title: Scala tympani cochleostomy II: topography and histology.
abstract: OBJECTIVE
  To assess intracochlear trauma using two different round window-related cochleostomy techniques in human temporal bones.
  
  
  METHODS
  Twenty-eight human temporal bones were included in this study. In 21 specimens, cochleostomies were initiated inferior to the round window (RW) annulus. In seven bones, cochleostomies were drilled anterior-inferior to the RW annulus. Limited cochlear implant electrode insertions were performed in 19 bones. In each specimen, promontory anatomy and cochleostomy drilling were photographically documented. Basal cochlear damage was assessed histologically and electrode insertion properties were documented in implanted bones.
  
  
  RESULTS
  All implanted specimens showed clear scala tympani electrode placements regardless of cochleostomy technique. All 21 inferior cochleostomies were atraumatic. Anterior-inferior cochleostomies resulted in various degrees of intracochlear trauma in all seven bones.
  
  
  CONCLUSIONS
  For atraumatic opening of the scala tympani using a cochleostomy approach, initiation of drilling should proceed from inferior to the round window annulus, with gradual progression toward the undersurface of the lumen. While cochleostomies initiated anterior-inferior to the round window annulus resulted in scala tympani opening, many of these bones displayed varying degrees of intracochlear trauma that may result in hearing loss. When intracochlear drilling is avoided, the anterior bony margin of the cochleostomy remains a significant intracochlear impediment to in-line electrode insertion.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7070, USA. adunka@med.unc.edu
authors.forename: Oliver F
authors.initials: OF
authors.lastname: Adunka
authors.forename: Andreas
authors.initials: A
authors.lastname: Radeloff
authors.forename: Wolfgang K
authors.initials: WK
authors.lastname: Gstoettner
authors.forename: Harold C
authors.initials: HC
authors.lastname: Pillsbury
authors.forename: Craig A
authors.initials: CA
authors.lastname: Buchman
mesh_terms: D002983:Clinical Competence; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D034381:Hearing Loss / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009864:Ontario; D012533:Scala Tympani / Q000033:anatomy & histology* / Q000601:surgery*; D011795:Surveys and Questionnaires