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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: [email protected]
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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
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

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Footnotes

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

References

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