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CT pre-operative planning of a new semi-implantable bone conduction hearing device

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Abstract

Purpose

Accommodating a novel semi-implantable bone conduction hearing device within the temporal bone presents challenges for surgical planning. This study describes the utility of CT in pre-operative assessment of such an implant.

Methods

Retrospective review of pre-operative CT, clinical and surgical records of 16 adults considered for device implantation. Radiological suitability was assessed on CT using 3D simulation software. Antero-posterior (AP) dimensions of the mastoid bone and minimum skull thickness were measured. CT planning results were correlated with operative records.

Results

Eight and five candidates were suitable for device placement in the transmastoid and retrosigmoid positions, respectively, and three were radiologically unsuitable. The mean AP diameter of the mastoid cavity was 14.6 mm for the transmastoid group and 4.6 mm for the retrosigmoid group (p < 0.05). Contracted mastoid and/or prior surgery were predisposing factors for unsuitability. Four transmastoid and five retrosigmoid positions required sigmoid sinus/dural depression and/or use of lifts due to insufficient bone capacity.

Conclusion

A high proportion of patients being considered have contracted or operated mastoids, which reduces the feasibility of the transmastoid approach. This finding combined with the complex temporal bone geometry illustrates the importance of careful CT evaluation using 3D software for precise device simulation.

Key points

• Preoperative temporal bone CT is essential for determining Bonebridge device suitability.

• Mastoid under-pneumatisation and prior mastoidectomy predict a retrosigmoid Bonebridge position.

• 3D simulation software is recommended for precise device positioning.

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Acknowledgments

The authors would like to thank Ms. Li Lening for her assistance in Bonebridge device planning. This paper was presented as an abstract at ECR 2015. The scientific guarantor of this publication is Associate Professor Kunwar Bhatia. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study was partly funded by Med-El Hong Kong Asia Pacific Headquarters and a grant from the Innovation and Technology Commission (Project No: ITS/225/12). No complex statistical methods were necessary for this paper. Institutional review board approval was waived by the institution because of its retrospective study design. Written informed consent was waived by the institutional review board. Some study subjects or cohorts have been previously reported in Tsang et al. The Bonebridge semi-implantable bone conduction hearing device: experience in an Asian patient. 2013 The Journal of Laryngology & Otology, doi: 10.1017/S0022215113002144. This paper was a short communication describing the surgical techniques and audiology outcome in the first patient in Asia to receive the Bonebridge device. It does not focus on the radiological aspect during pre-operative assessment, which is the focus of this study. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, SAR, China

    Eric K. C. Law & Kunwar S. S. Bhatia

  2. Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Willis S. S. Tsang & Michael C. F. Tong

  3. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Lin Shi

  4. Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Lin Shi

Authors
  1. Eric K. C. Law
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  2. Kunwar S. S. Bhatia
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  3. Willis S. S. Tsang
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  4. Michael C. F. Tong
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  5. Lin Shi
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Corresponding author

Correspondence to Kunwar S. S. Bhatia.

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Law, E.K.C., Bhatia, K.S.S., Tsang, W.S.S. et al. CT pre-operative planning of a new semi-implantable bone conduction hearing device. Eur Radiol 26, 1686–1695 (2016). https://doi.org/10.1007/s00330-015-3983-x

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  • DOI: https://doi.org/10.1007/s00330-015-3983-x

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