Assessment of the preoperative classification for computed tomography predictability of round window niche visibility through posterior tympanotomy during cochlear implant surgery

AbstractWhen the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

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Cochlear Implant Surgical Technique: Our Experience

Annals of Otology and Neurotology ◽

10.1055/s-0037-1608753 ◽

2018 ◽

Vol 01 (01) ◽

pp. 007-010

Author(s):

Milind Kirtane ◽

Kashmira Chavan

Keyword(s):

Surgical Technique ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Electrode Array ◽

Surgical Approaches ◽

Implant Surgery ◽

Original Technique ◽

Cortical Mastoidectomy ◽

Cochlear Implant Surgery ◽

Posterior Tympanotomy

Abstract Introduction Different surgical approaches have been adopted for cochlear implantation, with cortical mastoidectomy–posterior tympanotomy being the most commonly followed technique. Method In this article, we describe the surgical technique for cochlear implant followed at our center, which has been successfully implemented in more than 2,500 cochlear implant surgeries. Cochlear implant surgery using the cortical mastoidectomy–posterior tympanotomy technique has been performed in more than 2,500 cases with some modifications to the original technique over a period of time. Results In spite of not using tie-down holes and securing down the receiver–stimulator with sutures, no cases of receiver–stimulator displacement or outward electrode migration have been noted with the current technique of creating a snug-fitting subperiosteal pocket along with a hook for the electrode array. Conclusion Adhering to a strict intraoperative surgical protocol plays an extremely important role in carrying out successful cochlear implant surgeries with minimal complications.

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Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-016-3993-6 ◽

2016 ◽

Vol 273 (11) ◽

pp. 3609-3613 ◽

Cited By ~ 9

Author(s):

Philipp Mittmann ◽

A. Ernst ◽

M. Mittmann ◽

I. Todt

Keyword(s):

Cochlear Implant ◽

Round Window ◽

Implant Surgery ◽

Cochlear Implant Surgery ◽

Window Opening ◽

Dry Conditions ◽

Intracochlear Pressure ◽

Pressure Changes

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Role of HRCT imaging in predicting the visibility of Round window (RW) on patients underwent cochlear implant surgery

Clinical Epidemiology and Global Health ◽

10.1016/j.cegh.2019.10.003 ◽

2020 ◽

Vol 8 (2) ◽

pp. 432-436 ◽

Cited By ~ 2

Author(s):

Mozafar Sarafraz ◽

Mahsa Heidari ◽

Arash Bayat ◽

Mohammad Ghasem Hanafi ◽

Ali Fahimi ◽

...

Keyword(s):

Cochlear Implant ◽

Round Window ◽

Implant Surgery ◽

Cochlear Implant Surgery

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Cochlear Implant Surgery Through Round Window Approach Is Always Possible

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419834311 ◽

2019 ◽

Vol 128 (6_suppl) ◽

pp. 38S-44S ◽

Cited By ~ 3

Author(s):

Seong-Cheon Bae ◽

You-Ree Shin ◽

Young-Myoung Chun

Keyword(s):

Cochlear Implant ◽

Standard Procedure ◽

Round Window ◽

Lateral Wall ◽

Anatomical Variations ◽

Implant Surgery ◽

Cochlear Implant Surgery ◽

Alternative Procedures ◽

Electrode Insertion ◽

Window Approach

Objectives: The benefit of round window (RW) approach for cochlear implant (CI) has been well studied. Because the RW represents a natural door to scala tympani, it facilitates precise electrode insertion. Atraumatic electrode insertion can also be performed without drilling the cochlear lateral wall. However, the RW approach has several limitations. The purpose of this study is to describe successful CI surgeries utilizing the RW approach except for severe cases of temporal bone anomaly. The authors’ successful surgical solution for cases involving difficult RW access is also described. Materials and Methods: We retrospectively analyzed 377 consecutive surgeries of cochlear implantation performed between June 2010 and December 2018 by a single experienced surgeon. Standard and alternative procedures were used according to anatomical variations. Standard procedures included modified techniques of mastoidectomy in the RW approach, opening of facial recess, exposure of RW membrane, and electrode insertion. Difficult cases involving severe rotated cochlea or hypoplastic mastoid were successfully treated with RW insertion using alternative procedures such as external auditory canal (EAC) wall mobilization and endomeatal approach. Results: We performed CI surgery through a reproducible RW technique in two cases involving endomeatal approach and three cases of EAC mobilization. Other cases were treated using the standard procedure. Conclusion: Cochlear implant surgery through RW is reliable, safe, and effective. The RW technique is reproducible via several surgical procedures in most CI cases. Identification and safe exposure of RW membrane is a prerequisite for successful electrode insertion in cochlear implant surgery.

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