Article
Economic approach to the middle ear for cochlear implantation
Search Medline for
Authors
Published: | April 24, 2007 |
---|
Outline
Text
In 50 patients aged among 18 months to 11 years we used short retroauricular skin incision with formation of two skin flaps and one muscular-perosteum flap. Together with the anterior flap we also rise periosteum thus revealing the suprameatal spina, with ongoing detachment of skin from the posterior canal wall until the fibrous anulus is being reached. We put posterior wall canal skin ventraly with specially designed by us wound stretchener. Using House curette we remove part of the bone that is situated between exiting point of chorda and Rivini’s notch. This allows us to inspect incudostapedial joint and promontory. We form bony tunnel immediately behind the suprameatal spina. Direction of this tunnel points towards the incudostapedial joint and penetration of tympanic cavity is just above it. Using metal template and diamond burr we cut away bed for ceramic capsule of the implant and drill opening for the electrode.
We perform cochleostomy trough the external acoustic meatus between bony wall and elevated skin with diamond burr. The cochleostomy lies immediately over round window and heads up in oblique ventral direction. We carry out electrode insertion after securing the ceramic capsule to the bony bed. Electrode runs trough bony canal, middle ear and cochleostomy to the cochlear duct. After telemetric measurements and adjustments we close wound by suturing and tight dressing for the next 3 or 4 days.
This method offers the less invasive approach, short operation time and lack of risk to the adjacent structures as facial nerve or blood supply of the skin flaps and so on.