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European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 2/2021

01-02-2021 | Tympanotomy | Otology

Round window accessibility during cochlear implantation

Authors: Konrad Stuermer, Tanja Winter, Lisa Nachtsheim, Jens Peter Klussmann, Jan Christoffer Luers

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2021

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Abstract

Objective

To assess data regarding round window (RW) visibility and surgical approaches in cochlear implant cases, and to describe and analyze surgical steps relevant for the RW approach in cochlear implantation.

Study design

Prospective clinical study.

Methods

A questionnaire was completed by surgeons after each of altogether 110 cochlear implantations. Round window membrane (RWM) visibility was graded according to the St Thomas Hospital (STH) classification.

Results

Performing different surgical steps during the preparation of the RW niche, the RWM could be fully exposed (STH Type I) in 87%. A RW approach could be used for electrode insertion in 89% of the adult and 78% of the pediatric cases. The distribution of RW types differed significantly between adults and children. Drilling of the superior bony lip was the surgical step most frequently needed in adult as well as pediatric cases to obtain optimal RW exposure.

Conclusion

In children, optimized surgical exposure of the RW niche resulted in only 52% full RWM visibility; whereas in adults, this could be achieved in 87%. The facial nerve (FN) had to be exposed at the level of the posterior tympanotomy in more than 70% of pediatric cases with full RWM visibility; while in adult cases with 100% visibility, such specific exposure was necessary in only 33%. Thus, surgical preparation of the RW niche seems to be more demanding in children than in adults.
Literature
1.
Luers JC, Huttenbrink KB, Beutner D (2018) Surgical anatomy of the round window—implications for cochlear implantation. Clin Otolaryngol 43(2):417–424CrossRef
2.
Skarzynski H, Lorens A, Zgoda M, Piotrowska A, Skarzynski PH, Szkielkowska A (2011) Atraumatic round window deep insertion of cochlear electrodes. Acta Otolaryngol 131(7):740–749CrossRef
3.
Kang BJ, Kim AH (2013) Comparison of cochlear implant performance after round window electrode insertion compared with traditional cochleostomy. Otolaryngol Head Neck Surg 148(5):822–826CrossRef
4.
Adunka O, Unkelbach MH, Mack M, Hambek M, Gstoettner W, Kiefer J (2004) Cochlear implantation via the round window membrane minimizes trauma to cochlear structures: a histologically controlled insertion study. Acta Otolaryngol 124(7):807–812CrossRef
5.
Roland PS, Wright CG, Isaacson B (2007) Cochlear implant electrode insertion: the round window revisited. Laryngoscope 117(8):1397–1402CrossRef
6.
Singla A, Sahni D, Gupta AK, Loukas M, Aggarwal A (2014) Surgical anatomy of round window and its implications for cochlear implantation. Clin Anat 27(3):331–336CrossRef
7.
Toth M, Alpar A, Patonay L, Olah I (2006) Development and surgical anatomy of the round window niche. Ann Anat 188(2):93–101CrossRef
8.
Saylisoy S, Incesulu A, Kaya E, Pinarbasli O, Adapinar B (2014) The round window diameter in congenital aural atresia and comparison with sensorineural hearing loss and control group. J Comput Assist Tomogr 38(3):461–463CrossRef
9.
Leong AC, Jiang D, Agger A, Fitzgerald-O’Connor A (2013) Evaluation of round window accessibility to cochlear implant insertion. Eur Arch Otorhinolaryngol 270(4):1237–1242CrossRef
10.
Richard C, Fayad JN, Doherty J, Linthicum FH Jr (2012) Round window versus cochleostomy technique in cochlear implantation: histologic findings. Otol Neurotol 33(7):1181–1187CrossRef
11.
Paprocki A, Biskup B, Kozlowska K, Kuniszyk A, Bien D, Niemczyk K (2004) The topographical anatomy of the round window and related structures for the purpose of cochlear implant surgery. Folia Morphol (Warsz) 63(3):309–312
12.
Adunka OF, Radeloff A, Gstoettner WK, Pillsbury HC, Buchman CA (2007) Scala tympani cochleostomy II: topography and histology. Laryngoscope 117(12):2195–2200CrossRef
13.
Bae SC, Shin YR, Chun YM (2019) Cochlear implant surgery through round window approach is always possible. Ann Otol Rhinol Laryngol 128(6_suppl):38S–44SCrossRef
14.
O’Connell BP, Hunter JB, Haynes DS, Holder JT, Dedmon MM, Noble JH et al (2017) Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes. Laryngoscope 127(10):2352–2357CrossRef
15.
Finley CC, Holden TA, Holden LK, Whiting BR, Chole RA, Neely GJ et al (2008) Role of electrode placement as a contributor to variability in cochlear implant outcomes. Otol Neurotol 29(7):920–928CrossRef
16.
Wanna GB, Noble JH, Carlson ML, Gifford RH, Dietrich MS, Haynes DS et al (2014) Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Laryngoscope 124(Suppl 6):S1–S7CrossRef
17.
Okuno H, Sando I (1988) Anatomy of the round window. A histopathological study with a graphic reconstruction method. Acta Otolaryngol 106(1–2):55–63CrossRef
18.
Lloyd SK, Kasbekar AV, Kenway B, Prevost T, Hockman M, Beale T et al (2010) Developmental changes in cochlear orientation–implications for cochlear implantation. Otol Neurotol 31(6):902–907CrossRef
19.
Al-Muhaimeed HS, Abdelwahed HY (2015) Difficult cochleostomy in the normal cochlea. Egypt J Otolaryngol 31:149–155CrossRef
20.
Sharma R, Meher R, Passey J, Kumar J, Gupta A, Kharbanda S (2019) Comparative evaluation of round window niche accessibility pre-operatively on high-resolution computed tomography of the temporal bone with intra-operative findings. J Laryngol Otol 133(7):575–579CrossRef
21.
Hamamoto M, Murakami G, Kataura A (2000) Topographical relationships among the facial nerve, chorda tympani nerve and round window with special reference to the approach route for cochlear implant surgery. Clin Anat 13(4):251–256CrossRef
22.
Dalmia D, Behera SK (2017) Significance of round window niche drilling for cochlear implant surgery. Indian J Otol. 23(3):141–145CrossRef
23.
Briggs RJ, Tykocinski M, Xu J, Risi F, Svehla M, Cowan R et al (2006) Comparison of round window and cochleostomy approaches with a prototype hearing preservation electrode. Audiol Neurootol 11(Suppl 1):42–48CrossRef
24.
Mandour MF, Khalifa MA, Khalifa HMA, Amer MAR (2019) Iatrogenic facial nerve exposure in cochlear implant surgery: incidence and clinical significance in the absence of intra-operative nerve monitoring. Cochlear Implants Int 20(5):250–254CrossRef
25.
Wang LE, Xia J, Shen XX, Wang ZX, Wang W, Zhang DX (2015) Retaining chorda tympani nerve integrity during cochlear implant surgery. Chin Med J (Engl) 128(15):2115–2118CrossRef
26.
Thom JJ, Carlson ML, Olson MD, Neff BA, Beatty CW, Facer GW et al (2013) The prevalence and clinical course of facial nerve paresis following cochlear implant surgery. Laryngoscope 123(4):1000–1004CrossRef
27.
Luers JC, Huttenbrink KB (2016) Surgical anatomy and pathology of the middle ear. J Anat 228(2):338–353CrossRef
28.
Takahashi H, Sando I (1990) Computer-aided 3-D temporal bone anatomy for cochlear implant surgery. Laryngoscope 100(4):417–421CrossRef
29.
Weinreich HM, Francis HW, Niparko JK, Chien WW (2014) Techniques in cochlear implantation. Oper Tech Otolaryngol-Head Neck Surg 25(4):312–320CrossRef
30.
Hasaballah MS, Hamdy TA (2014) Evaluation of facial nerve course, posterior tympanotomy width and visibility of round window in patients with cochlear implantation by performing oblique sagittal cut computed tomographic scan temporal bone. Egypt J Otolaryngol 30:317–321CrossRef
31.
Jeon EJ, Jun B, Song JN, Kim JE, Lee DH, Chang KH (2013) Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images. Surg Radiol Anat 35(6):471–475CrossRef
Metadata
Title
Round window accessibility during cochlear implantation
Authors
Konrad Stuermer
Tanja Winter
Lisa Nachtsheim
Jens Peter Klussmann
Jan Christoffer Luers
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 2/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-06095-4

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