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Does cochleostomy location influence electrode trajectory and intracochlear trauma?

Ling Zhou1, David R Friedmann, Claudiu Treaba

  • 1Department of Otolaryngology, New York University School of Medicine, New York, New York.

The Laryngoscope
|October 28, 2014
PubMed
Summary

Cochlear implant insertion trauma can be minimized by using the cochleostomy (CO) or peri-round window (PRW) surgical approaches, which reduce intracochlear damage compared to the round window (RW) approach.

Keywords:
Cochlear implantcochleostomyhearing preservationinsertion traumaround window

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Insertion trauma during cochlear implantation can negatively impact hearing outcomes.
  • Surgical approach is a modifiable factor influencing insertion trauma.

Purpose of the Study:

  • To compare the risk of intracochlear trauma associated with cochleostomy (CO), peri-round window (PRW), and round window (RW) surgical approaches for cochlear implant insertion.
  • To evaluate insertion linearity and depth using a fresh frozen temporal bone model.

Main Methods:

  • Fifteen fresh frozen human temporal bones were used for cochlear implant insertions with a Cochlear 422 electrode.
  • Three surgical approaches (CO, PRW, RW) were employed, with five insertions per approach.
  • Insertions were assessed using fluoroscopic examination of histologic sections.

Main Results:

  • The round window (RW) approach resulted in modiolus contact in three of five insertions, unlike the CO and PRW approaches.
  • RW insertions were less linear (P < .05) and had a shallower angular depth (375°) compared to CO (487°) and PRW (413°) insertions (P < .05).
  • One RW insertion caused an osseous spiral lamina fracture and electrode malposition in the scala vestibuli; other insertions showed no trauma.

Conclusions:

  • The cochleostomy (CO) or peri-round window (PRW) approaches appear to minimize insertion trauma risk due to anatomical variability of the round window.
  • Successful insertion with minimal trauma is possible using any of the three approaches in cases with favorable round window anatomy.