Intact canal wall drill-out procedure for implantation of the totally ossified cochlea.
OBJECTIVE
To describe a simplified drill-out technique for insertion of a multichannel electrode in the completely ossified cochlea without radical mastoidectomy and obliteration.


METHODS
Description of a new surgical technique and case report.


METHODS
Temporal bone dissection laboratory and tertiary referral center.


METHODS
Adult and pediatric cochlear implant (CI) recipients.


METHODS
Access for circum-modular drill-out and electrode insertion without radical mastoidectomy and adequate function of multichannel CI.


RESULTS
Dissection of 10 cadaver temporal bones demonstrated feasibility of this technique. Highlights include facial recess cochleostomy and 8 mm tunnel; elevation of superiorly based tympanomeatal flap; removal of incus, cochleariform process, and tensor tympani; and identification of carotid canal and use of facial nerve monitor. A case report of an 11-year-year old child with total cochlear ossification and previous failure of a short (8 electrode) CI electrode insertion is presented. Complete insertion of a 22-channel electrode was successful and open-set word recognition is commencing.


CONCLUSIONS
The canal wall-up drill-out procedure allows complete electrode insertion without mastoid obliteration in patients with obliterated cochleas. Appropriate attention to the carotid artery and facial nerve is essential.
Balkany
T
T
University of Miami Ear Institute, FL 33101, USA.
Luntz
M
M
Telischi
F F
FF
Hodges
A V
AV
D002648:Child; D003051:Cochlea / Q000473:pathology / Q000601:surgery*; D019929:Cochlear Implantation; D003638:Deafness / Q000601:surgery*; D004424:Ear Canal / Q000601:surgery*; D005154:Facial Nerve; D005260:Female; D006801:Humans; D016343:Monitoring, Intraoperative; D009999:Ossification, Heterotopic / Q000473:pathology / Q000601:surgery*