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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2011 December;61(4):205-12
Inner ear endoscopy during cochlear implantation of cochlear dysplasia
Fritsch M. H.
St. Vincent Medical Center, Indianapolis, IN, USA
The aim of this paper was to perform endoscopic cochlear implantation by visualizing the dysplastic inner ear in order to visually guide the process of cochlear implant electrode insertion. A retrospective case review was conducted in a tertiary referral center. Three cochlear dysplasia patients representing five ears were endoscopically operated for cochlear implantation. Endoscopes (telescopic and fiberoptic) were used during cochlear implant surgery to visualize dysplastic inner ear structures and to guide the implant electrodes through the abnormal inner ear anatomy in real-time to their final best resting place within the cochlea. Using two endoscope types and the microscope for viewing the inner ear and inserting the implant electrodes, the ability to visualize anatomy and actively guide the electrodes was assessed. The five ears operated upon showed that endoscopic viewing of the dysplastic inner ear was superior to microscope use. All five ears showed different intra-cochlear anatomy. Some of the findings were: Each ear showed a foreshortened Scala tympani; fluid pulsations of various strengths representing cerebrospinal fluid were seen in all ears; all scalae were in communication with each other without developed partitions between them. No inner ear anatomy relating to functional hearing was seen. New surgically relevant anatomy was seen that altered surgical cochlear implantation technique during the case. Endoscopically, intra-cochlear anatomic relationships can be seen in real-time in three dimensions. Each dysplastic ear of this series had different anatomy representing a different end-point of development. No residual hearing anatomy was seen in any of the dysplastic ears. For patients with both profound hearing loss and cochlear dysplasia, the absence of anatomy seen in these five ears predicts that a hearing aid trial would be unsuccessful. In these audiometrically verified profound hearing loss cochlear implant candidates with dysplastic cochleas, early implantation without a hearing aid trial is encouraged. Using an endoscope, the cochlear implant electrode can be directly viewed and positioned during surgery using an endoscope. Due to the foreshortened length of the cochlear spiral, a compressed array electrode may be the best option for some cochlear deformity ears. New electrodes specifically designed for the common cavity ear are needed.