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<p>Cochlear implantation is the the treatment of choice for severe to profound hearing loss in paediatric population. For successful outcome of cochlear implantation it is very essential for cochlear implant surgeon to visualise the round window niche and round window membrane clearly through the facial recess for successfully inserting the Implant electrode into the scala tympani of cochlea. Round Window Niche and Membrane shows wide range of variation in position and shape due to varied anatomy of retro tympanum, making adequate intra-operative visualisation of the round window niche difficult. Round window niche and membrane visibility is important for successful cochlear implantation, and prerequisite for round window insertion greatly depends on definite identification of the round window niche, which may be difficult in many patients because of limited round window niche visibility and varied anatomical location of round window because of wide variation of retrotympanic anatomy. There is lot of lacunae in right surgical approach for difficult round window anatomy where there is minimal intracochlear trauma. To overcome the existing lacunae in research in this respect, current study was undertaken with aim to accurately execute electrode insertion by surgical approach with which there may be minimal intracochlear trauma in cases of difficult round window anatomy. Present study is observational study conducted on severe to profound hearing loss patients posted for cochlear implantation in ENT Department of Sri Guru Ram Das university of Health Sciences, Amritsar from January 2024 to January 2026. Inclusion Criteria: 1. Children Less than 5&#xa0;years with severe to profound hearing loss. Exclusion Criteria: 1. Age more than 5&#xa0;years, 2. Low IQ, 3. Complete Absent of Cochlear Nerve, 4. Hypoplastic Cochlear Nerve, 5. Hypoplastic or absent cochlear apparatus. Primary outcome variable studied: Technique used for electrode insertion into scala tympani in cases where round window anatomy was unfavourable which was indicated on preoperatively radiological testing was primary outcome parameter studied. Out of 43 patients 21 Patients were having Radiologically favourable anatomy with Class 1 Round window visualisation through facial recess PT and EPT was done for these patients. 11 patients were having favourable Round Window on HRCT and Class 2 A Visualisation through Facial recess, Round window edges milling and inferior cochleostomy was done for these patients. 6 Patients were having unfavourable round window and Class 2 B visualisation through Facial recess. Anteroinferior Cochleostomy was done for these patients. 5 Patients were having Unfavourable round window with Class 3 Visualisation where transcanal elevation of tympanic membrane was done and round window was identified. Successful ECAP s and Impedances were obtained in all patients included in study. Despite of many variations in round window anatomy, accurate preoperative radiological diagnosis of round window anatomy with respect to retro tympanum anatomy for electrode insertion to scala tympani is very important for every cochlear implant surgeon.Whenever there is anticipation of intracochlear trauma, alternate approaches which are available for electrode insertion to minimise intracochlear trauma should be used for cases of difficult round window anatomy.</p>

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Surgical Approaches for Varied Round Window Anatomy in Cochlear Implantation: An Evidence Based Study

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Jaskaran Singh,
  • Bhanu Bhardwaj,
  • Bhavika Verma

摘要

Cochlear implantation is the the treatment of choice for severe to profound hearing loss in paediatric population. For successful outcome of cochlear implantation it is very essential for cochlear implant surgeon to visualise the round window niche and round window membrane clearly through the facial recess for successfully inserting the Implant electrode into the scala tympani of cochlea. Round Window Niche and Membrane shows wide range of variation in position and shape due to varied anatomy of retro tympanum, making adequate intra-operative visualisation of the round window niche difficult. Round window niche and membrane visibility is important for successful cochlear implantation, and prerequisite for round window insertion greatly depends on definite identification of the round window niche, which may be difficult in many patients because of limited round window niche visibility and varied anatomical location of round window because of wide variation of retrotympanic anatomy. There is lot of lacunae in right surgical approach for difficult round window anatomy where there is minimal intracochlear trauma. To overcome the existing lacunae in research in this respect, current study was undertaken with aim to accurately execute electrode insertion by surgical approach with which there may be minimal intracochlear trauma in cases of difficult round window anatomy. Present study is observational study conducted on severe to profound hearing loss patients posted for cochlear implantation in ENT Department of Sri Guru Ram Das university of Health Sciences, Amritsar from January 2024 to January 2026. Inclusion Criteria: 1. Children Less than 5 years with severe to profound hearing loss. Exclusion Criteria: 1. Age more than 5 years, 2. Low IQ, 3. Complete Absent of Cochlear Nerve, 4. Hypoplastic Cochlear Nerve, 5. Hypoplastic or absent cochlear apparatus. Primary outcome variable studied: Technique used for electrode insertion into scala tympani in cases where round window anatomy was unfavourable which was indicated on preoperatively radiological testing was primary outcome parameter studied. Out of 43 patients 21 Patients were having Radiologically favourable anatomy with Class 1 Round window visualisation through facial recess PT and EPT was done for these patients. 11 patients were having favourable Round Window on HRCT and Class 2 A Visualisation through Facial recess, Round window edges milling and inferior cochleostomy was done for these patients. 6 Patients were having unfavourable round window and Class 2 B visualisation through Facial recess. Anteroinferior Cochleostomy was done for these patients. 5 Patients were having Unfavourable round window with Class 3 Visualisation where transcanal elevation of tympanic membrane was done and round window was identified. Successful ECAP s and Impedances were obtained in all patients included in study. Despite of many variations in round window anatomy, accurate preoperative radiological diagnosis of round window anatomy with respect to retro tympanum anatomy for electrode insertion to scala tympani is very important for every cochlear implant surgeon.Whenever there is anticipation of intracochlear trauma, alternate approaches which are available for electrode insertion to minimise intracochlear trauma should be used for cases of difficult round window anatomy.