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The trans-attic trans-canal approach for cochlear implantation, a safer and effective technique
Ezzat W.F.
Ain Shams University, ENT, Cairo, Egypt
The standard described technique of cochlear implantation is through a posterior tympanotomy and facial recess
approach. This “classic approach” is not without hazards and difficulties, asides danger of injury to the facial
nerve, sometimes aberrations in the course of the facial nerve or anomalies of the cochlea or the round window
may make this approach challenging. Various alternatives have been described to overcome these difficulties,
including the transcanal and the suprameatal approaches, but these are not without complications and
We describe our experience with a modification of the approach gaining the benefit of many approaches, using
what we call the “trans-attic trans-canal” approach. 131 cases of cochlear implants were performed using the
Pulsar and Sonata (MED-EL, Austria) implant in 117 cases and the Hi-Res 90K (Advanced Bionics, USA)
implants in 14 cases, over a period of 22 months, with a minimum of 4 months follow-up period after surgery,
and up to 2 years. The results show that we had one single case of facial paresis that resolved after 2 weeks due
to a dehiscent facial nerve. Audiologic and phoniatric results were comparable to the surgeries performed by the
classic approach.
In conclusion, the trans-attic - trans-canal is a safer and less time consuming approach that harvests the benefits
of avoiding electrode exposure in the canal, and avoids possible trauma to the facial nerve, with equal final