Clin Exp Otorhinolaryngol.  2018 Jun;11(2):89-95. 10.21053/ceo.2017.00927.

Endoscope-Assisted Cochlear Implantation

• Güneri EA
• Olgun Y

• KMID: 2412665
• DOI: http://doi.org/10.21053/ceo.2017.00927

Abstract

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.

Keyword

Cochlear Implants; Endoscope; Ear

MeSH Terms

Adult
Child
Cochlear Implantation*
Cochlear Implants*
Ear
Ear, Middle
Endoscopes
Humans
Membranes
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Adequate microscopical exposure of the round window region through posterior tympanotomy (right ear). Stapedial tendon, posterior crus of the stapes, incudostapedial joint and round window region are clearly visualized (A). Inadequate microscopical exposure of the round window region through posterior tympanotomy (facial recess approach, right ear). Round window region can not be visualized through the window delineated by chorda tympani laterally, facial nerve medially and the short process of incus cranially. The incudostapedial joint, umbo can be noticed (B). The round window niche could not be fully exposed in spite of a maximally opened proper posterior tympanotomy window (Saint Thomas Hospital classification type IIb) (C).

• 

  Fig. 2. Endoscopic view of the round window through the facial recess obtained with a 0º, 4 mm rigid endoscope before (A) and after (B) removing the round window niche (right ear).

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  Fig. 3. Endoscopic view of the round window (RW) region obtained with a 0º, 4 mm rigid endoscope inserted through the facial recess (right ear). RW region (A), RW membrane after removing the niche (B), membranous cochleostomy (C), electrode insertion (D).

• 

  Fig. 4. The first parameter used to determine the adequacy of the exposure: the depth of the region between the mastoid segment of the facial nerve and the round window on an axial computed tomography scan was evaluated in order to assess whether the facial recess approach would provide an adequate exposure (right ear; arrow points to the round window, arrowhead points to the mastoid segment of the facial nerve).

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  Fig. 5. The second parameter used to determine the adequacy of the exposure: the angle between the long axis of the IAC and a horizontal line drawn between the posterior borders of both internal auditory canals (IACs). (A) The angle is markedly increased on the right side and the IAC is inclined significantly anteriorly. (B) The IAC is nearly in horizontal orientation on the left side in comparison to (A). The expected orientation of the right IAC in relation to the location of the cochlea is illustrated in (C) (axial computed tomography scan).

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  Fig. 6. Rigid endoscopic view (0º, 2.7 mm) of the scala tympani and modiolus (left ear).

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