Hostname: page-component-77f85d65b8-6bnxx Total loading time: 0 Render date: 2026-04-22T14:17:59.112Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical anatomy of posterior tympanotomy: influence of the retrotympanum on round window exposure

Published online by Cambridge University Press:  29 May 2023

Francesco Maccarrone Open the ORCID record for Francesco Maccarrone [Opens in a new window] ,
Giulia Molinari ,
Matteo Fermi ,
Matteo Alicandri-Ciufelli ,
Livio Presutti ,
Sauro Tassi ,
Domenico Villari  and
Maurizio Negri
Francesco Maccarrone*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale ‘Ramazzini’ di Carpi, Carpi (MO), Italy
Giulia Molinari
Affiliation:
Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
Matteo Fermi
Affiliation:
Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
Matteo Alicandri-Ciufelli
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
Livio Presutti
Affiliation:
Department of Otorhinolaryngology and Audiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
Sauro Tassi
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale ‘Ramazzini’ di Carpi, Carpi (MO), Italy
Domenico Villari
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
Maurizio Negri
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Azienda USL di Modena, Ospedale ‘Ramazzini’ di Carpi, Carpi (MO), Italy
*
Corresponding author: Francesco Maccarrone; Email: fra.maccarrone@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To describe how the retrotympanic structures could influence the visibility of the round window niche and the round window membrane during cochlear implant surgery, and to investigate if a round window approach is possible even in cases with unfavourable anatomy.

Methods

Video recordings from 37 patients who underwent cochlear implantation were reviewed. The visibility of the round window niche and round window membrane at different timepoints was assessed according to a modified version of the Saint Thomas Hospital classification. The structures that concealed the round window niche and round window membrane were evaluated.

Results

After posterior tympanotomy, 54 per cent of cases had limited exposure (classes IIa, IIb and III) of the round window niche. After remodelling the retrotympanum, round window niche visibility significantly increased, with 100 per cent class I and IIa cases. Following remodelling of the round window niche, visibility of more than 50 per cent of the round window membrane surface was achieved in 100 per cent of cases.

Conclusion

Remodelling the retrotympanum and the round window niche significantly increased exposure of the round window niche and round window membrane respectively, allowing round window insertion in all cases.

Keywords

Retrotympanummiddle ear anatomymastoidectomycochlear implantation

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 2 , February 2024 , pp. 142 - 147
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Francesco Maccarrone takes responsibility for the integrity of the content of the paper

References

House, WF, Urban, J. Long term results of electrode implantation and electronic stimulation of the cochlea in man. Ann Otol Rhinol Laryngol 1973;82:504–17CrossRefGoogle ScholarPubMed
Clark, GM, Pyman, BC, Webb, RL, Bailey, QE, Shepherd, RK. Surgery for an improved multiple-channel cochlear implant. Ann Otol Rhinol Laryngol 1984;93(3 Pt 1):204–7CrossRefGoogle ScholarPubMed
Lehnhardt, E. Intracochlear placement of cochlear implant electrodes in soft surgery technique [in German]. HNO 1993;41:356–9Google ScholarPubMed
Richard, C, Fayad, JN, Doherty, J, Linthicum, FH Jr. Round window versus cochleostomy technique in cochlear implantation: histologic findings. Otol Neurotol 2012;33:1181–7CrossRefGoogle ScholarPubMed
Elafandi, H, Khalifa, MA, Elguindy, AS. Cochlear implantation outcomes with round window electrode insertion versus cochleostomy insertion. Int J Pediatr Otorhinolaryngol 2020;138:110272CrossRefGoogle ScholarPubMed
Leong, AC, Jiang, D, Agger, A, Fitzgerald-O'Connor, A. Evaluation of round window accessibility to cochlear implant insertion. Eur Arch Otorhinolaryngol 2013;270:1237–42CrossRefGoogle ScholarPubMed
Jiang, D, Fitzgerald-O'Connor, A. The assessment of the access to the round window approach through a posterior tympanotomy: a practical classification. In: Abstracts of 26th Politzer Society Meeting, Cleveland, USA, 13–16 October 2007. Politzer Society, 2007Google Scholar
Proctor, B. Surgical anatomy of the posterior tympanum. Ann Otol Rhinol Laryngol 1969;78:1026–40CrossRefGoogle ScholarPubMed
Anschuetz, L, Alicandri-Ciufelli, M, Bonali, M, Fermi, M, Caversaccio, M, Presutti, L et al. Novel surgical and radiologic classification of the subtympanic sinus: implications for endoscopic ear surgery. Otolaryngol Head Neck Surg 2018;159:1037–42CrossRefGoogle ScholarPubMed
Bonali, M, Fermi, M, Alicandri-Ciufelli, M, Mattioli, F, Villari, D, Presutti, L et al. Correlation of radiologic versus endoscopic visualization of the middle ear: implications for endoscopic ear surgery. Otol Neurotol 2020;41:e1122–7CrossRefGoogle ScholarPubMed
Molinari, G, Yacoub, A, Alicandri-Ciufelli, M, Monzani, D, Presutti, L, Caversaccio, M et al. Endoscopic anatomy of the chorda tympani: systematic dissection, novel anatomic classification, and surgical implications. Otol Neurotol 2021;42:e958–66CrossRefGoogle ScholarPubMed
Alicandri-Ciufelli, M, Fermi, M, Bonali, M, Presutti, L, Marchioni, D, Todeschini, A et al. Facial sinus endoscopic evaluation, radiologic assessment, and classification. Laryngoscope 2018;128:2397–402CrossRefGoogle ScholarPubMed
Stuermer, K, Winter, T, Nachtsheim, L, Klussmann, JP, Luers, JC. Round window accessibility during cochlear implantation. Eur Arch Otorhinolaryngol 2021;278:363–70CrossRefGoogle ScholarPubMed