Modification of preoperative preparation for cochlear implantation in patients with inner ear anomalies

The article presents a clinical observation demonstrating the importance of an improved protocol for computed tomography (CT) of the temporal bones in patients with developmental abnormalities of the inner ear before cochlear implantation (CI). The interest of the observation is due to the fact that the standard CT placement does not allow reliable visualization of the key structures of the cochlea, which, if inaccurately diagnosed, can affect the tactics of surgery and the results of rehabilitation. The clinical observation includes a 5-year-old patient with grade IV bilateral chronic sensorineural hearing loss, who was referred for a preoperative examination before undergoing CI. Taking into account the unclear quality of the CT scan of the temporal bones, as well as the suspicion of an anomaly in the development of the inner ear from these images, a CT scan of the temporal bones was used according to the proposed method. Repeated examination revealed the absence of an apical curl and an expansion of the cochlear aperture, which determined a high risk of intraoperative cerebrospinal fluid and the need to select an individual electrode. Based on the diagnostic data, a shortened electrode array with SEAL technology was selected. Intraoperatively, gusher-type liquorrhea occurred, which was successfully stopped after the introduction of the electrode. When the implant was subsequently connected, positive auditory reactions and improved sound perception were obtained. Thus, accurate preoperative visualization of cochlear anomalies thanks to the proposed method makes it possible to optimize surgical tactics, minimize intraoperative risks and ensure the effectiveness of auditory rehabilitation, which emphasizes the importance of an individualized approach in patients with congenital anomalies of the inner ear.

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