Cochlear Implantation in a severe middle ear malformation
Objectives
CI operation is a standard procedure for the treatment of severe hearing loss in children and adults.
Hearing impairments that require care can also occur as part of syndromic diseases. Depending on the syndromic influence on the anatomy of inner and middle ear structures, CI supply can be challenging or even impossible. CT and MRI are important points in the diagnosis of hearing disorders and in the preparation of surgical steps.
- Methods
A 3-year-old boy at the time of operation was referred to us from Moscow for CI care via a foundation. There is a complex cardiopulmonary disease and additional deafness on both sides. CT of the petrous bone and MRI of the head revealed labyrinth malformations and hypoplasia of the left cochlear nerve. In addition, the stapes seemed to be absent on both sides. Based on the audiological and imaging findings, we decided to treat the right ear.
 
- Results
A complex malformation in the area of the middle ear was found intraoperatively. The facial nerve runs freely over the promontory, the stapes is not present, and the round window cannot be identified either. A localization of the cochlea was initially unsuccessful. We therefore decided to insert a trial electrode and performed intraoperative conbeam CT. In this way, it was possible to identify the cochlea and actually place a CI.
NRTs were found intraoperatively, the further course was unremarkable. The little patient is benefiting from his CI treatment.
- Conclusion
Opportunities for intraoperative imaging like conbeam CT represent an important contribution to successful cochlear implantation in the presence of complex malformations esp. in the middle- and inner ear.
Langer J 1 , Pethe W
1 Ameos Klinikum Halberstadt, Halberstadt ENT Department, Germany

**Cochlear Implantation in a severe middle ear malformation**
Objectives
CI operation is a standard procedure for the treatment of severe hearing loss in children and adults.
Hearing impairments that require care can also occur as part of syndromic diseases. Depending on the syndromic influence on the anatomy of inner and middle ear structures, CI supply can be challenging or even impossible. CT and MRI are important points in the diagnosis of hearing disorders and in the preparation of surgical steps.
- Methods
A 3-year-old boy at the time of operation was referred to us from Moscow for CI care via a foundation. There is a complex cardiopulmonary disease and additional deafness on both sides. CT of the petrous bone and MRI of the head revealed labyrinth malformations and hypoplasia of the left cochlear nerve. In addition, the stapes seemed to be absent on both sides. Based on the audiological and imaging findings, we decided to treat the right ear.
 
- Results
A complex malformation in the area of the middle ear was found intraoperatively. The facial nerve runs freely over the promontory, the stapes is not present, and the round window cannot be identified either. A localization of the cochlea was initially unsuccessful. We therefore decided to insert a trial electrode and performed intraoperative conbeam CT. In this way, it was possible to identify the cochlea and actually place a CI.
NRTs were found intraoperatively, the further course was unremarkable. The little patient is benefiting from his CI treatment.
- Conclusion
Opportunities for intraoperative imaging like conbeam CT represent an important contribution to successful cochlear implantation in the presence of complex malformations esp. in the middle- and inner ear.
**Langer J** 1 , Pethe W
1 Ameos Klinikum Halberstadt, Halberstadt ENT Department, Germany

Bioactive glass (S53P4) and implantable hearing solutions after canal wall up or canal wall down surgery in chronic otitis cases

It is with great pleasure and enthusiasm, that on behalf of the Cochlear Implant centers of the Radboud UMC in Nijmegen and Erasmus MC Sophia Children’s Hospital in Rotterdam to invite you to attend the 16th European Symposium on Pediatric Cochlear Implantation to Rotterdam, the Netherlands in 2023.

Yours sincerely, on behalf of the CI Centers at Radboud UMC and Erasmus MC,