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Cochlear implantation through the round window: optimizing the surgical procedure
Mom T. , Bachy A. , Saroul N. , Pavier Y. , Avan P. , Gilain L.
University of Clermont- Ferrand1, Otolaryngology Head Neck Surgery, Clermont-Ferrand, France, 2University of Clermont- Ferrand1,
Laboratory of Sensorineural Biophysics-INSERM UMR 1107, Clermont-Ferrand, France
Objectives: Spreading indications of cochlear implantation, such as bilateral cases, makes it mandatory to lower
as much as possible the morbidity of the surgical procedure. The round window insertion allows for direct
implantation in the scala tympani. The question is how optimizing the quality of insertion through the round
window with the lower morbidity.
Patients and methods: This retrospective analysis includes all cases implanted with a cochlear implant
Digisonic SP (Neurelec) since 2004. We checked the operative charts and the depth of insertion. Surgical
technique, complications (facial palsy, infection, alteration of taste) were collected as well as the type of
electrode array. For comparisons, contingency tables were used and a CHI-square test was performed. A pvalue < 0.05 was considered significant.
Results: 126 cases of patients with non-malformed cochleas were implanted through the round window. The
mean age was 53.8+/-16.2 for adults and 3.5+/-2.6 for children (24 cases). The mean follow-up was 33+/-22
months. All cases were implanted through a transmastoid approach, with identification of the round window niche
through a posterior tympanotomy. A few cases required a combined transmeatal- transmastoid approach (8
cases). The straight electrode array had either a square or a soft pointed tip (n=84). Full insertion was achieved
in 79 out of 84 cases with a soft tip vs 18 out of 42 square tips (Chi square= 41.41, DOF=1, p< 0.0001). Two
cases were stuck at the round window niche by a prominent crista fensetrae (no possibility of deeper insertion
nor withdrawal). In all cases the chorda tympany was preserved. In one case a misrouting to the vestibule
required a revision surgery. No facial palsy, no infection, no cases of extrusion occurred.
Conclusion: Cochlear implantation through the round window with a soft-tip Digisonic SP can lead to a 94% rate
of full insertion. Drilling out of a prominent crista fenestrae is recommended. A combined transmeatal transmastoid approach can be used in order to clearly identify the round window and to preserve the chorda
tympani in case of narrow facial recess.