Radioclinical assessment of posterior tympanotomy difficulties during ordinary cochlear implantation: a prospective case-series study

Objectives: This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). Study design: It was a prospective case-series study. Settings: The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. Subjects: We included 73 CI candidates performed via the PTapproach Intervention: The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. Main outcome measure: We correlated this score with the intraoperative difficulty and surgical duration. Results: The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). Conclusions: Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.