Abstract
BACKGROUND: Surgical strategies for cochlear implantation in patients with chronic otitis media (COM) are diverse and largely depend on the extent of the underlying pathology. AIM: To develop a high-resolution computed tomography (HRCT)-based algorithm for guiding surgical strategy using correlations between imaging and operative findings. METHODS: We retrospectively analyzed the preoperative HRCT scans of 12 consecutive adult patients (n = 12) with COM who underwent cochlear implantation. Specific radiological markers were evaluated, including soft tissue extension, scutum erosion, mastoid pneumatization, and cochlear ossification. These findings were systematically correlated with the necessary surgical procedure (canal wall-up vs canal wall-down/subtotal petrosectomy) and intraoperative findings. RESULTS: Preoperative HRCT accurately predicted the necessary surgical approach in all cases in our cohort. Disease limited to the epitympanum with an intact posterior canal wall required a canal wall-up surgical approach (n = 7), whereas extensive soft tissue opacity involving the mastoid cavity necessitated a canal wall-down/subtotal petrosectomy approach (n = 5). HRCT achieved 100% sensitivity for detecting the single case of significant cochlear ossification in this preliminary series, allowing for appropriate preoperative planning. Postoperative computed tomography confirmed successful electrode placement in all cases. Clinical outcomes, including a low complication rate (one minor infection) and no disease recurrence, confirmed the accuracy of the imaging-based strategy. CONCLUSION: Preoperative HRCT reliably predicts the required surgical approach in COM. The proposed imaging-based algorithm may help standardize planning for successful cochlear implantation.