Cochlear implants (CIs) are the primary treatment method in patients with profound sensorineural hearing loss. Interpretation of postoperative imaging with conventional energy-integrating detector computed tomography (EID-CT) following CI surgery remains challenging due to metal artifacts. Still, the photon-counting detector (PCD-CT) is a new emerging technology with the potential to eliminate these problems. This study evaluated the performance of virtual monoenergetic (VME) EID-CT images versus PCD-CT in CI imaging. In this cadaveric study, two temporal bone specimens with implanted CIs were scanned with EID-CT and PCD-CT. The images were assessed according to the visibility of interelectrode wire, size of electrode contact, and diameter of halo artifacts. The visibility of interelectrode wire sections was significantly higher when reviewing PCD-CT images. The difference in diameter measurements for electrode contacts between the two CT scanner modalities showed that the PCD-CT technology generally led to significantly larger diameter readings. The larger measurements were closer to the manufacturer’s specifications for the CI electrode. The size of halo artifacts surrounding the electrode contacts did not differ significantly between the two imaging modalities. PCT-CT imaging is a promising technology for CI imaging with improved spatial resolution and better visibility of small structures than conventional EID-CT.

Purpose: Cochlear implantation is a standard approach to hearing rehabilitation and encompasses three main stages: appropriate patient selection, a challenging surgical procedure, which should be as atraumatic as possible and preserve cochlear structures, and lifelong postoperative follow-up. Computed tomography (CT) is performed to assess postoperative implant position. The Siemens Advanced Radar Target Identification System (ARTIS) Pheno provides fluoroscopic imaging during surgery and has so far been mainly used by cardiologists, neurosurgeons and trauma surgeons. Methods: Six patients with difficult anatomy or a challenging medical history were selected for a surgical procedure, during which we planned to use the ARTIS Pheno to accurately position and assess implant position under fluoroscopy during and immediately after surgery. In all six cases, the ARTIS Pheno was used directly in the surgical setting. The procedures were performed in cooperation with the neuroradiology department in an interdisciplinary manner. Results: In all six patients, fluoroscopy was used to visualise the procedure at different stages of surgery. In five patients, the procedure was successfully completed. This approach allowed us to finally assess implant position and confirm the correct and complete insertion of the electrode while the patient was still under anaesthesia. Conclusion: These cases showed positive surgical outcomes. Although the procedure is more complex than a standard approach, patients can be managed in a safe, effective and appropriate manner. The assessment of implant position in real time during surgery leads to greater patient and surgeon satisfaction. The approach presented here ensures a high quality of cochlear implant surgery even in difficult surgical situations and meets the requirements of modern surgery.

Einführung: Sollte es eine grundsätzliche Indikation zur Implantation eines CIs mit easy MRT CI bei Patienten geben? Falldarstellung: Eine 22jährige Patientin mit kongenitaler hochgradiger Hörminderung bds erleidet eine Fazialisparese und eine Anakusis links bei Operation eines Epidermoid im KHBW. Nebenbefundlich zeigt sich außerdem ein Hypophysenmikroadenom links. Bei progredienter Innenohrschwerhörigkeit erfolgt die Implantation eines CI rechts und im Verlauf zeigt sich ein Rezidiv des Epidermoids im KHBW links. Zu Verlaufskontrollen werden regelmäßig MRT- Untersuchungen und Laborkontrollen durchgeführt. Bei jeder MRT- Untersuchung klagt die Patientin über große Schmerzen und 3 Mal kommt es trotz Druckverband und Abbruch der Untersuchungen zu Magnetdislokationen, die operativ korrigiert werden müssen. Ohne das CI zeigt sich bei der Patientin mit SSD ein Hörrest von 120-130dB zwischen 0,5-4kHz. Der Hörgewinn mit dem CI ist gut mit einer ABK von 30-40dB, einer Freiburger Sprachaudiomtrie von 65 % bei 65dB, 85 % bei 70dB und 100 % bei 80dB sowie einem OLSA bei 65dB und 70dB von 99 %, adapl. OLSA +2,0dB. Therapie und Verlauf: Trotz großer Sorge um den guten Hörgewinn geht die junge voll berufstätige Patientin nach 7monatiger Auseinandersetzung mit dem MDK das Risiko ein und lässt sich umplantieren. Bereits nach 4Monaten liegt eine ABK von 30-40dB vor mit einer Freiburger Sprachaudiometrie von 55 % bei 55dB, 100 % bei 65dB und 80dB. Diskussion Ist es medizinisch zu verantworten bei Patienten mit zentralen Vorerkrankungen auf das easy MRT CochleaImplantat, welches bis 3Tesla MRT- gängig ist, zu verzichten? Kann bei jungen Menschen, bei denen zu erwarten ist, dass sie im Laufe ihres Lebens ein MRT brauchen werden, auf ein easy MRT- Cochlea Implantat verzichtet werden? Publication Date: 10 June 2020 (online) © . © Georg Thieme Verlag KG Stuttgart · New York

Introduction Intratympanic cortisone injections (ITI) have been established for sudden deafness for years. ITI can be used as primary therapy and, above all, as rescue therapy if systemic administration has not brought any improvement or if there are contraindications to systemic administration. Methods Many different forms of application, indication, duration and treatment have been used. Different local anesthetics, cortisone preparations, body and head positions are practiced. Results 103 patients are analyzed. In 55 cases, the injection after oral therapy. In 48 cases, given immediately due to extreme hearing loss or comorbidities the injections are well tolerated with rare unpleasant side effects. Discussion High-dose treatment with cortisone has been used for decades. The HODOKORT study brought significant dose reductions. The KORTEBO study could not be carried out, but there is need for it. There is a lack of evidence of an optimal indication, implementation and objective proof, which is urgently needed.

Background and purpose The complex anatomy of the petrous part of the temporal bone (or petrous temporal bone) is difficult to understand and constitutes a challenge in the daily diagnostic routine even for experienced neuroradiologists. High-resolution computed tomography (HRCT) is an integral part of equipment-based diagnostics of the rare entity of posterior semicircular canal dehiscence (PSCD). PSCD is characterised by an absence of the bony cover of the posterior semicircular canal in the petrous temporal bone. The aim of this study is to verify the prevalence of PSCD in a group of patients with residual hearing. Furthermore, it is our intention to clarify which location types of dehiscence are possible and which reconstructions are necessary correspondingly. Study design and setting We evaluated 1370 scans of the petrous part of the temporal bone of patients with residual hearing which were conducted at the participating hospitals of Koblenz, Mainz and Hanover between 2008 and 2016. We verified 37 cases of posterior semicircular canal dehiscence (PSCD). We conducted a sub-group analysis of these 37 HRCT scans including age group correlation and introduced a classification of PSCD. Results In 2.7% of the individuals (n = 37), PSCD was detected on at least one side. Furthermore, it was shown that the prevalence of PSCD increases relative to age. Conclusion In total, PSCD was detected in 2.7% of the individuals. Posterior dehiscence can be divided into an external and an internal location type. This distinction is crucial for the surgical procedure.