gms | German Medical Science

78th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

16.05. - 20.05.2007, Munich

Economic approach to the middle ear for cochlear implantation

Meeting Abstract

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  • corresponding author Ivan Zenev - Medical University Sofia, Sofia, Bulgaria
  • Emil Zenev - PAN-Klinik, Köln

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 78. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. München, 16.-20.05.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07hnod114

The electronic version of this article is the complete one and can be found online at:

Published: April 24, 2007

© 2007 Zenev et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.