Objectives: Congenital sensorineural hearing loss in children is a major disability and the cochlear implants have become mainstay of management.  The inner ear malformations are found in HRCT Temporal bone of about 20–40% of children with congenital sensorineural hearing loss, often posing challenges at various stages of cochlear implantation and rehabilitation.  Several classification system have brought more clarity on IEMs and expanded the indications for CI. The main objective of this study is to introduce a new prognosis oriented algorithm based on radiological and audiological findings that helps in decision making for cochlear or auditory brainstem implantation.
Methods: Two hundred and ten scans of children with IEM were considered for the study.  The HRCT TB and MRI were analysed with specific emphasis on six critical factors: morphology of cochlear lumen, cochlear aperture, cochlear nerve, potential CSF gushers and facial nerve anomaly.  Further, the audiological findings were taken into consideration to formulate an algorithm that helps in decision making, device and electrode selection, surgical planning and post-operative rehabilitation measures.
Results: Absent cochlear nerves were noted in 7 patients, while it was bilateral in 6 patients, unilateral in 1 patient.  Hypoplastic cochlear nerve was noted in 18 patients.
Conclusion: The new prognosis oriented algorithm of IEM based on the morphology of the cochlea, and audiological findings helps in easy identification of the anomaly, decision making about whether a CI or ABI required, selection of a suitable electrode, anticipate intra-operative problems such as perilymph gusher or facial nerve anomaly, and predict post-implantation speech perception ability.   This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of  children with CVM.

**_Objectives:_** Congenital sensorineural hearing loss in children is a major disability and the cochlear implants have become mainstay of management.  The inner ear malformations are found in HRCT Temporal bone of about 20–40% of children with congenital sensorineural hearing loss, often posing challenges at various stages of cochlear implantation and rehabilitation.  Several classification system have brought more clarity on IEMs and expanded the indications for CI. The main objective of this study is to introduce a new prognosis oriented algorithm based on radiological and audiological findings that helps in decision making for cochlear or auditory brainstem implantation.
**_Methods:_** Two hundred and ten scans of children with IEM were considered for the study.  The HRCT TB and MRI were analysed with specific emphasis on six critical factors: morphology of cochlear lumen, cochlear aperture, cochlear nerve, potential CSF gushers and facial nerve anomaly.  Further, the audiological findings were taken into consideration to formulate an algorithm that helps in decision making, device and electrode selection, surgical planning and post-operative rehabilitation measures.
Results: Absent cochlear nerves were noted in 7 patients, while it was bilateral in 6 patients, unilateral in 1 patient.  Hypoplastic cochlear nerve was noted in 18 patients.
**_Conclusion:_** The new prognosis oriented algorithm of IEM based on the morphology of the cochlea, and audiological findings helps in easy identification of the anomaly, decision making about whether a CI or ABI required, selection of a suitable electrode, anticipate intra-operative problems such as perilymph gusher or facial nerve anomaly, and predict post-implantation speech perception ability.   This simple classification of CVM using TBCT with cochlear nerve assessment by magnetic resonance imaging is helpful in the preoperative evaluation of  children with CVM.

A prognosis-oriented algorithm to help decision making in inner ear malformations.

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,