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Abstract
Minimally invasive cochlear implant surgery has become the mainstay of most experienced centers. Their advantages include reduced blood loss and tissue trauma, improved cosmesis, less hair removal and reduced surgical times. Minimally invasive techniques are being extended to include entrance to the inner ear via cochleostomy.
In children with thick cortical bone, surgical exposure for cochlear implant fixation is difficult when using a minimal access technique, cochlear implant fixation using the Mitek Quick Anchor system was performed in 15 children (mean age, 12 years). The mean cortical bone thickness was 5.6 mm in patients receiving the Mitek Quick Anchor system and 3.2 mm in patients undergoing conventional fixation.
The surgical trauma and postoperative oedema was decreased and allowed programming of the implant in a shorter period of time by using a minimal invasive approach in cochlear implant surgery for children and adults described by O’Donoghue and Nikolopoulos.
For cochlear implantation, the suprameatal approach can be an alternative safe surgical technique. typicalconventional mastoidectomy and posterior tympanotomy are not necessary. It is simple, safe and effective procedure; Chorda tympani is preserved in all cases and there is no danger for the facial nerve.
The combination of minimal access surgery with suprameatal approach provides the surgeon with a simple and safe technique with minimal drilling and improved esthetic results.
Preoperative imaging cannot always be used to determine the actual accessibility of the cochlear lumen. The insertion test device provides valuable intraoperative information on the accessibility of the cochlear lumen and helps the surgeon in choosing the best suited cochlear implant electrode variant for the patient.
Prefound sensorineural hearing loss secondary to cochlear dysplasia presents a surgical challenge during cochlear implantation. The standard transmastoid-facial recess approach can be performed in the majority of cases. In cases of common cavity deformity, the transmastoid labyrinthotomy approach has a number of advantages.
Cochlear ossification was once considered a contraindication to cochlear implantation. It is now known that patients with ossified cochleas benefit from implantation and, in cases of partial ossification, many perform as well as patients with patent cochleas.
Advances in the understanding of cochlear anatomy, the pathophysiology of labyrinthitis ossificans, and the development of surgical techniques have reduced the number of patients denied candidacy for cochlear implantation due to cochlear duct obstruction. Specific electrodes for use in the obstructed cochlea maximize insertion and access available ganglion cells.
Device migration of the receiver-stimulator package after implantation has been a potential cause of device failure. Fixation techniques of the cochlear implant receiver-stimulator package to the skull to prevent this complication are described.
The decreased thickness and increased curvature of the calvarium make protrusion and rocking of the implant receiver-stimulator problematic in children and save adults. By using a technique in which the calvarium is removed completely and dura exposed in creation of the bone well, the receiver-stimulator is recessed completely, which decreases the potential for rocking and mobility of the implant.
Cochlear implant device failure is an uncommon problem. In most cases, the original device should be explanted and a new device implanted. There are several technical aspects to revision surgery that can be used to minimize the risks and improve the outcomes of this procedure.