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Dyna-CT of the temporal bone for case-specific three-dimensional rendering of the stapedial muscle for planning of electrically evoked stapedius reflex threshold determination during cochlear implantation directly from the stapedius muscle via a retrofacial approach: a pilot study

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Evaluation of 3D Dyna-CTs to improve cochlear implantation (CI) planning and intraoperative electrically elicited stapedius reflex threshold (ESRT) measurements.

Methods

A prospective observational cohort study was performed. Anonymized data collection of Dyna-CTs and CI surgeries in which a retrofacial approach was implemented to access the stapedius muscle. 3D Dyna-CTs of 30 patients and the intraoperative confirmation of the predication in 5/30 patients during CI surgery were evaluated. Inter-rater reliability was also analyzed along with the predictive value of this evaluation.

Results

36 representative structures of the middle and inner ear and 3D renderings of the Dyna-CTs were evaluated by four otoneurological surgeons. Fleiss’ kappa values for the evaluation of the visibility were high (> 0.7) for most of the anatomical structures. The stapedius muscle was visible in 90% of the cases. Using the 3D data, the retrofacial access to the stapedius muscles was estimated as feasible in 86.7%. Fleiss’ kappa value of the evaluation of the accessibility was 0.942. The intraoperative exploration of the stapedius muscle confirmed the preoperative prediction in all five selected patients (four patients with predicted accessibility and one patient with predicted inaccessibility).

Conclusions

The use of Dyna-CT and 3D rendering is a helpful tool for preoperative planning of cochlear implantations and ESRT measurements from the stapedius muscle via the retrofacial approach.

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Acknowledgements

We thank Francesca Maule and Pedro Alexander Marquez Vergara for their help with the image data management and segmentation of the Dyna-CTs.

Funding

The development of the 3D Dyna-CT segmentation algorithm was sponsored by MED-EL Elektromedizinische Geräte GmbH, Innsbruck, Austria.

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Author notes

  1. Gerd Fabian Volk and René Aschenbach are co-first authors.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany

    Gerd Fabian Volk, Maria Gadyuchko, Thomas Bitter, Sven Koscielny & Orlando Guntinas-Lichius

  2. Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany

    René Aschenbach & Ulf Teichgräber

Authors
  1. Gerd Fabian Volk
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  2. René Aschenbach
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  4. Thomas Bitter
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  5. Sven Koscielny
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  6. Ulf Teichgräber
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  7. Orlando Guntinas-Lichius
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Corresponding author

Correspondence to Orlando Guntinas-Lichius.

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Conflict of interest

All authors declare that they do not have conflict of interest. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Orlando Guntinas-Lichius wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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405_2019_5773_MOESM1_ESM.docx

Supplement Figure 1. 3-D visualization of the temporal bone in correspondence to the Dyna-CT in three planes as available during evaluation. Green = inner ear (cochlea, semicircular ducts); yellow = facial nerve and chorda tympani; red = stapedius muscle. The cube is an orientation marker: R = right; I = inferior; A = anterior. (DOCX 448 kb)

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Volk, G.F., Aschenbach, R., Gadyuchko, M. et al. Dyna-CT of the temporal bone for case-specific three-dimensional rendering of the stapedial muscle for planning of electrically evoked stapedius reflex threshold determination during cochlear implantation directly from the stapedius muscle via a retrofacial approach: a pilot study. Eur Arch Otorhinolaryngol 277, 975–985 (2020). https://doi.org/10.1007/s00405-019-05773-2

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  • DOI: https://doi.org/10.1007/s00405-019-05773-2

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