Is mastoidectomy indispensable in cochlear implant surgery?

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Devices

Background:

• Cochlear implantation (CI) traditionally uses the mastoidectomy posterior tympanotomy approach (MPTA).
• The suprameatal approach (SMA) is a nonmastoidectomy alternative for CI surgery.
• The necessity of mastoidectomy in CI procedures warrants reevaluation.

Purpose of the Study:

• To compare the mastoidectomy posterior tympanotomy approach (MPTA) with the suprameatal approach (SMA) for cochlear implantation.
• To evaluate the advantages and disadvantages of each surgical technique.
• To assess the impact of mastoidectomy on electrode expandability and secretory otitis media (SOM).

Main Methods:

• Retrospective study of 290 cochlear implant patients (1989-2002).
• 157 patients underwent MPTA, 133 underwent SMA.
• Examined electrode expansion in reoperated MPTA patients and SOM course in 56 children.

Main Results:

• Mastoidectomy in MPTA led to bony regrowth and obliterated cavities, hindering electrode expansion in reoperated patients.
• Mastoidectomy did not influence the course of chronic secretory otitis media (SOM).
• Postoperative SOM rates were similar between MPTA and SMA groups.

Conclusions:

• The suprameatal approach (SMA) provides adequate exposure for cochlear implantation.
• Mastoidectomy is not essential for CI surgery and may present more disadvantages than benefits.
• Nonmastoidectomy approaches like SMA facilitate safe electrode insertion and may prevent complications.