High-resolution computed tomography predicts optimal cochlear implantation strategy in patients with chronic otitis media

Figure 1 Imaging-based decision algorithm for surgical planning in cochlear implantation for chronic otitis media. This algorithm is derived from the systematic analysis of preoperative high-resolution computed tomography. The primary branch point is the status of the mastoid cavity: A clear or well-aerated cavity permits a canal wall-up mastoidectomy, whereas complete opacification of the mastoid necessitates a canal wall-down or subtotal petrosectomy to ensure complete disease eradication. The second branch depends on the graded severity of cochlear ossification. If cochlear ossification is grade 0 or grade I, standard cochlear implant insertion is typically feasible. For grade II ossification (involving the basal turn), specialized drilling at the basal turn or an alternative scala vestibuli approach may be required. For grade III ossification (extending > 180°), extensive drill-out procedures (e.g., cochlearostomy at the second turn) are necessary. These scenarios mandate specific preoperative counseling and technical preparation. This imaging-driven protocol tailors the surgical strategy to disease extent, aiming to optimize both oncological safety and auditory outcomes. CWU: Canal wall-up; CO: Cochlear ossification; CI: Cochlear implantation; CWD: Canal wall-down; STP: Subtotal petrosectomy.

Figure 2 Representative preoperative high-resolution computed tomography dictates surgical strategy and correlates with postoperative outcomes. A: Well-defined soft-tissue opacity (hollow arrow) confined to the epitympanum, with a well-aerated mastoid; B: Fully inserted cochlear implant electrode array (hollow arrowhead) with preserved ear canal anatomy after successful canal wall-up mastoidectomy; C: Complete opacification of the middle ear and mastoid (solid asterisk), with severe cochlear ossification (dotted circle) and posterior canal wall erosion; D: Obliterated mastoid cavity and partially inserted electrode array (solid arrowhead) following subtotal petrosectomy. CWU: Canal wall-up; Pre-op: Pre-operative; Post-op: Post-operative; STP: Subtotal petrosectomy.