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Endoscopic approach to the round window through posterior tympanotomy for cochlear implantation in children: A study
Nader Nassif1, Luca Oscar Redaelli de Zinis1
1Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Head and Neck Surgery, University of Brescia and Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Piazzale Spedali Civili 1, 25123, Brescia, Italy.
Insights
This study shows that rigid endoscopy via posterior tympanotomy is feasible for pediatric cochlear implantation, enabling clear visualization of the round window and scala tympani insertion.
Area of Science:
- Otolaryngology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Posterior tympanotomy is a surgical approach used in otologic procedures.
- Direct visualization of the round window and scala tympani is crucial for cochlear implantation.
Purpose of the Study:
- To assess the feasibility of using rigid endoscopy through a posterior tympanotomy approach.
- To evaluate the visualization capabilities of this technique for the round window and scala tympani in pediatric patients.
Main Methods:
- A 1.9 mm, 0° rigid endoscope was used in eight children undergoing cochlear implantation.
- The endoscope was inserted via a 2 mm transmastoid posterior tympanotomy after a mini-invasive surgical approach.
- Surgical complications and hearing thresholds were monitored.
Main Results:
- Complete visualization of the round window niche was achieved in all cases.
- No procedure-related complications were observed.
- Hearing thresholds were preserved in 9 out of 10 ears.
Conclusions:
- Rigid endoscopy through posterior tympanotomy provides excellent visualization of the round window niche.
- This technique facilitates accurate guidance of the cochlear implant electrode array into the scala tympani.
Objective:
To demonstrate the feasibility of rigid endoscopy through posterior tympanotomy, which provides both a view of the round window and direction of the scala tympani in children.
Methods:
After a standard mini-invasive surgical approach with postauricular access and transmastoid posterior tympanotomy of 2 mm, a 0°, 1.9 mm diameter and 11 cm long endoscope is positioned in proximity of the upper part of the posterior tympanotomy to obtain a panoramic view of the inferior part of the medial wall of the tympanic cavity. Surgical complications and changes in hearing threshold were analyzed.
Results:
Eight children were submitted to cochlear implantation with endoscopic assistance through posterior tympanotomy. Complete visualization of the round window niche was possible in every ear. No complications related to the procedure were observed. Preoperative threshold was preserved in 9 of 10 ears.
Conclusions:
Direct endoscopic view through the posterior tympanotomy allows visualization of the entire round window niche as well as the angle of introduction of the multi-electrode array along the direction of the scala tympani.
