Lina Lasminingrum
Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
Sally Mahdiani
Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
Arif Dermawan
Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
Fakhri Muhammad Suradi Kartanegara
Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
Tamara Tantarto
Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
ABSTRACT
Cochlear implantation is widely accepted for children with bilateral profound sensorineural hearing loss, though anatomical variations of the temporal bone may increase surgical difficulty. To evaluate preoperative CT and MRI findings in Indonesian pediatric cochlear implant candidates and assess surgical difficulty using the Potential Difficult Surgery (PDS) scoring system. A retrospective descriptive study was conducted on 49 children (98 ears) with congenital bilateral sensorineural hearing loss who underwent CT and MRI between 2012 and 2017. Anatomical characteristics were assessed using Vaid's system, which scores four parameters: mastoid pneumatization, facial recess width, canal-sigmoid sinus alignment, and cochlear basal turn orientation. No inferential statistical analysis or hypothesis testing was performed in this study. Most ears demonstrated favorable anatomy: well-pneumatized mastoids (79.59%), wide facial recesses (83.67%), favorable sigmoid alignment (79.36%), and optimal basal turn orientation (89.79%). However, 20.41% had poor pneumatization and misaligned sigmoid sinuses, 16.32% had narrow facial recesses, and 6.12% showed inner ear malformations. PDS classification revealed Grade 1 (minimal complexity) in 41.84%, Grade 2 (moderate complexity) in 53.06%, and Grade 3 (high complexity) in 5.10% of ears, with most patients facing moderate surgical complexity. This study provides the first local application of the PDS score to Indonesian pediatric cases, demonstrating that CT and MRI with PDS scoring effectively anticipate intraoperative challenges and guide surgical planning.
Keywords: Cochlear Implant, CT-Scan, MRI, Pediatric Otology, Surgical Difficulty, PDS Score.
