Rabindra Bhakta Pradhananga, Bigyan Raj Gyawali, Pabina Rayamajhi, Bebek BhattaraiIndian Journal of Otology 2021 27(1):7-10
Introduction: Round window (RW) insertion of the electrodes during cochlear implantation is the most favorable route considered by many surgeons. The objective of this study was to review the anatomy of the RW based on visibility and accessibility of RW niche (RWN) and RW membrane (RWM) and to assess their implications in surgical difficulties during cochlear implantation in different age groups. Materials and Methods: This was a retrospective observational study conducted at the Department of ear, nose, and throat-Head and Neck Surgery, Institute of Medicine, Kathmandu, Nepal. We analyzed the record data of all the cochlear implants from January 2015 to December 2019 for the visibility of RWM, RWN, and associated surgical difficulties in different age groups. RWM visibility was classified as; Grade I (>50% of RWM is visible), Grade II (25%–50% of RWM is visible), Grade III (<25% of RWM is visible), and Grade IV (RWM is not visible). Similarly, RWN visibility was classified a s; Type A (difficult to visualize), Type B (partially visible), and Type C (fully visible). Our final sample size was 81. Results: The most common variant of RWN and RWM was Type C (37 cases) and Grade IV (37 cases), respectively, in the age group of <15 years. In cases >15 years, Type B (eight cases) was the most common variant of RWN and Type II (six cases) was the most common variant of RWM. There was a statistically significant association between the visibility of the RWN and RWM and the visibility of RWN and different levels of surgical difficulty (P < 0.05). Conclusions: Type C RWN and Type IV RWM were the most common variants found, mostly seen in the pediatric population. With poorer visibility of RWN, RWM visibility decreases, increasing the difficulty level of the surgery.
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