A novel radiological method to evaluate the posterior tympanotomy depth for cochlear implantation: our experience in 257 patients

PURPOSE: This study aimed to validate our novel proposed radiological evaluation of the posterior tympanotomy (PT) depth. This dimension represents the bone of the facial recess needed to be drilled to get access into the middle ear during cochlear implantation. METHODS: It was a retrospective observational study that included 257 patients who underwent cochlear implantation from July 2018 to April 2021 in tertiary referral institutions. Two physicians evaluated the preoperative HRCT to measure the PT depth in the oblique para-sagittal cut. On the other hand, two other physicians evaluated the unedited surgical videos to judge the PT depth and classified it into an ordinary PT or deep PT. Then, the preoperative radiological measurements were correlated with the intraoperative findings. RESULTS: The radiological PT depth ranged from 2.5 to 5.4 mm with a mean of 3.91 ± 0.886. Sixty-six patients had ordinary PT, and 191 patients had deep PT. Spearman’s correlation coefficient revealed a strong correlation between the preoperative radiological PT depth measurements and the intraoperative PT depth judgments (p value < 0.0001). CONCLUSIONS: We created a novel radiological method to measure the posterior tympanotomy depth. This method was valid, reproducible, and reliable in the preoperative radiological evaluation of the PT depth with high sensitivity (91.71%), specificity (90.62%), and accuracy (91.44%). We also found a significant impact of the PT depth on the PT difficulty during cochlear implantation.