Re: New topic: how does the ENT surgeon locate the cochlea?

[Guest guest]

In a message dated 9/27/2004 6:59:46 PM Pacific Daylight Time,

lehfeldt@... writes:

" How do you locate the cochlea, and when you drill the hole to put the

electrode though, how do you make sure it's being inserted correctly? "

good question,, while in surgery, the surgeon will be using floroscopy

(live-time xray) as he/she guide the wire/electrone in.

Lee

[Guest guest]

Add the MRI and CT scan to that.

Regards/

Jerome

Re: New topic: how does the ENT surgeon locate the

cochlea?

In a message dated 9/27/2004 6:59:46 PM Pacific Daylight Time,

lehfeldt@... writes:

" How do you locate the cochlea, and when you drill the hole to put the

electrode though, how do you make sure it's being inserted correctly? "

good question,, while in surgery, the surgeon will be using floroscopy

(live-time xray) as he/she guide the wire/electrone in.

Lee

[Guest guest]

In a message dated 9/28/2004 12:35:08 AM Pacific Daylight Time,

jt1@... writes:

Add the MRI and CT scan to that.

not while in surgery.

Lee

[Guest guest]

Hi Folks:

This is a question that needs to be well answered by the Otologist. Well in a

nut shell the cochlea is the most important organ of hearing, situated in the

inner ear area. This is like the Central Processing Unit (CPU) of a computer in

processing sound waves to be sent to the brain via the auditory nerve for

interpretation. So every surgeon has the expertise and experience in identifying

this organ of hearing inside the ear. During their years of study they always do

sections of mastoids, temporal bone, cochlea and other important mechanics of

the hearing. Hence they are very thorough with this. When a physician does not

answer these questions does not mean that he/she does not know, but has what is

called a " I don't care attitude " .

Well how does the surgeon see this?

1. CT Scan and MRI will tell him/her if all is well with the Cochlea before

surgery.

2. During surgery, when using an incision from behind the ear pinna, they know

where this is placed in the ear. Especially when they do surgery related to

mastoids and reconstruction of the ossicles they see the cochlea at all times

and cannot miss it. Since the cochlea is very close to the facial nerve,

vestibule and balance nerves, it is always in the field of view during surgery

as mentioned above. They always use a surgical microscope to magnify the field

of view.

I have had multiple (8) surgeries in both my ears to clear out infections. Due

to complications from an earlier surgery done 22 years ago my right side facial

nerve was severed and was subesquently grafted. This posed a complication to the

surgeon, under whose care I am now, with regards to facial nerve condition. Even

the use of a facial nerve monitor during surgery seemed to un-nerve the

physician.

Folks I wish to share with you all an exciting technology that exists and was

used during two of my procedures. Dr Darius Kohan my physician in NYC has

successfully used this advanced image guidance system that allows him to get a

three dimensional hologram image of the temporal and mastoid areas. What happens

here is, a day before surgery, a normal CT scan of the temporal is done and

these scans are uploaded into this imaging system. After the scan, various

points on the temporal bones are maked for registering before the surgery.

What happens here is before surgery is commenced, this advanced imaging system

is connected and registered. On activation the system produces a three

dimensional hologram of the surgical area. This presents color coded images of

the outer, middle and inner ear structures alongwith the areas of infections (eg

cholesteatomas) separately color coded. These includes the ear canal, tympanum,

ossiccular masses, atrium, facial nerve, vestibulum, cochlea, auditory nerve,

balance nerves, mastoid air cells etc to name a few. This helps the surgeon to

understand the internal ear anatomy even before he/she makes a surgical

incision. This exciting technology was used twice during my surgery. The most

recent one being last thursday at the Manhatten, Eye, Ear and Thorat Hospital

(MEETH).

I have been shown saved images of the entire surgical procedure taken by this

system and am amazed with what I saw. My facial nerve was not affected and all

area of ear infections were successfully cleared with the help of this system.

Dr Darius Kohan was able to see clearly and understand the best approach to

surgery using this imaging technology during my surgery. I am providing you with

the link to this amazing technology that was used on me during my two surgeries

by Dr Darius Kohan. The link is http://www.landmarx.com/

Should any of you be interested to speak to Dr Darius Kohan about this wonderful

technology, please call his office number 212 319 2400 at NYC.

With the use of such a system, complicated ENT surgeries will be a thing of the

past. Now I am waiting out for the ears to completely heal, before Dr Darius

Kohan will attempt to implant me with a cochlear implant. This system also

helped him to make decisions on which ear to implant depending on the condition

of the cochleas. So right now he has decided to implant me on the left ear and

will be done as soon as the ears have healed and infections completely cleared.

Regards

Ravi