title: Cochlear Implantation through the Middle Fossa Approach: A Review of Related Temporal Bone Studies and Reported Cases.
abstract: IntroductionMiddle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach.ObjectiveThe objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach.Data SourcesPubMed, MD consult and Ovid-SP databases.Data SynthesisA total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar.ConclusionsThe middle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.
authors.affiliation: Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil; Department of Otorhinolaryngology, Instituto Nacional de Rehabilitación, Mexico City, Mexico.
authors.forename: Juan Carlos Cisneros
authors.initials: JC
authors.lastname: Lesser
authors.affiliation: Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Rubens Vuono de
authors.initials: RV
authors.lastname: Brito Neto
authors.affiliation: Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Graziela de Souza Queiroz
authors.initials: GS
authors.lastname: Martins
authors.affiliation: Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil.
authors.forename: Ricardo Ferreira
authors.initials: RF
authors.lastname: Bento
keywords: cochlear implants; deafness; middle fossa approach; sensorineural hearing loss