title: Intact canal wall drill-out procedure for implantation of the totally ossified cochlea.
abstract: 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.
authors.affiliation: University of Miami Ear Institute, FL 33101, USA.
authors.forename: T
authors.initials: T
authors.lastname: Balkany
authors.forename: M
authors.initials: M
authors.lastname: Luntz
authors.forename: F F
authors.initials: FF
authors.lastname: Telischi
authors.forename: A V
authors.initials: AV
authors.lastname: Hodges
mesh_terms: 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*