An optical coherence tomography study for imaging the round window niche and the promontorium tympani

An optical coherence tomography study for imaging the round window niche and the promontorium tympani Tympanosclerosis may involve the tympanic membrane, the ossicles, and the oval and round window niche, respectively. The surgical treatment of the obliterated oval window niche is most challenging. Beside stapesplasty, vibroplasty coupling the floating mass transducer (FMT) onto the round window niche and into a new, so-called third window is indicated. In the latter situation, drilling a hole into the promontorium is necessary to couple the FMT close to the membranous endosteum. Damage of the membranous inner ear must be avoided. The question was whether OCT is useful to identify the endosteum and to provide microanatomical information of the round window niche. OCT was carried out on human temporal bone preparations, in which a third window was drilled leaving the membranous labyrinth and the fluid-filled inner ear intact and the overhang of the round window niche was removed. An especially equipped operating microscope with integrated OCT prototype (spectral-domain-OCT) was used. The OCT images and 3D reconstructions demonstrate the usefulness of OCT to measure the drilling cavity, to visualize the inner ear structures, and to obtain microanatomical information of the round and oval window niche. These findings may have an impact on stapes surgery, on cochlea implantation, and on vibroplasty coupling the FMT onto the round and third window. OCTguided drilling allows for more precise identification of the intact inner ear.