Endoscope assisted versus microscopic cochlear implantation-a double blinded randomized trial.

Area of Science:

• Otolaryngology
• Surgical Technology
• Auditory Implants

Background:

• Microscopic cochlear implantation via trans-mastoid posterior tympanotomy can be limited by poor visualization of the round window niche.
• Optimal visualization is crucial for successful round window insertion and hearing preservation.

Purpose of the Study:

• To evaluate the efficacy of using an endoscope as an adjunct to the traditional microscopic technique for cochlear implantation.
• To determine if endoscopic assistance improves visualization and success rates of round window insertion.

Main Methods:

• A double-blinded randomized controlled trial was conducted with patients undergoing cochlear implantation.
• Patients were divided into two groups: microscopic cochlear implantation (Group A) and endoscope-assisted cochlear implantation (Group B).
• The Round Window Niche Structural Visibility Index (RSVI) was used to quantify visibility in both groups.

Main Results:

• The endoscope-assisted group showed a significantly higher mean RSVI score (8.44 ± 1.37) compared to the microscopic group (5.47 ± 2.56; p < 0.05).
• Endoscope-assisted cochlear implantation was associated with statistically significant higher chances of successful round window insertion (Chi square = 15.45; p < 0.05).
• Electrically Evoked Compound Action Potential (ECAP) values showed no significant difference between groups for most electrodes, suggesting comparable neural response.

Conclusions:

• While microscopy remains the primary tool, endoscopy serves as a valuable adjunct for cochlear implantation in cases with difficult round window niche visualization.
• Endoscopic assistance enhances visualization, increases the likelihood of successful round window insertion, and aids in promoting hearing preservation.