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Round window electrode insertion in the inner ear pathology
Kuzovkov V. , Yanov Y. , Tretyakova A. , Radionova J.
Saint Petersburg ENT and Speech Research Institute, Saint-Petersburg, Russian Federation
A number of authors suggest that round window (RW) electrode array insertion decreases inner ear trauma and
promotes hearing preservation. However, inner ear pathology can interfere with this approach. The surgeon
usually faces on with cochlea abnormalities and ossified scala tympany. The number of patients with
malformations and labyrinthitis ossificans constantly increases. We believe that the RW approach is the best
choice for these cases despite the lack of benefit from hearing preservation.
Since the complete shift at our institute in mid-2008 from cochleostomy to the RW surgical approach, more than
2000 cochlear implantations (CI) have been performed on pediatric and adult patients. Cochlear malformations
were found in 118 children. Labyrinthitis ossificans of basal turn was found in 77 cases with different length of
obliteration from ossified window to 5-6 mm ossification of descending part of basal turn. Ossification of the
whole first turn or more than one turn was excluded from the study. According to L. Sennaroglu, the
malformations of cochlea encountered and chosen for CI (71) included 4 common cavities, 5 incomplete
partitions type I (IP I, cystic cochlea) and 20 IPs type II (Mondini deformity).
In three cases of common cavity and two IP I cases, the round window membrane was not identified and the
electrode was inserted via cochleostomy. In all Mondini cases, the RW niche was present, but in two cases
cochleostomy was performed due to mucosa thickening as a result of otitis media with effusion, and in two cases
- due to facial nerve position.
In every case of ossification the drilling started from the round window niche. The length of ossification was 0.5 1 mm in 24 cases, 1 - 4 mm - in 36 patients, more than 4 mm - in 17 cases. The ossified RW and scala timpany
lumen had different color in each case in every case, looking whiter then labyrinthine capsule.
RW electrode insertion was achieved in 89.04 % of cochlear malformation cases. The full insertion of standard
electrodes has been achieved in all included ossification cases, although it was not a “pure RW insertion”.
Thus RW insertion is promising in malformed ears and RW may serve as an important landmark to facilitate CI in
cases of labyrinthitis ossificans.