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Cochlear implant electrode insertion: the round window revisited.

Peter S Roland1, Charles G Wright, Brandon Isaacson

  • 1Department of Otolaryngology, Head and Neck Surgery, Southwestern Medical Center, Dallas, Texas 75390-9035, USA.

The Laryngoscope
|June 23, 2007
PubMed
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Round window (RW) insertion for cochlear implants offers a less traumatic approach. Anatomical study shows drilling overhangs improves RW visibility and access, aiding hearing preservation.

Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Anatomy

Background:

  • Cochlear implant electrode insertion typically uses cochleostomy.
  • The round window (RW) presents an alternative insertion portal.
  • Understanding RW anatomy is crucial for atraumatic electrode placement.

Purpose of the Study:

  • To investigate round window (RW) anatomy for atraumatic cochlear implant electrode insertion.
  • To assess the impact of bony overhangs on RW visibility.
  • To evaluate the variability of the RW opening for electrode passage.

Main Methods:

  • Dissection of 30 human cadaveric temporal bones.
  • Microscopic study of the RW niche and surrounding structures.
  • Measurement of RW membrane visibility before and after drilling overhangs.

Related Experiment Videos

  • Assessment of RW opening size and contour variability from within the scala tympani.

    • Main Results:

    • Bony overhangs of the RW niche significantly limit surgical visibility.
    • Drilling overhangs increased RW membrane visibility by 1.5 to 3 times (up to 13 times in small openings).
    • Substantial variability exists in RW opening size (0.8-1.75 mm²) and contour, potentially requiring drilling near the cochlear aqueduct.

    Conclusions:

    • Round window (RW) insertion is a potentially less traumatic alternative to cochleostomy.
    • RW insertion may be advantageous for hearing preservation.
    • Careful drilling of the RW margin is necessary due to proximity of the cochlear aqueduct.