title: Suprameatal approach for cochlear implantation in 45 Chinese children.
abstract: OBJECTIVE
  To investigate the feasibility of applying the suprameatal approach (SMA) for cochlear implantation in Chinese children with profound sensory hearing loss, and to demonstrate a technical modification incorporated in the procedure due to an observed racial difference.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty-five Chinese children (total 47 ears) with profound sensory hearing loss were surgically treated from May 2005 to May 2006. The patients were followed anywhere from 1 month to 20 months post-surgery, with 30 patients being followed for more than 6 months.
  
  
  METHODS
  All patients received cochlear implantation through the suprameatal approach. In this procedure, the cochleostomy was performed in one stage after the suprameatal tunnel was finished, rather than the two-stage approach described by Kronenberg (who firstly introduced the suprameatal approach). Three patients with low-lying dura (which is considered to be the contraindication for cochlear implantation with SMA) were treated with a further modified surgical approach.
  
  
  RESULTS
  Among the 47 ears, full electrode pairs were completely inserted in 45 ears without surgical difficulties, but 1 ear was only fitted with 9 pairs of electrodes because of an ossified cochlea, and another with just 8 pairs of electrodes due to serious cochlear dysplasia. An intraoperative "gusher" occurred in the dysplasia case, and a small piece of temporalis muscle was used, along with biology glue, to seal the cochleostomy and prevent further leakage. In 1 case, the electrode was inserted into the cochlea through the tunnel lateral to the chorda tympani because adhesion had occurred between the incus and chorda tympani. There were no postoperative complications in any case. Thirty cases exhibited better hearing or speech development from cochlear implantation after more than 6 months of follow-up.
  
  
  CONCLUSIONS
  The SMA was found to be a simple and safe technique for cochlear implantation in Chinese children. It enables wide exposure of the middle ear, and is especially suitable for cases with a narrow facial recess, an anteriorly located facial nerve, or an ossified cochlea. It is almost impossible to injure the facial nerve or the chorda tympani nerve. The cochleostomy can be performed in one stage in those patients with a normal cochlea. With some modifications, a low-lying dura will not be the absolute contraindication of SMA.
authors.affiliation: Department of Otolaryngology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Otolaryngology Institute of Shanghai Jiaotong University, Clinical Auditory Center of Shanghai, Shanghai 200233, China. yinshankai@china.com
authors.forename: Shankai
authors.initials: S
authors.lastname: Yin
authors.forename: Zhengnong
authors.initials: Z
authors.lastname: Chen
authors.forename: Yaqin
authors.initials: Y
authors.lastname: Wu
authors.forename: Line
authors.initials: L
authors.lastname: Wang
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Wensheng
authors.initials: W
authors.lastname: Zhou
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhou
authors.forename: Jiayun
authors.initials: J
authors.lastname: Huang
authors.forename: Zhisen
authors.initials: Z
authors.lastname: Shen
authors.forename: Jianxin
authors.initials: J
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003638:Deafness / Q000601:surgery; D004431:Ear, External; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies