Cochlear implantation surgery without posterior tympanotomy: can we still improve it?
CONCLUSIONS
The amendments made to pre-existing transcanal approaches limit the possibility of extrusion of the electrode and reduce the time of 'blind' surgery.


OBJECTIVE
Alternative techniques to classic mastoidectomy and posterior tympanotomy for cochlear implantation have already been described but their main drawbacks result in either: (i) the risk of an electrode extrusion through the skin as the groove is drilled into the auditory canal or (ii) the risk of a facial nerve injury as the tunnel is drilled blindly into the posterior canal wall. The aim of this study was to describe and evaluate a new transcanal approach for cochlear implantation ruling out these difficulties.


METHODS
Through a minimal retroauricular skin incision, a cochleostomy is performed directly via the auditory canal. The passage for the electrode is performed after drilling both a suprameatal hollow and a 1.5 mm hole into the superior-posterior canal wall, which opens the facial recess by an anterior approach. Thanks to this hole a transwall tunnel can afterwards be dug safely.


RESULTS
Twenty-three patients (8 adults, 15 children) were implanted without any difficulty. The mean follow-up was 22 months. No postoperative complication was observed.
Guevara
Nicolas
N
Department of Otorhinolaryngology, Pasteur Hospital, University Center, Nice, France. guevara.n@chu-nice.fr
Bailleux
Sonanda
S
Santini
Jose
J
Castillo
Laurent
L
Gahide
Ivan
I
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003051:Cochlea / Q000601:surgery; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D004432:Ear, Middle / Q000601:surgery; D004567:Electrodes, Implanted; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D055815:Young Adult