TY - JOUR
T1 - The effect of round Windowvs cochleostomy surgical approaches on cochlear implant electrode position a flat-panel computed tomography study
AU - Jiam, Nicole T.
AU - Jiradejvong, Patpong
AU - Pearl, Monica S.
AU - Limb, Charles J.
N1 - Publisher Copyright:
© Copyright 2016 American Medical Association. All rights reserved.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - IMPORTANCE The round window insertion (RWI) and cochleostomy approaches are the 2 most common surgical techniques used in cochlear implantation (CI). However, there is no consensus on which approach is ideal for electrode array insertion, in part because visualization of intracochlear electrode position is challenging, so postoperative assessment of intracochlear electrode contact is lacking. OBJECTIVE To measure and compare electrode array position between RWI and cochleostomy approaches for CI insertion. DESIGN, SETTING, AND PARTICIPANTS Retrospective case-comparison study of 17 CI users with Med-El standard-length electrode arrays who underwent flat-panel computed tomography scans after CI surgery at a tertiary referral center. The data was analyzed in October 2015. EXPOSURES Flat-panel computed tomography scans were collected between January 1 and August 31, 2013, for 22 electrode arrays. The surgical technique was identified by a combination of operative notes and imaging. Eight cochleae underwent RWI and 14 cochleae underwent cochleostomy approaches anterior and inferior to the round window. MAIN OUTCOMES AND MEASURES Interscalar electrode position and electrode centroid distance to the osseous spiral lamina, lateral bony wall, and central axis of the modiolus. RESULTS Nine participants were men, and 8, women; the mean age was 54.4 (range, 21-64) years. Electrode position was significantly closer to cochlear neural elements with RWI than cochleostomy approaches. Between the 2 surgical approaches, the RWI technique produced shorter distances between the electrode and the modiolus (mean difference, -0.33 [95%CI, -0.29 to -0.39]mmin the apical electrode; -1.42 [95%CI, -1.24 to -1.57]mmin the basal electrode). This difference, which was most prominent in the first third and latter third of the basal turn, decreased after the basal turn. CONCLUSIONS AND RELEVANCE The RWI approach was associated with an increased likelihood of perimodiolar placement. Opting to use RWI over cochleostomy approaches in CI candidatesmay position electrodes closer to cochlear neural substrates and minimize current spread. These findings need to be interpreted in light of the increased potential for osseous spiral lamina trauma with reduced distances between the electrode array and modiolus.
AB - IMPORTANCE The round window insertion (RWI) and cochleostomy approaches are the 2 most common surgical techniques used in cochlear implantation (CI). However, there is no consensus on which approach is ideal for electrode array insertion, in part because visualization of intracochlear electrode position is challenging, so postoperative assessment of intracochlear electrode contact is lacking. OBJECTIVE To measure and compare electrode array position between RWI and cochleostomy approaches for CI insertion. DESIGN, SETTING, AND PARTICIPANTS Retrospective case-comparison study of 17 CI users with Med-El standard-length electrode arrays who underwent flat-panel computed tomography scans after CI surgery at a tertiary referral center. The data was analyzed in October 2015. EXPOSURES Flat-panel computed tomography scans were collected between January 1 and August 31, 2013, for 22 electrode arrays. The surgical technique was identified by a combination of operative notes and imaging. Eight cochleae underwent RWI and 14 cochleae underwent cochleostomy approaches anterior and inferior to the round window. MAIN OUTCOMES AND MEASURES Interscalar electrode position and electrode centroid distance to the osseous spiral lamina, lateral bony wall, and central axis of the modiolus. RESULTS Nine participants were men, and 8, women; the mean age was 54.4 (range, 21-64) years. Electrode position was significantly closer to cochlear neural elements with RWI than cochleostomy approaches. Between the 2 surgical approaches, the RWI technique produced shorter distances between the electrode and the modiolus (mean difference, -0.33 [95%CI, -0.29 to -0.39]mmin the apical electrode; -1.42 [95%CI, -1.24 to -1.57]mmin the basal electrode). This difference, which was most prominent in the first third and latter third of the basal turn, decreased after the basal turn. CONCLUSIONS AND RELEVANCE The RWI approach was associated with an increased likelihood of perimodiolar placement. Opting to use RWI over cochleostomy approaches in CI candidatesmay position electrodes closer to cochlear neural substrates and minimize current spread. These findings need to be interpreted in light of the increased potential for osseous spiral lamina trauma with reduced distances between the electrode array and modiolus.
UR - http://www.scopus.com/inward/record.url?scp=84997585990&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84997585990&partnerID=8YFLogxK
U2 - 10.1001/jamaoto.2016.1512
DO - 10.1001/jamaoto.2016.1512
M3 - Article
C2 - 27355198
AN - SCOPUS:84997585990
SN - 2168-6181
VL - 142
SP - 873
EP - 880
JO - JAMA Otolaryngology - Head and Neck Surgery
JF - JAMA Otolaryngology - Head and Neck Surgery
IS - 9
ER -