title: Cochlear implantation through the round window with a straight slotted electrode array: optimizing the surgical procedure.
abstract: The question addressed here is how optimizing the quality of insertion through the round window with the lower morbidity, when using a straight and slotted electrode array of regular length. This retrospective analysis includes all cases implanted with a cochlear implant Digisonic SP (Neurelec-Oticon Medical) since 2004. We checked the operative charts, the depth of insertion, and the follow-up. For comparisons, contingency tables were used and a Chi-square test was performed. A p value <0.05 was considered significant. 126 cases of patients with non-malformed cochleas were implanted through the round window. The mean age was 53.8 ± 16.2 for adults and 3.6 ± 2.6 for children (24 cases). The mean follow-up was 33 ± 22 months. The straight electrode array had either a square or a soft pointed tip (n = 84). Full insertion was achieved in 79 out of 84 cases with a soft tip vs. 18 out of 42 square tips (χ (2) = 41.41, DOF = 1, p < 0.0001). Two cases were stuck at the round window niche by a prominent crista fenestrae. In all cases but one, the chorda tympany was preserved. In one case, a misrouting to the vestibule required a revision surgery. Implantation through the round window with a straight and slotted electrode array with a soft tip (Digisonic SP, Neurelec-Oticon Medical) can lead to a full insertion in 94 % of cases. Drilling out a prominent crista fenestrae is recommended.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France. tmom@chu-clermontferrand.fr.|Laboratory of Biophysics of Sensorineureal Handicaps, Faculty of Medicine, INSERM-UMR 1107, Université d'Auvergne Clermont 1, Clermont-Ferrand, France. tmom@chu-clermontferrand.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Mom
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bachy
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Aubry
authors.initials: A
authors.lastname: Houette
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.|Laboratory of Biophysics of Sensorineureal Handicaps, Faculty of Medicine, INSERM-UMR 1107, Université d'Auvergne Clermont 1, Clermont-Ferrand, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Pavier
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Pastourel
authors.affiliation: Department of Neuroradiology, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gabrillargues
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Saroul
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Hospital Center CHU Gabriel Montpied, Université d'Auvergne Clermont 1, 30 place Henri Dunant, 63000, Clermont-Ferrand, France.|Laboratory of Biophysics of Sensorineureal Handicaps, Faculty of Medicine, INSERM-UMR 1107, Université d'Auvergne Clermont 1, Clermont-Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Gilain
authors.affiliation: Laboratory of Biophysics of Sensorineureal Handicaps, Faculty of Medicine, INSERM-UMR 1107, Université d'Auvergne Clermont 1, Clermont-Ferrand, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Avan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002814:Chorda Tympani Nerve; D019929:Cochlear Implantation / Q000295:instrumentation*; D003638:Deafness / Q000000981:diagnostic imaging / Q000601:surgery*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012405:Round Window, Ear / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014722:Vestibule, Labyrinth / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Cochlear implant; Electrode array; Insertion; Round window anatomy