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All investigations performed elsewhere at the time of SSNHL, including MRI, showed normal results. The left ear showed no indications of hearing loss. The review of the relevant literature supported SV electrode placement in cases with difficult if not impossible ST electrode placement due to cochlear ossification.Ī 45-year-old Austrian female was referred to the ear, nose and throat (ENT) department of the Medical University of Graz, Austria for CI, after she had been diagnosed as deaf in the right ear2 years ago due to SSNHL. We found the 3D segmentation of the inner ear structures clinically useful in making the decision of placing the electrode in SV and as well in the surgical planning of the cochleostomy to access the SV. This article reports a case of ST ossification as identified by the 3D segmentation of the inner ear. The same technique could be applied in cases with different degrees of scala tympani (ST) ossification to identify how deep it has extended and this helps surgeons to decide the placement of the CI electrode either in ST or in scala vestibuli (SV). 3D segmentation of the inner ear has been applied clinically in cases with inner ear malformations to accurately identify anatomical structures available, thereby simplifying the CI electrode placement.

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Labyrinthitis ossificans and how far it extends inside the cochlear lumen can be visualized by computed tomography (CT) images however, it could be challenging for young and inexperienced surgeons and or radiologists to compile the entire series of CT scans in bringing a three-dimensional (3D) representation of the anatomical structure in mind. Labyrinthitis ossificans is often a side effect of some of the SSNHL causes and creates surgical challenges in the placement of cochlear implant (CI) electrode. An SSNHL can be the result of variety of reasons including infections, head trauma, autoimmune diseases, exposure to certain drugs that treat cancer or severe infections, blood circulation problems and neurological disorders such as multiple sclerosis. During 20, the annual incidence of SSNHL was 27 per 100,000 patients in the USA and this incidence rate increases with increasing age, ranging from 11 per 100,000 in patients younger than 18 years to 77 per 100,000 in patients 65 years and older. Sudden sensorineural hearing loss (SSNHL) is an unexplained, rapid loss of hearing either all at once or over a few days and often affects only one ear. Review of the literature identified a total of 13 published reports on cochlear implantation electrode placement in scala vestibuli in cases with ossification in the ST. The hearing threshold measured by PTA was ≤ 40 dB across all frequencies tested.

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Postoperative CT confirmed the full insertion of a flexible electrode.

Postoperative computed tomography (CT) to confirm the electrode placement in the scala vestibuli and PTA was performed to assess the hearing threshold following the cochlear implantation.

3D segmentation of the inner ear identified the extent of ossification in the ST and assisted in the surgical planning of cochleostomy drilling anterior-superior to the round window to access the scala vestibuli for the electrode placement. Clinical presentation of a 45-year-old Austrian female who was referred with a history of sudden sensorineural hearing loss 2 years ago in the right ear, confirmed by pure tone audiometry (PTA) and acoustically evoked auditory brainstem response (ABR). The present report describes a case of cochlear implantation in the scala vestibuli assisted by 3D segmentation of the cochlea for a patient with ossification in the ST and reviews the relevant literature. The scala vestibuli placement of cochlear implantation electrode is an alternate solution in these patients and is well supported by the literature. Three-dimensional (3D) segmentation of the inner ear offers accurate identification of ossification and surgical planning of the cochleostomy to access the scala vestibuli. Patients with scala tympani (ST) ossification present a distinct surgical challenge.

Scala vestibuli