title: Combined posterior tympanotomy/endomeatal access in cochlear implantation.
abstract: Alternative techniques for cochlear implant surgery have been described, such as endomeatal- and suprameatal-alone approaches, without traditional posterior tympanotomy. A combined posterior tympanotomy/endomeatal approach is proposed as a way to enhance surgical safety and effectiveness. 64 patients, 34 men and 30 women, mean age 28 (range 1-81 years), 26 pre-verbal and 38 post-verbal, were submitted to cochlear implantation, 32 by means of the described combined posterior tympanotomy/endomeatal approach and 32 with traditional posterior tympanotomy-alone approach. Good anatomic and functional results were observed, with intraoperative improvements in visibility and accessibility of cochleostomy site in difficult cases without any complication, such as tympanic membrane perforation, external canal skin lesions, or extrusion at 12 months. No significant differences were found with traditional technique complication rates excepting for partial insertion data, with statistically significant better results with combined access. The combined posterior tympanotomy/endomeatal approach facilitates the array insertion in conditions of bad exposition/accessibility of promontory and round window. Moreover, this double-way access hinders an incomplete or incorrect positioning. It should be always considered as an alternative to the traditional posterior tympanotomy of one-way access.
authors.affiliation: Otosurgery and Cochlear Implant Unit, Santobono Pausilipon Paediatric Hospital, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Della Volpe
authors.forename: Italo
authors.initials: I
authors.lastname: Cantore
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nolè
authors.forename: Paola
authors.initials: P
authors.lastname: Valente
authors.forename: Alfonso Maria
authors.initials: AM
authors.lastname: Varricchio
authors.forename: Michela
authors.initials: M
authors.lastname: Santandrea
authors.forename: Valentina
authors.initials: V
authors.lastname: Santandrea
authors.forename: Rocco
authors.initials: R
authors.lastname: Cantore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D003638:Deafness / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult