title: Cochlear implantation via the middle fossa approach:  surgical and programming considerations.
abstract: OBJECTIVE
  To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary-care referral center with a well-established cochlear implant program.
  
  
  METHODS
  Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation.
  
  
  METHODS
  Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients.
  
  
  METHODS
  Complications, hearing thresholds, and speech perception outcomes were evaluated.
  
  
  RESULTS
  Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP.
  
  
  CONCLUSIONS
  Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ricardo Ferreira
authors.initials: RF
authors.lastname: Bento
authors.forename: Aline Gomes
authors.initials: AG
authors.lastname: Bittencourt
authors.forename: Maria Valéria Schmidt
authors.initials: MV
authors.lastname: Goffi-Gomez
authors.forename: Paola
authors.initials: P
authors.lastname: Samuel
authors.forename: Robinson Koji
authors.initials: RK
authors.lastname: Tsuji
authors.forename: Rubens
authors.initials: R
authors.lastname: de Brito
mesh_terms: D000328:Adult; D001309:Auditory Threshold / Q000502:physiology; D059248:Chemoradiotherapy / Q000009:adverse effects; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery*; D004427:Ear Diseases / Q000628:therapy; D005154:Facial Nerve / Q000502:physiology; D005260:Female; D034381:Hearing Loss / Q000628:therapy*; D006312:Hearing Loss, Bilateral / Q000601:surgery; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000628:therapy; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D013067:Speech Perception; D013686:Telemetry; D013701:Temporal Bone / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome