title: Combining perimodiolar electrode placement and atraumatic insertion properties in cochlear implantation -- fact or fantasy?
abstract: CONCLUSIONS
  Except for basal cochlear traumatization, all specimens implanted into scala tympani showed atraumatic insertion properties and good perimodiolar electrode positioning. Cochleostomy preparation and placement can have a significant impact on levels of basal cochlear trauma.
  
  
  OBJECTIVE
  In the past, perimodiolar cochlear implant electrodes increased the risk for intracochlear traumatization when compared to free-fitting arrays. Recently, however, clinical evidence for atraumatic perimodiolar implantations with preservation of residual hearing has been described. The aim of this paper was to histologically evaluate a perimodiolar cochlear implant array for its insertion properties in cadaver human temporal bones. Surgical and electrode factors, as well as preparation artifacts influencing intracochlear trauma, were considered in the evaluation.
  
  
  METHODS
  Sixteen human temporal bones were harvested up to 24 hours post mortem and implanted immediately with the Nucleus 24 Contour Advance cochlear implant electrode array. Implantations were either performed using a regular caudal approach cochleostomy or through the round window membrane. After implantation, all bones underwent special histological processing, which allowed sectioning of undecalcified bone. Insertion properties were evaluated according to a grading system.
  
  
  RESULTS
  Fourteen specimens were implanted into scala tympani and only two exhibited basal trauma attributable to electrode insertion characteristics. Two bones were implanted into scala vestibuli after causing trauma in the region of the cochleostomy. Insertion depths ranged from 180 degrees to 400 degrees. All bones showed good perimodiolar electrode positioning. Basal trauma due to surgical issues and histological artifacts was present in 10 of 16 bones.
authors.affiliation: Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. adunka@med.unc.edu
authors.forename: Oliver F
authors.initials: OF
authors.lastname: Adunka
authors.forename: Harold C
authors.initials: HC
authors.lastname: Pillsbury
authors.forename: Jan
authors.initials: J
authors.lastname: Kiefer
mesh_terms: D001309:Auditory Threshold / Q000502:physiology; D001489:Basilar Membrane / Q000293:injuries / Q000473:pathology; D003051:Cochlea / Q000293:injuries* / Q000473:pathology; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects; D006801:Humans; D009925:Organ of Corti / Q000293:injuries / Q000473:pathology; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012421:Rupture; D013701:Temporal Bone / Q000473:pathology