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Combined preoperative HRCT parameters for prediction of round window visibility in pediatric cochlear implant patient
Mahitab Mohamed Rashad Ghoneim1, Mohamed Rashad Ghonim2, Ahmed Ali Mohamed Badawy3
1Diagnostic and Interventional Radiology Department, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Egypt.
Insights
Combined analysis of high-resolution computed tomography (HRCT) temporal bone parameters, including Kashio line, fascial recess width (FRW), and round window location (RWL), significantly improves the prediction of round window (RW) visibility for posterior tympanotomy.
Area of Science:
- Radiology
- Otolaryngology
- Surgical Planning
Background:
- Accurate visualization of the round window (RW) is crucial for successful cochlear implantation.
- Posterior tympanotomy is a surgical approach that requires precise anatomical knowledge.
- High-resolution computed tomography (HRCT) of the temporal bone is used for pre-operative assessment.
Purpose of the Study:
- To assess the added value of combined HRCT temporal bone parameters in predicting round window (RW) visibility.
- To evaluate the accuracy of individual and combined radiological measurements for pre-operative planning of posterior tympanotomy.
Main Methods:
- A retrospective observational study included 45 pediatric cochlear implant candidates.
- HRCT temporal bone scans were analyzed, classifying RW visibility as fully or partially/non-visible.
- Radiological measurements, including Kashio posterior line, fascial recess width (FRW), and round window location (RWL), were compared between groups.
Main Results:
- Individual parameters like Kashio posterior line, FRW, and RWL significantly differentiated RW visibility (P < 0.05).
- The Kashio line showed 84.2% sensitivity and 80% accuracy.
- Combining the Kashio line with FRW and RWL measurements (≥7.45 mm sum) improved prediction sensitivity to 91.4% and overall accuracy to 88.6% (P=0.003).
Conclusions:
- Combined analysis of HRCT temporal bone parameters (Kashio line, FRW, RWL) enhances the prediction accuracy of round window visibility.
- This combined approach offers superior sensitivity and accuracy compared to using single parameters for surgical planning in cochlear implant candidates.
Objective:
To evaluate the add value of combined analysis of high resolution computed tomography (HRCT) temporal bone parameters in accurate prediction of round window (RW) visibility through posterior tympanotomy.
Patients And Methods:
a retrospective observational study was held in a tertiary center, conducted on 45 cochlear implant pediatric candidates between January 2017 and September 2019. Candidates were referred for CT temporal bone. They were classified into fully visible RW cases and partially or non-visible RW cases. Radiological measurements were compared between the two groups for prediction of RW visibility separate and in combination.
Results:
45 patients were included in the study (26 males (57.8%) and 19 females (42.2%)). Their median age was 4 years (2-12 years). There were 38 (84.4%) fully visible and 7 (15.6%) partially or non-visible RW cases. Kashio posterior line (n:32/3), fascial recess width (FRW) (mean: 4.9 (3.5-7.5)/4.2 (4-4.7) mm) and round window location (RWL) (3 (1-4)/2.8 (1-3)mm) measurements significantly differentiated between the two groups; (P value 0.034, 0.012 & 0.025 respectively). Posterior kashio line and cut off values of ≥4.75 mm of FRW & 2.95 mm of RWL were showed sensitivity 84.2%, 63.2% & 65.8%, and accuracy 80%, 68.9% &68.9% in prediction of RW visibility respectively. Combination of Kashio prediction line with cut off value ≥ 7.45 mm (sum of FRW & RWL) showed P value 0.003 with further improve in the sensitivity and overall accuracy in prediction of RW visibility from 84.2% to 80% up to 91.4% and 88.6% respectively.
Conclusion:
combined parameters using Kashio line with FRW and RWL increases sensitivity and overall accuracy in prediction of RW visibility rather than single parameter.
