Machine learning-based prediction of the outcomes of cochlear implantation in patients with inner ear malformation.

OBJECTIVE: The objectives of this study are twofold: first, to visualize the structure of malformed cochleae through image reconstruction; and second, to develop a predictive model for postoperative outcomes of cochlear implantation (CI) in patients diagnosed with cochlear hypoplasia (CH) and incomplete partition (IP) malformation. METHODS: The clinical data from patients diagnosed with cochlear hypoplasia (CH) and incomplete partition (IP) malformation who underwent cochlear implantation (CI) at Beijing Tongren Hospital between January 2016 and August 2020 were collected. Radiological features were analyzed through 3D segmentation of the cochlea. Postoperative auditory speech rehabilitation outcomes were evaluated using the Categories of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR). This study aimed to investigate the relationship between cochlear parameters and postoperative outcomes. Additionally, a predictive model for postoperative outcomes was developed using the K-nearest neighbors (KNN) algorithm. RESULTS: In our study, we conducted feature selection by using patients' imaging and audiological attributes. This process involved methods such as the removal of missing values, correlation analysis, and chi-square tests. The findings indicated that two specific features, cochlear volume (V) and cochlear canal length (CDL), significantly contributed to predicting the outcomes of hearing and speech rehabilitation for patients with inner ear malformations. In terms of hearing rehabilitation, the KNN classification achieved an accuracy of 93.3%. Likewise, for speech rehabilitation, the KNN classification demonstrated an accuracy of 86.7%. CONCLUSION: The measurements obtained from the 3D reconstruction model hold significant clinical relevance. Despite the considerable variability in cochlear morphology across individuals, radiological features remain effective in predicting cochlear implantation (CI) prognosis for patients with inner ear malformations. The utilization of 3D segmentation techniques and the developed predictive model can assist surgeons in conducting preoperative cochlear structural measurements for patients with inner ear malformations. This, in turn, can offer a more informed perspective on the anticipated outcomes of cochlear implantation.

Cochlear implant surgery through oval window: A novel approach in a child with facial nerve aberration.

Cochlear implantation is safe for simple case presentations. However, facial nerve (FN) aberrations may impede insertion of the electrode through a round window and increase the risk of iatrogenic FN injury. We developed a novel method of cochlear implantation, a present the case of a child with FN aberrations. Inferior displacement of a horizontal segment of FN lay on the surface of th e promontory, obscuring the round window. The oval window was used and the electrode successfully inserted. No postoperative complications occurred, and significant improvement in speech perception was achieved. This novel approach is suitable for patients with FN aberrations.

Anatomical study of presigmoid-retrolabyrinthine approach based on temporal bone high-resolution CT.

BACKGROUND: The surgical approach of acoustic neuroma includes translabyrinthine, transcranial fossa, suboccipital retrosigmoid sinus, and presigmoid retrolabyrinthine approach. Aims/Objective: To provide the anatomical basis for the surgical selection of presigmoid retrolabyrinthine approach by measuring the anatomical parameters of retrolabyrinthine space of the petrous bone by high-resolution CT. MATERIAL AND METHODS: A retrospective study of 208 high-resolution CT (HRCT) images of 104 patients examined in our hospital were analyzed retrospectively. Forty-nine males and 55 females were included in this study. Lines were drawn on the HRCT to measure the morphological data for pre-operational assessment. RESULT: Morphological data were retracted from HRCT, for preoperational assessment. CONCLUSION AND SIGNIFICANCE: Using the standard postprocessing images of temporal bone HRCT can predict the size of the retrolabyrinthine space and the degree of exposure to the inner auditory canal, providing an important anatomical index for the choice of presigmoid retrolabyrinthine approach.

Slotted labyrinthotomy approach with customized electrode for patients with common cavity deformity.

OBJECTIVES/HYPOTHESIS: Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. STUDY DESIGN: Retrospective review of 13 cochlear implant (CI) patients with CCD. METHODS: Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. RESULTS: The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P < .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P > .05). CONCLUSIONS: For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:468-472, 2018.

Predicting Auditory Outcomes From Radiological Imaging in Cochlear Implant Patients With Cochlear Nerve Deficiency.

OBJECTIVE: To compare imaging and outcome data in cochlear implant (CI) patients with and without cochlear nerve deficiency (CND). STUDY DESIGN: Retrospective study comparing presurgical imaging (via high-resolution computed tomography and three-dimensional magnetic resonance imaging) to postsurgical auditory outcomes in CI patients with and without CND. PATIENTS: Forty-three CI patients with CND diagnosed according to preoperative imaging were included in the CND group. A control group (non-CND; n = 43) was matched to the CND group in terms of age at implantation, CI device type, preoperative hearing threshold, and sex. RESULTS: Across all subjects, internal auditory canal (IAC) diameter, cochlear nerve canal (CNC) diameter, and the number of nerve bundles were significantly correlated with all auditory outcome measures (p < 0.0125 in all cases). Across CND subjects, CNC diameter was significantly correlated with SIR, MUSS, and MAIS-IT/ MAIS scores (p < 0.0125 in all cases). Auditory outcomes were significantly poorer for CND patients with one rather than two nerve bundles. Across non-CND subjects, CNC diameter was significantly correlated only with SIR scores (p < 0.0125). IAC diameter, CNC diameter, and the number of nerve bundles were significantly smaller, and auditory outcomes were significantly poorer for the CND group than for the non-CND group (p < 0.05 in all cases). Results were similar when data only from patients ≤ 5 years old (n = 31) were analyzed. CONCLUSIONS: CNC diameter and the number of nerve bundles can significantly predict auditory outcomes for CI patients with CND. The results suggest that presurgical imaging may be useful in predicting CI outcomes for congenitally deaf patients.

Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional (3D) reconstruction of cone-beam computed tomography (CT). METHODS: Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography (PSG) in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 31, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured. RESULTS: Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm 2 and 6.11 ± 1.76 cm 2 to 17.13 ± 1.91 cm 2 and 5.22 ± 1.20 cm 2 . CONCLUSIONS: Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.

Minimal incision access for pediatric and adult cochlear implantation.

BACKGROUND: Cochlear implant surgery is widely practiced. Minimal incision cochlear implant surgery has been developed with the aims of reducing the impact of surgery on the patient and improving cosmesis while maintaining the low morbidity of conventional wider access approaches. This study aimed to assess the surgical technique and complication rate of minimal incision cochlear implantation (MICI) for children and adults. METHODS: Data for this study were obtained via a retrospective analysis. Totally 378 patients were included in the study. All patients received minimal incision cochlear implantation, using the skin protector during the process of the operation. The surgical complications of MICI were recorded in a spreadsheet format. The incidence of major and minor complication were analyzed, and appropriate treatment was provided. RESULTS: A total of 40 (10.5%) complications were noted in the study. There were 0 life-threatening, 9 major, and 31 minor complications. Of the nine major complications, five were device failures, one developed infection and extrusion, and three required receiver-stimulator repositioning. CONCLUSIONS: MICI is as safe as standard cochlear implantation (SCI) and affords with it other benefits. Eliminating the scalp flap avoids devascularization and minimizes the opportunity of flap infection or necrosis. Complications not related to the flap are similar to SCI.