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Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10—point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.

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Conflicts of interest

Nothing to declare.

Informed consent

Has been obtained for high resolution computed tomography of the temporal bones.

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Authors and Affiliations

  1. Head Neck & ENT Imaging Division, Star Imaging and Research Center, Pune, 411001, India

    Sanjay Vaid

  2. Department of Otorhinolaryngology, K.E.M. Hospital, Rastapeth, Pune, 411011, India

    Neelam Vaid

  3. Dr. Manoj’s Multispeciality ENT Hospital, Calicut, Kerala, India

    Manoj Manikoth

  4. Department of Diagnostic Imaging and Radiology, Grant Medical Foundation, Pune, 411001, India

    Amit Zope

  5. 2, National Hsg Society, Baner Road, Aundh, Pune, Maharashtra, 411007, India

    Sanjay Vaid

Authors
  1. Sanjay Vaid
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  2. Neelam Vaid
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  3. Manoj Manikoth
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  4. Amit Zope
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Corresponding author

Correspondence to Sanjay Vaid.

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Fig. S1

Figure showing a well pneumatized mastoid (a) and a non- pneumatized mastoid (b).tiff (TIFF 1410 kb)

Fig. S2

Figure showing (a) normally positioned descending facial nerve canal (arrow) within a well pneumatized mastoid and (b) showing the descending facial canal (arrow) overhanging the round window niche associated with a hypopneumatized mastoid.tiff (TIFF 1353 kb)

Fig. S3

Figure showing a high placed jugular bulb (arrow) extending above the level of the floor of the internal auditory canal (IAC) and basal cochlear turn (c: cochlea).tiff (TIFF 1244 kb)

Fig. S4

Figure showing the relative position of the basal turn of cochlea (BT) to the malleoincudal joint (arrows).tiff (TIFF 1728 kb)

Fig. S5

Figure showing lines along the anterior margin of the internal auditory canals,scored as favourable if the lines are straight (a), and scored as unfavourable if the lines are angled or intersecting (b).tiff (TIFF 1855 kb)

Fig. S6

Figure showing Mondini deformity with fused cystic apical and middle turns of the cochlea (open arrows) and dilated vestibule (V).The modiolus appears defective (arrows).Vestibular aqueduct/endolymphatic sac are markedly dilated (asterix).tiff (TIFF 1325 kb)

Fig. S7

Figure showing Incomplete Partition Type I with a cystic featureless cochlea (open arrows) and dilated vestibule (V).The cochlea has a wide communication with the internal auditory canal (arrows).tiff (TIFF 1147 kb)

Fig. S8

Figure showing labyrinthitis ossificans Balkany Grade 1 with small ossific plaques (arrows) involving scala tympani of the basal cochlear turns on both sides in the region of the round window on HRCT (a).The MRI (b) image shows the hypointense plaques (arrows) partially obliterating the normal hyperintense signal in the scala tympani of the basal cochlear turns on both sides.tiff (TIFF 1238 kb)

Fig. S9

Figure showing otosclerosis with hypodense otospongiotic plaques (white arrows) involving region of the the fissula ante fenetram representing Grade 1 fenestral otosclerosis and the classical ‘double ring’ or ‘halo’ sign of hypodense rings in the pericochlear otic capsule (black arrows) representing Grade 2a otosclerosis. Fenestral otosclerosis is always present in these cases (white arrow) anterior to the oval window (asterix).tiff (TIFF 1232 kb)

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Vaid, S., Vaid, N., Manikoth, M. et al. Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery. Indian J Otolaryngol Head Neck Surg 67, 150–158 (2015). https://doi.org/10.1007/s12070-015-0858-z

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  • DOI: https://doi.org/10.1007/s12070-015-0858-z

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