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This case-control study compared FAO patients with FNS (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093) to non-FAO with FNS (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092) and two control groups without FNS of post-lingually deafened patients: FAO (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092) and non-FAO (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092). Clinical data from medical record included surgical details, complications, PC-CT findings (bone thickness between the middle electrodes and the facial nerve), hearing outcomes, and implant fitting at two years. Manual segmentation of PC-CT was performed using ITK-SNAP software to measure the bone radiodensity between the mid-array electrode and the adjacent facial nerve. No significant differences were found between FNS and non-FNS patients in demographics, surgical outcomes, complications, audiometric data, or implant programming at 2 years post-surgery. A significant difference in bone radiodensity was observed in patients with FAO (1483.57\u2009\u00b1\u2009122.37 HU (Hounsfield Units)) compared to those without FAO (2403.51\u2009\u00b1\u2009128.24 HU;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In the non-FAO with FNS group, one patient exhibited an exceptionally short distance (0.13\u00a0mm) between the first portion of the facial nerve and the middle electrodes. When comparing FNS and non-FNS patients, no significant differences were observed in bone radiodensity (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.85) or in bone thickness (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.75). ITK-SNAP enables manual PC-CT segmentation to assess bone radiodensity and thickness between cochlear implant electrodes and the facial nerve. In otosclerosis, lower radiodensity alone doesn\u2019t explain FNS, but reduced bone thickness may contribute.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-45916-0","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T16:14:18Z","timestamp":1777047258000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing bone radiodensity and thickness in cochlear implant patients through manual photon-counting CT image segmentation using ITK-SNAP"],"prefix":"10.1038","volume":"16","author":[{"given":"Rapha\u00eble","family":"Quatre","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c5sa","family":"Bonnard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Ekl\u00f6f","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaijsa","family":"Edholm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Wales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"issue":"7","key":"45916_CR1","doi-asserted-by":"publisher","first-page":"3327","DOI":"10.1007\/s00405-021-07036-5","volume":"279","author":"M Assiri","year":"2022","unstructured":"Assiri, M., Khurayzi, T., Alshalan, A. & Alsanosi, A. 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IRB approval: 2023-06178-01. Principal Investigator: \u00c5sa Bonnard.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval statement"}}],"article-number":"13403"}}