Posterior Tympanotomy/Endomeatal Combined Approach in Cochlear Implantation

Abstract

Objective: An alternative posterior tympanotomy/endomeatal combined approach for cochlear implantation is presented. Surgical steps and our results in 64 patients, 32 submitted to combined posterior tympanotomy/endomeatal approach and 32 underwent to traditional surgery, are reported.

Method: Sixty-four patients, 34 men and 30 women, mean age 28 years (range, 1-81 years), 26 preverbal and 38 postverbal, were submitted to cochlear implantation, 32 by means of a combined posterior tympanotomy/endomeatal approach and 32 with traditional posterior tympanotomy alone approach.

Results: We reported good anatomic and functional results with intraoperative improvements in visibility and accessibility of cochleostomy site in difficult cases. At 12 months we did not observe any complication such as tympanic membrane perforation, external canal skin lesions, or extrusion. No significant differences were found with traditional technique complication rates excepting for partial insertion data, with statistically significant better results with combined access.

Conclusion: The combined posterior tympanotomy/endomeatal approach facilitates the array insertion in conditions of bad exposition/accessibility of promontory and round window. Moreover, this double way access hinders an incomplete or incorrect positioning. It should be always considered as an alternative to the traditional posterior tympanotomy 1-way access.