Grueninger Ivo, Lippl Lisa, Canis Martin, Simon Florian, Spiro Judith E, Spiegel Jennifer L, Hempel John Martin, Müller Joachim, Volgger Veronika
Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Germany.
MED-EL Medical Electronics GmbH, Innsbruck, Austria.
Otol Neurotol. 2022 Apr 1;43(4):e454-e460. doi: 10.1097/MAO.0000000000003486.
To evaluate interindividual anatomical variations of the epitympanum and the usable space for implantation of active middle ear implants (AMEI) as well as the usefulness of a tablet-based software to assess individual anatomy on computed tomography (CT) scans.
CT scans of 126 patients, scheduled for cochlea implantation (50.8% men; 0.6-90.0 yr) without middle ear malformations or previous middle ear surgery and with slice thickness ≤0.7 mm were analyzed.
Since no standardized measurements to assess the size of the epitympanum are available, relevant distances were defined according to anatomical landmarks. Three independent raters measured these distances using a tablet-based software. Interrater correlation was computed to evaluate the quality of the measurement process. Descriptive data were analyzed for validation and for evaluation of interindividual anatomical variations. Influence of age and sex on the taken measurements was assessed.
No relevant correlation between age or sex and the anatomy of the epitympanum was found. Interrater correlation ranged from Spearman's ρ = 0.3-0.9 and there were significant differences between individual rater results for various combinations. Descriptive data revealed high interindividual anatomical variance of the epitympanum, especially regarding the distance between incus and skull base.
The reported descriptive data regarding the anatomy of the epitympanum emphasizes the importance of preoperative planning, especially since the height of the epitympanum showed great interindividual variance potentially limiting implantation of AMEIs. The herein used tablet-based software seems to be convenient for preoperative assessment of individual anatomy in the hand of otosurgeons.
评估上鼓室的个体间解剖变异以及有源中耳植入物（AMEI）植入的可用空间，同时评估基于平板电脑的软件在计算机断层扫描（CT）上评估个体解剖结构的实用性。
分析了126例计划进行耳蜗植入的患者的CT扫描图像（男性占50.8%；年龄0.6 - 90.0岁），这些患者无中耳畸形或既往中耳手术史，且切片厚度≤0.7mm。
由于尚无评估上鼓室大小的标准化测量方法，因此根据解剖标志定义了相关距离。三名独立评估者使用基于平板电脑的软件测量这些距离。计算评估者间相关性以评估测量过程的质量。分析描述性数据以进行验证和评估个体间解剖变异。评估年龄和性别对所测数据的影响。
未发现年龄或性别与上鼓室解剖结构之间存在显著相关性。评估者间相关性范围为Spearman's ρ = 0.3 - 0.9，不同组合的个体评估者结果之间存在显著差异。描述性数据显示上鼓室存在高度个体间解剖变异，尤其是砧骨与颅底之间的距离。
所报告的关于上鼓室解剖结构的描述性数据强调了术前规划的重要性，特别是因为上鼓室的高度显示出很大的个体间差异，这可能会限制AMEI的植入。本文中使用的基于平板电脑的软件似乎便于耳外科医生在术前评估个体解剖结构。
