title: Impact of the surgical experience on cochleostomy location: a comparative temporal bone study between endaural and posterior tympanotomy approaches for cochlear implantation.
abstract: The goal of this study was to evaluate, in the hands of an inexperienced surgeon, the cochleostomy location of an endaural approach (MINV) compared to the conventional posterior tympanotomy (MPT) approach. Since 2010, we use in the ENT department of Nice a new surgical endaural approach to perform cochlear implantation. In the hands of an inexperienced surgeon, the position of the cochleostomy has not yet been studied in detail for this technique. This is a prospective study of 24 human heads. Straight electrode arrays were implanted by an inexperienced surgeon: on one side using MPT and on the other side using MINV. The cochleostomies were all antero-inferior, but they were performed through an endaural approach with the MINV or a posterior tympanotomy approach with the MPT. The positioning of the cochleostomies into the scala tympani was evaluated by microdissection. Cochleostomies performed through the endaural approach were well placed into the scala tympani more frequently than those performed through the posterior tympanotomy approach (87.5 and 16.7 %, respectively, p ≤ 0.001). This study highlights the biggest challenge for an inexperienced surgeon to achieve a reliable cochleostomy through a posterior tympanotomy, which requires years of experience. In case of an uncomfortable view through a posterior tympanotomy, an inexperienced surgeon might be able to successfully perform a cochleostomy through an endaural (combined approach) or an extended round window approach in order to avoid opening the scala vestibuli.
authors.affiliation: Department of Ear Nose Throat Surgery, Institut Universitaire de la Face et du Cou, Centre Hospitalo-Universitaire, 31 Avenue de Valombrose, 06100, Nice, France. vdsclair@gmail.com.
authors.forename: Clair
authors.initials: C
authors.lastname: Vandersteen
authors.affiliation: Asclepios Research Team, INRIA, 2004 Route des Lucioles, Valbonne, 06902, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Demarcy
authors.affiliation: Department of Biostatistics, Cimiez's Hospital, Centre Hospitalo-Universitaire, 4 Avenue Reine Victoria, Nice, 06000, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Roger
authors.affiliation: Department of Biostatistics, Cimiez's Hospital, Centre Hospitalo-Universitaire, 4 Avenue Reine Victoria, Nice, 06000, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Fontas
authors.affiliation: Department of Radiology, Pasteur's Hospital, Centre Hospitalo-Universitaire, 30 Voie Romaine, Nice, 06000, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Raffaelli
authors.affiliation: Asclepios Research Team, INRIA, 2004 Route des Lucioles, Valbonne, 06902, France.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ayache
authors.affiliation: Asclepios Research Team, INRIA, 2004 Route des Lucioles, Valbonne, 06902, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Delingette
authors.affiliation: Department of Ear Nose Throat Surgery, Institut Universitaire de la Face et du Cou, Centre Hospitalo-Universitaire, 31 Avenue de Valombrose, 06100, Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Guevara
mesh_terms: D002983:Clinical Competence; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D006801:Humans; D008876:Middle Ear Ventilation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008953:Models, Anatomic; D011446:Prospective Studies; D012405:Round Window, Ear / Q000601:surgery; D012533:Scala Tympani / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery
keywords: Cochlear implantation; Cochleostomy; Endaural approach; Learning skills; Minimally invasive surgery; Surgery resident