engleski

ZAGREB SURGICAL APPROACH FOR COCHLEAR IMPLANTATION

Objective. The classical surgical technique for cochlear implantation includes mastoidectomy and posterior tympanotomy. These two steps need time and are connected with possible complications (facial nerve palsy). The aim of this study was to find faster, easier and safer approach, without mastoidectomy and posterior tympanotomy for cochlear implantation. Methods. From November 1st, 2000, this technique was performed in 47 children, aged 3 to 18 years. First steps are the same as in the retroauricular approach in the middle ear surgery (retroauricular incision is performed, as a part of classical J-shaped skin incision and posterior tympanomeatal flap is elevated). Tunnel is drilled under the suprameatal spina. Tunnel begins 5-8 mm posteriorly and superiorly to suprameatal spina and ends in superior-posterior bony meatal wall about 5 mm laterally to the annulus. Bone curettage is performed in the same place as for stapedectomy in order to visualise stapes and promontory antero-inferior to stapes. Place of the curettage and the tunnel are than connected by drilling of the bony groove. Cochleostomy is drilled in the classical place, antero-inferior to the stapes. Rest of J-shaped incision is than performed and receiver-stimulator bed and electrode array channel is drilled. The receiver-stimulator is fixed in the bed. The electrode is placed in the tunnel under the suprameatal spina and the groove in external meatus and passed through into the cochleostomy. A small part of temporal fascia is left to cover the groove. Results. X-rays confirmed that in all patients the electrode was in the right place. No facial nerve injury either other complication was seen in our 47 patients. Conclusions. This technique needs half of time necessary for the classic cochlear implantation. The technique is, what is more important, safer than classic implantation.

cochlear implantation; surgery

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