to Cochlear's Contour Advance (CA). Incidence of abnormal X‐rays was 1.24% overall, 4% in the Slim Modiolar group, and 0.3% in the CA group. The Slim Modiolar electrode accounted for 4 of 7 cases requiring reinsertion, and in all 4 of these cases, electrode fold‐over was identified on the X‐ray. NRT was normal in 1 of these 4 cases.ConclusionThe use of Cochlear's Slim Modiolar electrode was associated with a significantly increased risk of abnormal intraoperative X‐ray compared to the CA electrode. Given the risk of fold‐over with routine insertion and normal electrical testing using the Slim Modiolar electrode, we recommend routine use of intraoperative skull X‐ray to confirm electrode position.

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Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy

Abstract: When faced with challenging temporal bone anatomy, intraoperative CT can provide critical details of the patient's microanatomy that allows for improved localization of the electrode and adjustments in operative techniques for successful cochlear implantation.

Cited by 11 publications

References 39 publications

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

Cochlear Implantation in Children with Enlarged Vestibular Aqueduct: A Systematic Review of Surgical Implications and Outcomes

Utility of Intraoperative Radiographs in Pediatric Cochlear Implant Surgery

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