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Grading system for the selection of patients with congenital aural atresia for active middle ear implants

  • Head and Neck Radiology
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Abstract

Introduction

Active middle ear implants (aMEI) are being increasingly used for hearing restoration in congenital aural atresia. The existing gradings used for CT findings do not meet the requirements for these implants. Some items are expendable, whereas other important imaging factors are missing. We aimed to create a new grading system that could describe the extent of the malformation and predict the viability and challenges of implanting an aMEI.

Methods

One hundred three malformed ears were evaluated using HRCT of the temporal bone. The qualitative items middle ear and mastoid pneumatization, oval window, stapes, round window, tegmen mastoideum displacement and facial nerve displacement were included. An anterior- and posterior round window corridor, oval window and stapes corridor were quantified and novelly included. They describe the size of the surgical field and the sight towards the windows.

Results

The ears were graded on a 16-point scale (16–13 easy, 12–9 moderate, 8–5 difficult, 4–0 high risk). The strength of agreement between the calculated score and the performed implantations was good. The comparison of the new 16-point scale with the Jahrsdoerfer score showed that both were able to conclusively detect the high-risk group; however, the new 16-point scale was able to further determine which malformed ears were favorable for aMEI, which the Jahrsdoerfer score could not do.

Conclusion

The Active Middle Ear Implant Score for aural atresia (aMEI score) allows more precise risk stratification and decision making regarding the implantation. The use of operative corridors seems to have significantly better prognostic accuracy than the Jahrsdoerfer score.

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Abbreviations

aMEI:

Active middle ear implant

EAC-A:

External ear canal atresia

EAC-S:

External ear canal stenosis

OW:

Oval window

RW:

Round window

R 2 :

Coefficient of determination

VSB :

Vibrant Soundbridge™

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Facial Plastic Operations, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Henning Frenzel & Barbara Wollenberg

  2. Department of Otorhinolaryngology, University Hospital Innsbruck, Innsbruck, Austria

    Georg Sprinzl

  3. Department of Radiology, University Hospital Innsbruck, Innsbruck, Austria

    Gerlig Widmann

  4. Department of Neuroradiology, University Hospital Schleswig-Holstein, Lübeck, Germany

    Dirk Petersen & Christian Mohr

Authors
  1. Henning Frenzel
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  2. Georg Sprinzl
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  3. Gerlig Widmann
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  4. Dirk Petersen
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  5. Barbara Wollenberg
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  6. Christian Mohr
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Corresponding author

Correspondence to Henning Frenzel.

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Frenzel, H., Sprinzl, G., Widmann, G. et al. Grading system for the selection of patients with congenital aural atresia for active middle ear implants. Neuroradiology 55, 895–911 (2013). https://doi.org/10.1007/s00234-013-1177-2

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  • DOI: https://doi.org/10.1007/s00234-013-1177-2

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