Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study

Abstract

Objectives This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). Study design It was a prospective case-series study. Settings The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. Subjects We included 73 CI candidates performed via the PT approach Intervention The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. Main outcome measure We correlated this score with the intraoperative difficulty and surgical duration. Results The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). Conclusions Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.